The Kaiser Permanente Advanced Care at Home program combines home visits, telehealth encounters and remote patient monitoring connected to specialized command centers that coordinate services to help achieve a 30-day readmission rate that is lower than the national average. And importantly, the program also keeps patients connected to their homes and everything inside them that is conducive to their healing.
“That might be their loved ones, it might be their pets and we've had several patients who said, ‘I gain energy from being in my garden,’ and so during the day they'll be outside,” said Vivian Reyes, MD. She is the physician lead for the program and an emergency physician for The Permanente Medical Group, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“The beauty of this program is that it allows patients to be in their comfort zone with all the things that are nurturing for them, and allows them to feel better,” Dr. Reyes said.
While the environment is different for the patient, the role of the physician is the same as it would be for a hospitalist or other hospital-based specialist leading a care team in a traditional brick-and-mortar facility.
“These physicians are driving the patient's care,” Dr. Reyes said. “The physician is seeing the patient virtually just like they would on their rounds in the hospital and then throughout the day as needed.”
If a patient needs to be examined, it can be done in coordination with a home health nurse or community paramedic.
And while patients have told Kaiser Permanente care team members that 24/7 access to in-home care is not necessary, Dr. Reyes says she and her colleagues want to make sure patients can access the care team at any time, day or night.
“Sometimes patients are like, ‘Oh my gosh, I feel like you guys are always here,’” she said. “So, some feedback we got early in the programs was ‘You don't need to be here so much,’ which I think is probably better than hearing the opposite.”
Improvement in patient care
Patients receiving care through Advanced Care at Home and similar programs, had a low mortality rate and minimal complications compared with patients who received care at traditional hospitals according to a JAMA Health Forum study by Centers for Medicare & Medicaid (CMS) researchers examining records from almost 11,200 patients in hospital-at-home programs between fall 2021 and spring 2023.
Kaiser Permanente’s Advanced Care at Home was launched three years ago by The Permanente Medical Group and Northwest Permanente. And it now provides care for about 1,000 patients a year.
The organizations partnered with a Boston-based vendor, Medically Home, whose technology platform handled the logistics of getting care such as phlebotomy services into patients' homes. Meanwhile, Kaiser Permanente’s EHR was used for documentation and order entry.
“We built the program from the ground up, but we did partner with Medically Home to manage in-home service providers,” Dr. Reyes said. “We were able to get the program up and running more quickly by working with them because they already had some of these service providers under contract.”
Also, Kaiser Permanente conducted an in-house patient satisfaction survey and compared the finding with results from the Hospital Consumer Assessment of Healthcare Providers and Systems survey for Northern California.
Dr. Reyes said patient ratings for their hospital-at-home program were higher or tied with the highest scores given to brick-and-mortar hospitals.
More specifically, “patients using the system’s hospital-at-home services said their care teams were more responsive (85% versus 67%), experienced smoother care transitions (76% versus 52%), and had overall better experiences (80% versus 71%) than patients who received traditional inpatient care,” according to a 2022 STAT News essay co-written by Stephen Parodi, MD. He is executive vice president of external affairs and corporate development and associate executive director of The Permanente Medical Group.
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Caregiver transformation
Families also appreciated the program, and Dr. Reyes said that there are three types of family caregivers the program usually sees.
“There are some who don’t want to be involved in care—and that’s fine,” Dr. Reyes said. “Another type really wants to get involved and wants to be empowered to be involved. And there are those who are hesitant at first and then, when they come into the program, really enjoy it. It’s really up to them how involved they want to be. The goal is not to burden family or other caregivers.”
Dr. Reyes recalled how one woman described her transformation as a caregiver.
“She said: ‘Before this program, I was petrified to be alone with my mother because I was afraid I was going to do something wrong,’” Dr. Reyes said. “But, during the program she said she became much closer to her mom than she had ever felt before.”
Other advantages of being inside a patient’s home include removing clutter, electric cords and other objects that may contribute to raising the risk of a fall and seeing inside medicine cabinets to learn exactly what patients are taking.
In one instance, Dr. Reyes said a patient was using an albuterol nebulizer that no longer had any albuterol in it.
Waiver needs permanent extension
The list of conditions treated through the program includes chronic obstructive pulmonary disease, congestive heart failure, COVID-19 and pneumonia.
Dr. Reyes said she’d like to see it expand to include pediatric patients, post-surgical or perioperative care and chemotherapy.
As an integrated health system, Kaiser Permanente has had an easier road with implementing acute care at home because it didn’t need to get prior authorization from other health plans to offer the service.
“It’s easier to create this program in an integrated system like ours,” Dr. Reyes said, adding that nonintegrated systems were able to build programs thanks to the CMS Acute Hospital Care at Home waiver initiated during the public health emergency.
While the waiver was extended to the end of this year, Dr. Reyes said some health systems are reluctant to invest further in the programs until the waiver is made permanent.
The AMA signed a letter requesting an extension of the Acute Hospital Care at Home Waiver (PDF) for five years. Ten AMA Health System Program members also signed on to the letter.
