Mass General Brigham plans to dramatically scale up its hospital-at-home program, a project executives say will help contain health care spending and manage an ongoing capacity crunch at its hospitals.
Gregg Meyer, president of MGB’s community division and executive vice president of value-based care at the system, said the expansion marks the culmination of decades of developments that have helped providers better care for patients remotely. At the same time, the health system is increasingly under pressure from state regulators to reduce spending.
“Several things came together,” Meyer said. “We built some capability and confidence over time. We’ve got more data to say that this is convenient and enjoyed by patients at lower costs, but by the way, it is safe. And then at the same time, the technology is getting easier and easier. And, absolutely, our desire to respond to the health care cost mandates are incredibly important to us.”
As part of the expansion, the system appointed home health care veteran Heather O’Sullivan to the new role of president of home-based care. Most recently, O’Sullivan worked for one of the country’s largest home health care providers, Kindred at Home, which has since rebranded to CenterWell Home Health.
Hospital-at-home services provide hospital-level care out of a patient’s residence. While these services are not ideal for extremely ill patients who require constant monitoring and rapid medical care, some companies and providers have found they work well for those who are stable enough to be monitored remotely. In addition to virtual meetings and phone calls, patients receive in-person visits from paramedics, nurses, advanced practice providers, physicians, administrative staff, and case managers.
Mass General Brigham already has some smaller programs aimed at delivering hospital level care to patients outside hospital walls, from remote patient monitoring with smart watches, to episodic home-based urgent care, to hospital-coordinated care delivered by paramedics. The system also has small programs around home-based palliative care and remote primary care.
The system will grow its hospital-at-home programs from 25 remotely monitored patients managed out of Massachusetts General Hospital and Brigham and Women’s Hospital to upward of 200 remote patients in the next two and a half years. By the end of 2023, the health system hopes to have 90 hospital-at-home beds managed by MGH, Brigham, Newton-Wellesley Hospital, and Salem Hospital.
The system has 800 people supporting home care currently. It will hire an additional 200 over the next 12 months.
“It’s as if we are creating the equivalent of a Newton-Wellesley size hospital,” Meyer said.
Meyer compared these programs to the tradition of doctors making house calls, which he used to perform as a general practitioner in England’s National Health Service. There is a convenience to meeting people where they are, he said. And caring for someone in their own space is often more informative of how they will recover than if everything were managed in a hospital.
“One of the first things I learned doing house calls is always ask to look in the refrigerator, because sometimes it’s pretty bare,” Meyer said. “It tells you something.”
A 2019 clinical trial performed by Mass General Brigham researchers showed that home-based hospital care reduced the cost of care by 38 percent compared to services delivered inside a hospital facility. Such programs have also been shown to reduce readmissions — patients who are readmitted to the hospital within 30 days of being discharged. Fewer readmissions will help the system keep more patients out of the hospital, further helping its ongoing capacity crisis, Meyer said.
David E. Williams, president of the Boston consulting firm Health Business Group, said as of June, 242 hospitals in 36 states had begun using a Medicare hospital-at-home model. Yet those programs have seen only a small percentage of patients.
Estimates suggest that upward of 10 percent of admissions could currently be cared for inside a patient’s home, he said. But the complexity of delivering hospital-quality care at home has prevented more rapid adoption, including the difficulty of hiring the clinical staff needed to travel to people’s homes, nuances of delivering medication to patients without an on-site pharmacy, and reimbursement challenges from insurers.
As these problems get resolved, as many as 30 percent of people with certain conditions — from urinary tract infections to pneumonia to congestive heart failure — may be cared for remotely, he said.
“It’s a radical thing to think about, being in the hospital at home,” said Williams.
Mass General Brigham’s program will begin with patients who come into the hospital for a procedure and whose follow-up care can be managed at home. The program will expand to include patients who come to the emergency room or are referred to the system from primary care or a specialist and are admitted to an at-home program rather than to a hospital bed.
The health system has already increased a fleet of vehicles that will help deliver care remotely from two to 10, which can conduct basic blood testing, connect with a patient’s electronic medical record, and carry urgent medical supplies. Work is ongoing to coordinate the delivery of medical equipment needed to remotely monitor patients, with possible plans to engage with outside vendors.
Meyer said Mass General Brigham plans to employ all the people who deliver the care, though that may change as the program expands.
After hospital at home, Meyer said, the system could expand into more general remote monitoring, offering patients who are home-bound, frail, or lack transportation access to primary care. Palliative care at home will also be expanded.
“If someone put me on the spot and asked why are we doing this, we’re doing this because it’s really good for patients. Oh, and by the way, it absolutely does help us on the cost front,” Meyer said.