For two decades, the John A. Hartford Foundation has invested in the development and spread of the Hospital at Home model of care, which provides safe, high-quality, hospital-level care to older adults with select conditions in the comfort of their own home.
Over those years, studies have consistently shown that the model delivers improved care and outcomes at lower costs. But adoption has been limited, leading us to conclude that Hospital at Home was ahead of its time.
Now, its time has come. The Center for Medicare and Medicaid Innovation (CMMI), part of the Centers for Medicare and Medicaid Services (CMS), awarded a $9.6 million Health Care Innovation Award to the Icahn School of Medicine at Mount Sinai—in consultation with Johns Hopkins University—to test a version of Hospital at Home called the Mobile Acute Care Team (MACT).
In support of the federal demonstration, the Hartford Foundation has awarded a four-year, $1,612,922 grant to augment the evaluation of the federal demonstration, providing for qualitative analysis and a greater understanding of implementation in order to inform future spread of the model. The award will also support the development of technical assistance resources in anticipation of a successful demonstration.
To understand the significance of this federal demonstration, it’s helpful to take a look at how we arrived at this point.
Hospitals are without a doubt the most expensive and dangerous places to receive your health care. They are particularly unsafe for older adults, who experience a disproportionate burden of complications, functional decline, harm, and even death as inpatients.
Beginning in 1994, the Hartford Foundation invested in the development of the Hospital at Home model, which defines treatment protocols and identifies appropriate patients with some of the most common causes of hospital admission for older adults: congestive heart failure, pneumonia, respiratory problems such as emphysema, and skin infections.
Care is provided at home by a team of physicians, nurses, and others using mobile diagnostic technology. People can have medications or fluid given intravenously at home. And patients and family members are supported by the health care team.
The model was developed by geriatricians John Burton and Bruce Leff at Johns Hopkins, and tested at sites around the country. Clinical trials of the Hospital at Home model led to better health outcomes and it significantly lowered costs. And—no surprise—it was highly rated by patients and caregivers. The model has been featured in the Wall Street Journal, USA Today, Forbes, and U.S. News & World Report, as well as in the leading health policy journal, Health Affairs.
Hospital at Home is no ‘boutique’ model. In fact, if we look at the diagnoses covered by Hospital at Home and the criteria to use it, it is estimated that the model could be used in place of more than half a million hospital admissions each year. If spread, the Hospital at Home model could conservatively reduce health care spending by $1-2 billion per year.
Based on strong outcomes, Hartford Trustees in 2004 approved funding to support early dissemination of the model. The chief adopter was the U.S. Department of Veteran’s Affairs (VA). It’s been used in the Portland, Oregon VA for more than a decade now, as well as in a number of other VA hospitals. It’s been implemented within Medicare Managed Care in systems such as Presbyterian Health in Albuquerque and Centura Health in Colorado Springs.
While its limited adoption did lead us to conclude that the model was ahead of its time, it’s important to note that health care delivery has changed significantly since we first tested it. There are new financial penalties for hospitals with high readmissions rates. There are forms of payment that bundle hospitalization with post-hospital care where this approach makes good financial sense.
So it’s in this new environment that the Center for Medicare and Medicaid Innovation (the CMS Innovation Center) has made a significant investment in the Hospital at Home model. The $9.6 million federal award to our Hartford Center of Excellence in Geriatric Medicine at Mount Sinai is one of just 39 awards conferred nationally. It represents an opportunity to leverage CMS’ attention and legitimacy, while gaining an understanding of the model in today’s quality and payment environment. It also allows us to begin preparing for the next phase of the model’s spread.
The Hartford Foundation is thrilled to partner with CMS on this important demonstration. Our successful efforts have always been predicated upon strong evidence and partnership, key components of this initiative. The other essential ingredient is leadership. This effort benefits from exceptional leadership from not just one, but two of our Hartford Centers of Excellence in Geriatric Medicine: Al Siu, professor and system chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, and Bruce Leff, professor of medicine in the Division of Geriatrics at Johns Hopkins.
Additionally, a powerful National Advisory Board has been assembled with leaders who can guide dissemination of the model, including Randy Krakauer, chief medical director of Aetna’s Medicare division, and Ziad Haydar, chief medical officer for Ascension Health. Ascension is the nation’s largest Catholic and largest non-profit health system.
The collaboration between the Hartford Foundation and CMS to support the spread of Hospital at Home represents the highest form of partnership, one that builds upon a shared vision: improving the health of acutely ill elders at lower cost.