Care at Home Strategy
With the Strategy Accelerator program, efforts to strategically prioritize care at home programs for deployment take shape.
Editor’s Note: Contributors to this report include Eric Lam, Associate Principal, Sg2; Brianna Motley, Principal, Sg2; Heidi Pandya, MSHA, Principal, Sg2; and Jayme Zage, PhD, Principal, Sg2.
Amid increasing inpatient lengths of stay; capacity limitations; and pressure from competitors, policy makers, payers and patients, the forces pointing to care at home as an opportunity continue to mount. However, success requires careful planning and analysis to craft a tailored approach that matches local opportunities to organizational capabilities and resource availability. Sustainability in care at home is tied to matching your portfolio of programs with the organization’s priorities in strategic growth, value-based care and patient experience.
To identify and prioritize care at home opportunities, 49 organizations recently participated in a Strategy Accelerator program offered by Vizient and Sg2. Sg2 faculty led the group through six weeks of intense education on care at home programs and a tool-based opportunity assessment to support prioritization and advance their strategic positioning.
Laying the foundation
Opportunities exist across the System of CARE (Clinical Alignment and Resource Effectiveness) to move all levels of care into the home setting. Sg2 categorizes care at home into four distinct areas.
Figure 1. Four categories of care at home
- On-demand care at home: mostly encounter-based services
- Chronic care at home: longitudinal low-acuity, care management services over a short or long time frame
- Continuing care at home: restorative and recovery care
- Acute care at home: acute hospital-level care
Foundational elements can accelerate program development and enable a path to scale.
- Home health: home health services have the infrastructure to coordinate home-based services, and home health providers are experienced in delivering care in the home.
- Virtual visits and remote monitoring: core technologies enable home services and support every category of home care.
- Virtual triage and a digital platform: these features allow appropriate placement of patients in care at home and enable the digital connectivity of home-based programs with all components of the System of CARE.
The early stages of adoption. Most participating organizations are in the early phases of adoption, still evaluating which care at home offerings to invest in and which patients to include in their pilot efforts. As a result, most organizations selected phase 1 (the earliest phase) in the analytic tool to assess the opportunity in their market.
Focus on specific opportunities aligned to strategic goals. The opportunity to free up inpatient capacity for growth or to avoid unnecessary admissions was significant for academic medical centers (AMCs), large community hospitals and midsized facilities (see table below). This opportunity for care at home services significantly outstrips provider capacity to supply those services. It is critical to focus programs on key patient populations that can best meet strategic goals. Specifically, organizations can segment the patient population by age, payer, social determinants, clinical criteria, geography and those specialties with provider champions.
Opportunities for avoided admissions and IP beds saved by care at home program, participating hospitals
Take a portfolio approach. Scale for care at home programs can be achieved by designing a targeted portfolio of care at home services that supports strategic ambitions—for instance, a low-acuity portfolio targeted at expanding access to disease management including lab at home, primary care at home, direct-to-consumer testing and ED at home. In addition, developing lower-acuity care at home programs at the beginning helps build the necessary experience to eventually scale to full hospital at home. This is the approach many participating organizations are taking.
Evaluate the business case holistically. Approach the business case by using it to address strategic concerns, such as how care at home can help the organization address goals and challenges, what program elements will do that, how the programs can achieve financial sustainability, and how to stage program rollout over time. Tailor the business case for different audiences to provide the adequate specificity desired. The business case also requires a careful financial impact analysis, including direct, indirect and downstream effects. Business cases should address unit impacts, implications of shifting care within an organization, consumeristic benefits and future value-based payments.
To build the ideal portfolio of programs, it is necessary for organizations to:
- Understand the organization’s current capabilities, including the starting point for foundational elements. Starting points include examining opportunities based on internal analytics and local market trends, assessing whether foundational elements are in place and align with opportunities, and identifying champions.
- Identify the best go-to-market approach. Define the operating and financial models, which then guide an evaluation of whether partners are needed to accelerate growth. Determine which portfolio of services will best meet strategic objectives.
- Work through staffing models. A final key element is addressing staffing challenges, which are among the largest constraints on launching or expanding home care programs. Potential solutions identified included partnering with third parties and targeting early- and late-career professionals who may be open to the unique challenges of in-person or remote care.