Hospital-at-Home Innovation During COVID-19 and Beyond

For many years, we have not questioned the traditional wisdom of hospitalizing acutely ill people for medical care. But what if some acutely ill people could receive high-quality medical care in the comfort of their own homes? And what if that care actually led to better outcomes, reduced costs and enhanced patient experience?

What was once a small but mighty contingent of health care systems providing “hospital-at-home” care before the pandemic has grown into a larger movement. With this model, hospitals across the country are “admitting” patients to their own homes for acute care with excellent results. As highlighted in AHA’s recent issue brief on hospital-at-home, patients receiving this care have a 20% reduction in mortality, were three times less likely to be admitted to an emergency department than usual care patients and have higher satisfaction with their care. And these results are achieved at a 25% lower cost of care.

The COVID-19 pandemic has spurred a number of innovations in health care delivery that have the potential to positively alter how care is provided in the years ahead. Hospital-at-home is one of those promising models.

As we move into a new era of health care delivery, hospital-at-home is an innovative model for providing quality, person-centered care. It gives hospitals an opportunity to be leaders in this space and shape what health care can look like for years to come.

Case study: Digital Solutions in Oncology

Digital oncology solutions can help standardize and improve patient care. Learn how Roche helped set up a Germany-wide molecular tumor board.

The Marien Hospital in Wesel, North Rhine-Westphalia, Germany treats a number of complex oncology patients. The hospital is based at a single site, with 16 different medical departments, approximately 432 beds, and 1,000 employees. Every year the hospital treats approximately 20,000 inpatients and 50,000 outpatients.1 In collaboration with Roche, Marien Hospital explored the use of digital oncology solutions to improve patient care.

Overview 

As we are moving towards a digital world, with medical knowledge increasing at an exponential rate,2 there is a pressing need for the simplification and standardization of hospital processes to enable healthcare professionals to clearly understand and interpret available data. 

One challenging, yet crucial, process for oncology patient care is the management of tumor board meetings, which involves the handling of large amounts of cancer patient case data and requires the input of multiple specialists to align on the optimal treatment recommendations.

Adding to the complexity is the advancement in next-generation sequencing (NGS) and an increasing number of available cancer treatment options, which is further progressing the field of oncology towards precision medicine. This leads to a rising need and formation of molecular tumor boards.3, 4

In 2020, healthcare professionals at the Marien Hospital partnered with Roche Healthcare Consultants to establish a standardized and digitalized molecular tumor board workflow for their institution. Prior to this project, the hospital had no molecular tumor boards in place, and a lack of expertise in executing this innovative and complex type of tumor board. 

1 in 5 Physicians Has Considered Quitting Their Current Job, Survey Finds

The Medscape Physician Nonclinical Careers Report 2021 published Oct. 8 found one in five physicians has considered leaving their current job to pursue nonclinical careers. 

Researchers surveyed more than 2,500 physicians across the U.S. for the annual report. 

Key takeaways: 

  • Fifty-eight percent of those wanting to change career paths said they planned to make the change within three years. 

     
  • Eight in 10 looking for a career change are actively exploring other options, with 53 percent looking online.

Patients Doing More of their Own Research Online, Often Leaving Doctor's Office with Questions

The majority of Americans don’t fully understand the information their provider tells them, leading them to consult third-party resources like the internet, a new survey found.

And patients often don’t fully grasp their own personal medical information, according to the survey by the American Health Information Management Association Foundation. 

Three in 4 Americans leave the doctor confused and dissatisfied for reasons that include disappointment in the level of Q&A they have with their doctor, confusion about their health and a need to do more research, according to a survey of 1,000 U.S. adults. The study was commissioned by the foundation and conducted by Kelton Global.

Digital pharmacies on the rise. But who is going to pay?

Today at HLTH, panelists discussed how digital is changing the medication delivery space and who will pay for the services.

Today consumers are used to getting just about everything delivered at their doorstep. But historically, getting medication required a trip to the doctor’s office and then a stop at the pharmacy. However, digital may interrupt this paradigm. 

It’s no secret that medication adherence is a major issue in healthcare. While medication costs have often been pointed to as the main barrier to adherence, transportation is another obstacle. 

“In a lot of the surveys we’ve seen, only 16% of our patients are saying that it is financial. It's typically that the pharmacy is too far away, or I just don't have time, or they have a medical disability, or they don't have a car,” Amanda Epp, CEO of ScriptDrop, said at HLTH 2021 this morning. “So being able to provide transportation to those patients to get what they need, to provide therapy is really the first step. What we like to do is we look at the medication, where the patients are at, where the pharmacy is. We use the power of the brick and mortar pharmacy. Almost all patients are within five miles of their pharmacy. So taking in all of those data points to determine if it is an antibiotic and the patient needs it within an hour to get on therapy.”

Alternative to traditional pharmacies 

The traditional healthcare system takes a lot of time for patients to navigate, according to Dr. Melynda Barnes, chief medical officer at Ro, said during a panel at HLTH. 

“The average American will wait 24 days after they make an appointment to see their provider. They will then go to the provider and see that person for 12 minutes, and that visit will cost them over $100. On average, they will then go to a pharmacy with a wait of 45 minutes,” Barnes said. 

Uptick in Patient Messages May Increase Physician Burnout

In an Oct. 12 Research Letter from JAMA Network Open entitled, “Trends in Electronic Health Record Inbox Messaging During the COVID-19 Pandemic in an Ambulatory Practice Network in New England,” the authors address COVID-19 related disruptions regarding how patients access routine care. They explain that anecdotal evidence indicates that ambulatory physicians saw an increase in patient medical advice requests (PMARs) and they compared patient message volume during the pandemic with levels pre-pandemic.

The letter states that “This cross-sectional study analyzed deidentified electronic health record metadata (Signal, Epic Systems) from March 2018 to June 2021 in a large ambulatory practice network in New England. This study was deemed exempt for review and informed consent by Yale University’s institutional review board because it involves secondary research of deidentified electronic health record metadata that did not include any patient identifier or private health information. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.”

That said, “Trends in inbox message volume (categorized by message type and source), time in the inbox, visit volume and type (in-person vs telehealth), patient volume, and patient use of the patient portal were examined using descriptive statistics. Physician specialties were grouped into primary care, medical, and surgical specialties. Variables were compared before (March 2018 to February 2020) and during (March 2020 to June 2021) the COVID-19 pandemic. To assess whether the onset of the pandemic was an inflection point in PMARs, message volume per physician per day was modeled by piecewise linear regression using a spline for month with a single knot at March 2020 and Huber-White SEs. Three months of inbox message data were missing (3 of 40 months [7.5 percent]) and excluded from the analysis. To test for significance (P < .05), we used a 2-sided Wald test for equivalence of the coefficients. We used Stata statistical software version 16 (StataCorp) for data analyses.”

Fraud-Proofing Your Telehealth Strategy

By now, you’ve likely read hundreds, if not thousands, of stories about telehealth and its precipitous rise sparked by the pandemic. While telehealth usage has dipped from its peak in April 2020, overall utilization is still 38 times higher than before the pandemic. The numbers lend credence to the numerous benefits touted throughout the public health emergency, most notably serving as a vital lifeline for high-risk patients, reducing the risk of exposure for staff, alleviating patient demand on facilities, and more. The reality is that telehealth has solidified itself as a permanent fixture within our healthcare system.  

However, the explosion in adoption has drawn bad actors who are taking advantage of the relaxed regulatory environment and technological vulnerabilities. Capturing and combatting fraud in today’s healthcare landscape requires the convergence of innovation and experience to drive value beyond the margins. Organizations must take a multi-layered approach to identify, address, and prevent fraud.

Why Storytelling is Critical in Medicine?

I love stories, either told, written, or listened to. Songs tell stories, as does art. Blogs such as the rich content open so many doors for rich conversations. Telling stories is part of who I am.

I love stories, either told, written, or listened to. Songs tell stories, as does art. Blogs such as the rich content open so many doors for rich conversations. Telling stories is part of who I am. My father loved to tell them, as did my grandfather, whose name I took. They were called bull-sh*tters – and perhaps some refer to me that way at times. In medicine, I find storytelling to be critical. Each time we present a case, we are telling a story. Those residents and students who can present a case to me in a way that draws me in while giving me the necessary facts, but goes the next step that allows me to see that person in their life are the ones I know will be amazing doctors.

Information that goes unshared is considered information lost. However, stories need not always be shared. I encourage all of my students to write down their stories now. Memory is nasty and tends to erase such information over time in all of us. In writing a story, we capture it for ourselves and can reflect on that event and grow from it. That is more than enough. We bring concepts to reality by sharing a story by framing a lesson in a life event others can relate to. Reading about a disease pales in comparison to seeing a patient with that disease. The latter is not always possible. Hearing a case enhances learning, and this is why medical schools have drifted away from lectures to small group learning. These formats revolve around shared stories that allow each student to care about the patient and become invested in learning about the illness. In time who we saw and who we heard about become blurred – but the knowledge survives.

Why B2C2B will be the future go-to-market strategy for virtual care

Propeller vet Chris Hogg writes on the go-to-market strategies for digital health companies.

The pleasure and pain of digital health go-to-market

The Achilles heel of digital health has always been the go-to-market strategy. Early digital health companies, to their credit, focused exclusively on solving problems for patients and providers. Their solutions were often effective, for example OmadaBig Health and Propeller Health [Disclosure: Hogg previously served as COO and CCO at Propeller], but did not look like the tools traditionally used in healthcare.

Digital health companies were not drugs, not DME, not labs, not traditional clinical services. When these companies were "clinical services" they used the "wrong" providers or delivered the care in the "wrong" setting, according to lengthy and complex billing rules and code descriptors. They were products and services without a classification, which is not a great place to be in healthcare.

Without a standard classification, traditional reimbursement was impossible, so two models emerged from entrepreneurs that worked around the classification system. Early on a few companies were able to acquire patients directly and charge cash, or for example Kardia. This segment is now growing quickly, as evidenced in startups like Ro, Cove and Calibrate.