By 2030, all baby boomers will be over 65 – all as alternative care models emerge. McKinsey estimates $265 billion The value of healthcare services for Medicare patients could shift from traditional facilities to the home by 2025.
Rather than thinking that patients are “discharged” once they leave the hospital, implying that care is complete, many healthcare professionals believe that it is time to treat home as a fundamental care environment that must be well integrated in the care continuum.
Cindy Gaines, RN, is Chief Clinical Transformation Officer at Lumeon, a clinical automation company. She says the focus should be shifted from discharge planning to home care orchestration – which can reduce the cost of care and complications and generate positive feedback from patients, providers and caregivers.
We interviewed Gaines to get a better understanding of what this switch entails and to delve deeper into the home hospital.
Q. What are the challenges to effective coordination between the hospital and home?
A. A variety of factors have prompted increased attention to the home hospital—the pandemic, continued staffing shortages, rising costs, patient complications such as delirium—causing CMS to increase the financial incentives to provide care at home without reducing quality or access. While there are many benefits to patients receiving care in their own homes, it also comes with many challenges.
Hospital-at-home is not a discharge from the hospital, it provides hospital-level care at home. This makes care coordination one of the biggest challenges as it is currently a manual, tedious and expensive process.
With a home-based hospital, this process piles on several additional layers of complexity, such as remote patient monitoring equipment, patient-reported outcomes, nursing care, physical therapy, food, medication delivery, and more. Resources ranging from specialties like cardiology and endocrinology to services like case management and social services are often siloed, making coordination even more difficult.
As organizations design best-practice clinical protocols for hospital-based programs, they must also consider the process for orchestrating everything necessary to achieve the best outcomes, utilizing both internal and external resources, as well as appropriate reimbursement. Implementing these protocols in a standardized manner is challenging, which can burden staff with unnecessary work and disconnect, causing delays, inefficiencies, gaps in care, and payment denials.
Q. You say that hospitals and healthcare systems need to shift focus from discharge planning to care orchestration in the hospital. What do you mean by this and what will this shift bring about?
A. For years, I have advocated removing the term “layoffs” from our healthcare vocabulary. We move patients from the intensive care unit to the floor, but we discharge them from the hospital. The term discharged by definition means release from obligations. After the patient goes home, the hospital’s role in the inpatient period of care is considered complete.
On the other hand, viewing the completion of a hospital stay as a transition in care reinforces a less episodic, more holistic view of patient care. Home becomes another care environment in the care continuum in which the patient manages their own care, with support from providers in the outpatient setting. This is at the heart of public health.
That said, hospital-at-home takes the home experience to a whole new level. Remember, it is not a hospital discharge; it is essentially the delivery of hospital-level care in the home by the inpatient care team.
What is the difference between discharge planning and home care orchestration? Discharge planning involves the patient going home to care for themselves. Details such as the patient’s transportation home, prescriptions, therapies, and follow-up appointments are discussed to ensure a smooth transition home.
With home care orchestration, the team coordinates hospital care at home, both clinical and non-clinical care. Everything from food service and housekeeping to daily nursing visits, transportation, medication administration and specialty consultations, to name a few. And this home care orchestration happens every day for the patient at home.
So why is this important? By shifting the focus from “discharge planning” to “home care orchestration,” healthcare systems and payers can not only reduce healthcare costs, but also reduce complications and gain favorable feedback from patients, caregivers, and caregivers.
This requires a complex array of services, making it ripe for automating the manual workflow processes, tasks, activities and events that bring it to life. Clinical workflow automation addresses the challenges by standardizing processes, increasing efficiency, and reducing administrative tasks.
Q. What role do remote monitoring devices and telehealth visits play in this home care orchestration style of hospital-at-home?
A. With continued labor restrictions, rising costs, and the shift to home care, healthcare organizations and patients alike have embraced enabling technology. Remote monitoring and the use of telehealth are technologies that have boomed during the pandemic and are now a widely accepted healthcare delivery modality.
The use of devices to remotely monitor blood pressure, blood sugar levels, medication adherence and activity makes it easier for patients to track their measurements at home, while making this data available to their healthcare providers. Data from these devices can be integrated into the EHR, giving healthcare providers access to information in real time to manage care remotely.
These technologies play a critical role in the home hospital by augmenting home visits with remote monitoring data and virtual visits, giving patients access to the full range of hospital services – making services such as a nephrology consultation, case management and mental health care easily accessible to patients at home.
Q. What role do home care, social services, and non-clinical services such as medication delivery and housekeeping play in the orchestration of home care?
A. The key to successful home care orchestration is the holistic view of what it takes to achieve the best patient outcomes. The organization provides home care at hospital level. This should include a full range of services, taking into account each patient’s situation, such as care support at home, social determinants of health, mobility, language barriers, etc.
The orchestration challenges begin with identifying patients who could benefit from this care. These patients can be identified prior to admission to the emergency department, or on the hospital floor when they have improved enough to go home.
Regardless, assessing patients against specified requirements is often manual in nature, requiring significant resources to identify patients and leaving programs underutilized. Clinical workflow automation can alleviate this burden by electronically assessing all patients and applying the criteria in real time across both care environments and highlighting those patients who meet the criteria.
This allows staff to work directly with the appropriate patients to obtain consent and begin the process of placement into the home.
Once at home, the main challenge is the orchestration of services – particularly the orchestration of non-clinical services, for example food service, pharmacy delivery, housekeeping, home set-up and support services. Currently, hospital-at-home services often use clinical resources to manually coordinate non-clinical services.
With limited resources in our current healthcare environment, we need to think about using solutions like clinical workflow automation to support both the healthcare team and the patient by adapting to the patient’s needs, while ensuring nothing falls through the cracks slips off the net.
An example is using automation to communicate to the food delivery team that the patient is currently having an MRI in the hospital and not to deliver food to the patient’s home until 2 p.m. This may seem like an insignificant example.
But now we’re talking about patient experience, food quality, medication implications, and inefficiencies for the team. It’s not the same as getting a tray from the kitchen and not finding the patient in their room and coming back later. Someone brings food from all over town. It has to be there at the right time.
Coordinating the right information to the right teams at the right time is labor intensive. Using clinical workflow automation in home care orchestration frees up staff and ensures patient needs are met in a timely manner.
With our aging population in the US, the concept of discharging patients needs a refresh. Expanding the continuum of care to integrate care at home will improve patient care outcomes, physician satisfaction, and financial performance.
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