What It Takes To Successfully Launch, Sustain Care At Home

In the first two posts of this series, we outlined the opportunity for health systems to develop a robust, comprehensive C@H program, and how to think about financial implications of actively shifting care to patients’ homes.

This post digs into the benefits of leveraging vendors or building out internal capabilities, and, importantly, how to ensure clinician buy-in.

Be strategic about engaging vendors

At its core, C@H includes three key modules:

1. Telehealth hardware and software in the patient’s home and with clinicians that facilitate two-way audio/video/text communications

2. Remote monitoring sensors and connected devices that allow clinicians to keep track of patient’s vital signs and other metrics

3. Command center technology that facilitates the orchestration of in-home resources deployment and virtual care provision

A variety of platform vendors can support all three modules across the breadth of a C@H operating model, including building the required integrations to the electronic medical record, with varying degrees of sophistication. However, health systems should be aware that vendor solutions are evolving. This is especially apparent when it comes to supporting multiple initiatives simultaneously. Even if working with a platform vendor, health system leaders should expect to invest in workflow automation and logistics optimization to scale operations that are critical for program economics. Many systems that operate C@H programs today are still using burdensome manual workflows. For example, each admission to a H@H program requires multiple phone calls, messages, and emails to vendors to initiate and coordinate delivery of equipment and services to the patient’s home, including telehealth kits, durable medical equipment, connected devices, oxygen, and more. This manual orchestration extends throughout the episode and applies to deploying clinicians, medication, and other contracted services. Regardless of whether and where systems opt to build or rely on a vendor, investment will be required to streamline and automate workflows and support scaling in H@H and into other modalities.

Some health systems have adopted and integrated point solutions with their EMR, such as telehealth and remote monitoring. This approach presents a low-cost option to get started but health systems should apply lessons learned from previous experiences of adding disparate technologies on top of their existing tech stack.

At the outset, we expect most health systems will rely on trusted vendors for specific in-home services such as mobile labs, imaging, DME, and in-home nursing. As programs scale up, various elements can be brought in-house. Program operators who aim to handle these needs internally from the outset must be clear on service fulfillment expectations and the unique aspects of certain C@H modalities. For example, home health nurses may need clinical upskilling to feel comfortable caring for hospital level acuity patients. From an operational standpoint, scheduling approaches may need to be adjusted for home health nurses to accommodate the flexibility some higher acuity models require. These challenges can be overcome, but operators should not expect a simple plug-and-play approach of existing capabilities into a modern C@H operation.

The importance of getting clinician buy-in

Scaling C@H can’t be done without clinician buy-in and support, so it is important for systems to invest time and resources in stakeholder education and engagement.

Providing care at home, particularly acute care, is still relatively new — this, along with the inherent challenge in launching any new program, may result in sluggish adoption from clinicians. However, there are several strategies systems can employ. First, passionate leadership along with a sturdy governance and engagement structure is critical. Having a clinical champion with a consistent, disciplined message to referring providers will help to make sure the program takes root and doesn’t languish post-launch.

As a part of the engagement process, leadership should also use reliable data that illustrates success from their program. These feedback loops provide opportunities to reinforce and reiterate the potential for C@H but can also help bring the program to life.

Finally, making the process for clinicians to admit into the C@H program as frictionless as possible will go a long way to establishing a steady pattern of referrals. This process will vary by system, but common tactics include proactive flags in the EMR to identify potentially eligible patients, embedded administrative support in the ED and on inpatient floors, and easy communication channels with C@H clinical teams. The referral and enrollment process to home should be designed as a push from the site of care versus a need for the C@H program to constantly pull patients in.

Launching a successful care at home program requires a wide breadth of clinical, operational, and technological capabilities. Regardless of whether those capabilities are vended or built, they will take time to initiate and run smoothly. The same is true for gaining clinician buy-in. Leaders should be realistic about timing and early expectations while remaining diligent in laying the groundwork for a successful program.

In sum, C@H presents a unique opportunity for health systems to take the reins on the next frontier of care delivery innovation. Before launching a program, health systems need to think through a myriad of clinical, financial, and operational questions, but few care models can offer the same potential for achieving the triple aim of better outcomes, better experience, and lower cost.