H2C2 (HOME HOSPITAL AND CRITICAL CARE) - A 2.5 YEAR EXPERIENCE USING A NEW MODEL OF HOSPITAL AT HOME: DEVELOPMENT AND IMPLEMENTATION

Background:

The CMS Hospital at Home (H@H) program during the COVID 19 pandemic was successfully applied as a suitable alternative to unnecessary admissions in lower risk patient populations. As the top 5% pts ($50,000/Year) account for 50% of the US healthcare expenditure over 15 years (5:50 Rule), we sought to investigate the long-term clinical and financial effectiveness and sustainability of new model of home hospital and critical care (H2C2) on the top 5% patients.

Methods:

68 consecutive pts with top 5% annual cost profile (~4 admissions/pt with severe chronic dx [CHF, CAD, CODP, sepsis] +/-ventilator, PEG, dialysis, LifeVest) were enrolled in a multiple MSO program. On-site & On-line care started 3/2019 via patented processes and individualized protocols/devices (24/7 monitoring + ICU level Telemetry, 12-lead ECG). All Medicare Part A, B & D costs, admissions and LOS for pts were computed and normalized per phase (PRIOR, DURING, POST H2C2) to determine effectiveness and sustainability.

Results:

Of the 68 patients, 90% discharged to PCP, 6% admitted to hospice and 4% remained on the program for continuous care. There were no deaths at home. Compared to baseline, H2C2 had an over 70% sustained total cost reduction.

Conclusion:

This is 1st study to assess long-term clinical & financial impacts of H2C2 in top 5% of high-risk/cost pts. H2C2 was safe with a significantly sustained reduction of admissions and costs both during and 1.5 years post H2C2. Further studies are warranted for scalability.