The Marshfield Clinic Health System is located in central Wisconsin and offers services to an area of about 45,000 square miles. In those rural parts of Wisconsin and northern Michigan, patients can be forced to spend hours in transport trying to reach the nearest hospital or clinic.
Narayana Murali, MD, remembers joining Marshfield Clinic in 2006 and meeting a 67-year-old woman with diabetes who traveled 200 miles four times a year just to titrate her medications and optimize her heath. He figured there was a better alternative.
The following year, Dr. Murali was given the opportunity to provide her with virtual care, do exams over video, review vital signs and laboratory tests, and arrange for diuretic infusions—all while allowing the patient to stay in the comfort of her home.
That is the whole point of hospital-at-home care, said Dr. Murali, who today is chief medical officer of medicine services at Geisinger, 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.
Dr. Murali spoke about the differences between hospital-at-home care and home health care, the successes he saw in Wisconsin, and his current role at Geisinger in a recent episode of “AMA Update.”
Hospital-at-home vs. home health
Home health care primarily involves nursing services, physical therapy, occupational therapy, social work and perhaps one or two additional aid services focused on patients with chronic diseases, Dr. Murali noted.
With hospital-at-home, the care potential is far more substantial.
"You're having a physician available 24/7," he said, noting that other health professionals such as nurse practitioners, skilled nurses, physical therapists, emergency medical technicians, infusionists and phlebotomists are available. Lab testing and imaging also is available, along with ambulance services.
Durable medical equipment like oxygen services and antibiotics are also available, and digital advances make it possible for patients to be monitored 24 hours per day.
Innovation in Wisconsin
Marshfield Clinic, also a member of the AMA Health System Program, started offering hospital-at-home care in 2016 under Dr. Murali’s leadership as executive vice president of care delivery and chief clinical strategy officer.
As Dr. Murali noted in U.S. Senate testimony, the hospital-at-home care effort showed numerous signs of success between 2016 and 2019, including:
- 44% fewer 30-day readmissions and a 50% drop in emergency department visits compared with those treated in the hospital.
- Greater than 90% patient-satisfaction rates.
- Saving about 15–30% per incident when compared to historical baseline costs.
- Saving 1.2 million miles of patient driving thanks to the virtual service.
Helping an innovator do even more
Last year, Dr. Murali left Marshfield to join Geisinger, where he is helping to develop strategic plans that focus on customer expectations, the quality and cost of care, and the overall improvement of care.
Geisinger offers two models of care that resemble hospital-at-home offerings. One is a mobile integrated health service that connects with paramedics who can deliver infusion services. The second model is called Geisinger at Home. For that service, Geisinger’s team of doctors and other health professionals visit patients at home as needed.
"There are about 11,000 patients who have received that kind of care," Dr Murali said. "Much of the focus is on Medicare Advantage patients to reduce their visits to ER and manage their care proactively.
"Geisinger is an extremely innovative organization," he said. "It has been on the forefront of technology innovation and how care is provided in the state of Pennsylvania."
“AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.
