St. Luke's Health System, an 11-hospital network based in Kansas City, Missouri, initiated its Hospital In Your Home care model in July 2022 to reduce costs, improve outcomes and enhance the patient experience.

THE PROBLEM

Saint Luke’s historically has had positive patient experience scores, but continuously strives to improve. The HIYH care model offers the patient the opportunity to stay in the comfort of their home, receive quality care and remain close to family.

"We believed that taking care of the patient where they wanted to be cared for would improve the overall patient experience," said Deborah Gash, senior vice president and chief digital officer at St. Luke's Health System. "Total cost of care for a patient seen in the hospital typically includes emergency room visits, hospitalization and post-acute care services.

"We also anticipated the HIYH model would improve patients’ overall health status, reduce readmissions, and lower the utilization of post-acute care services and ED visits, thereby providing a higher value service to the community," she continued.

Further, Saint Luke’s believed this care model would help address the capacity constraints that exist in the brick-and-mortar facility and alleviate workforce challenges. Since the onset of the pandemic, Saint Luke’s has seen high volume in facilities.

The HIYH model provided an opportunity to expand capacity without construction of new hospital beds. It also provides a unique work experience for healthcare workers, which leadership believes will enable clinical staff to continue in the profession, practice at the top of their licensure in new and challenging ways, and potentially attract new generations of caregivers to the healthcare field.

PROPOSAL

After launching Hospital In Your Home, Saint Luke’s expected to see an increase in overall patient satisfaction for similar acute care hospitalizations, reduced readmission rates, and health outcomes consistent with a brick-and-mortar acute care stay.

In addition, it expected to be able to more quickly and easily fill RN positions and provide those caregivers with a more satisfying clinical experience and greater job satisfaction. Lastly, Saint Luke’s expected to see a reduction in ED holds and the ability to accept transfers from outlying community hospitals for tertiary care services.

MEETING THE CHALLENGE

Saint Luke’s partnered with Medically Home to establish an integrated virtual and physical care model to manage the census of HIYH.

"The care model leverages technology provided by Medically Home called Cesia, which is integrated into the Epic EHR and installed in the home to connect the patient to the virtual command center," Gash explained. "It provides anytime access to providers and patients and ensures oversight and management of the patient’s health.

"The command center’s procedures and workflows are designed to support 24/7/365 high-acuity care at home," she continued. "It is staffed by Saint Luke’s physicians, nurse practitioners and registered nurses who are experienced and trained in providing high-acuity care at home."

The command center is connected to in-home service providers to ensure a seamless support team during the hospital stay. Saint Luke’s provides the technology, which enables any patient to participate in the program that meets the clinical criteria.

The technology is designed for redundancy, reliability and ease of use. The command center team coordinates with various service providers to bring supportive care to the home. Key to the success of the program is this service provider network, which delivers everything a patient needs to the home on demand, Gash said.

"Saint Luke’s has cared for more than 250 patients since the inception of the program in July 2022," she reported. "The average patient age is 78 and, to date, 54.3% are female. Predominant reasons for admission: 52% heart failure, 13% COPD, 11% pneumonia and 9% COVID."

RESULTS

The program has been successful in a number of ways.

"Patient satisfaction has been 18% higher in the HIYH program versus those hospitalized in a bricks-and-mortar facility," Gash said. "Patients appreciate being able to stay in the comfort of their home and anecdotally report they feel better able to manage their chronic conditions.

"Readmission rates declined 15% for the HIYH population, with zero patients discharged to post-acute care and no incidents of hospital-acquired infections or mortality," she continued. "To date, outcome goals related to cost and quality have been achieved, and Saint Luke’s has seen a reduction in ED holds for these patients."

ADVICE FOR OTHERS

HIYH programs are complex, and require a solid management team to ensure oversight and success, Gash advised.

"The partnership with Medically Home was important because it provided the technology needed to manage the service provider network, helped establish the necessary protocols and workflows, and identified and created the service provider network," she continued. "Saint Luke’s required use of its enterprise EHR to ensure clinical transparency, which is important for continuity of care.

"Our experience with HIYH has opened up receptivity to other care models and strengthened our willingness to innovate," she concluded.

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