Home Hospital Early Adopters Accelerator

Born out of opportunity during the COVID-19 pandemic, our Home Hospital Early Adopters Accelerator (HHEAA) is supporting hospitals and health systems to provide healthcare services in locations other than hospitals, making a more comfortable and less disruptive experience to low-acuity patients and their daily routines while also preserving hospital beds and staff for higher acuity patients.

We launched the HHEAA in September 2021 to leverage CMS’s emergency Hospital Without Walls waiver, put into place in response to a strain on hospital bed capacity during the pandemic. The waiver provided regulatory flexibility to hospitals to provide care in locations beyond their facilities, including in a patient’s home.

We capitalized on this opportunity by interviewing health system leaders to determine what tools they needed to implement home hospitals. We then partnered with a national expert in home hospitals, Ariadne Labs, to develop the tools hospitals needed to deliver these crucial services outside traditional healthcare facilities.

Over thirty-two working weeks, clinicians and home hospital subject matter experts from across the country and the globe participated in the HHEAA to collaboratively create 20 knowledge products (e.g., tools such as workflows and protocols) for successful home hospital implementation. Phase one of the HHEAA started in September 2021; in 2023, CaroNova and Ariadne Labs launched phase two, which focuses on the evaluation, implementation support, and dissemination.

Participating Hospitals and Health Systems

• Atrium Health
• CaroMont Health
• Carteret Health Care
• Discovery Health
• H. Lee Moffitt Cancer Center & Research Institute 
• McLeod Health 
• Medical University of South Carolina Health Charleston
• Novant Health
• Sentara Healthcare
• The MetroHealth System 
• UNC Health
• Vanderbilt University Medical Center
• Tidelands Waccamaw Community Hospital
• WakeMed Health and Hospitals
• Wentworth-Douglass Hospital
• And 4 additional institutions

Evaluation

Ariadne Labs is working with CaroNova to evaluate the current uptake and perceptions of HHEAA knowledge products one year after the Accelerator’s first phase ended in June 2022. In February 2023 Ariadne Labs consulted with CaroNova to refine the year two evaluation plan. Once approved, the evaluation will determine the usefulness and impact of the HHEAA knowledge products and provide input on how to increase their effectiveness.

The year two evaluation will add to the results of the year one evaluation. The year one evaluation shows that more than 90% of HHEAA participants surveyed believe the knowledge products are useful and will improve patient care. One participant lauded the research that was used to develop the products.

Implementation

We and Ariadne Labs have implemented a comprehensive strategy to support Accelerator participants as they implement knowledge products or launch home hospital programs. The strategy focuses on a peer learning community and consultation with subject matter experts at Ariadne Labs. Highlights include: a monthly newsletter distributed to participating hospitals that includes educational opportunities and advocacy updates, a monthly brown bag luncheon for participating hospitals to discuss home hospital best practices and implementation challenges, and a series of webinars to address participating hospitals’ needs and the financial benefits of home hospitals.

Dissemination

CaroNova worked with Ariadne Labs on three manuscripts about the Accelerator. The first manuscript details the innovative way that the HHEAA, with participation from clinicians and experts across the country and the globe, used the Scrum Agile methodology in a virtual environment to develop knowledge products.

The second manuscript explains the outcomes of the HHEAA maintaining regular participation from knowledge product developers to generate a variety of high-quality and useful knowledge products.

The third paper describes the business case for using the Scrum Agile methodology in healthcare.

We jointly drafted the manuscripts and submitted them to journals such as Implementation Science, the Harvard Business Review, and the Journal of General Internal Medicine. 

We continue to spread the value of the HHEAA and home hospital broadly to researchers, policymakers, patients and practitioners. We will present at conferences and before healthcare stakeholders, publish results on the Ariadne labs website, publish in outlets aimed at the general public, and collaborate with professional societies and patient advocacy groups.

Policy and Advocacy Support

CaroNova’s advocacy efforts have paid off on the federal level.

To date, we have provided evidence of the efficacy and local adoption of home hospitals to government relations officers meeting with state delegations in Washington, D.C. to ensure Congressional lawmakers understood the value of home hospitals to the Carolinas. 

As a result of consistent efforts from home hospital advocates and experts, when Congress passed the Hospital Inpatient Services Modernization Act in December 2022, it included support for home hospitals. This legislation extends Medicare reimbursement for delivering home hospitals beyond the end of the COVID-19 public health emergency (PHE). We are also working with hospitals to navigate state regulatory requirements after the federal PHE.

Hospitals are interested in the legal standing to operate home hospital programs past PHE because of Certificate of Need concerns. CaroNova is communicating with the North Carolina Division of Health Service Regulation (DSHR) and working with them to issue a letter that allows CMS-waivered hospitals to continue to participate in the Hospital Without Walls program through the two-year extension. CaroNova will support the drafting of the letter should DSHR support this plan. If DSHR issues that guidance, hospital members feel encouraged about expanding and growing home hospital programs across North Carolina.

Next Steps

We will continue to support hospital participants by providing educational opportunities and facilitating shared insights about lessons learned about how they have overcome challenges.

the HHEAA will have helped spread a new model that improves the outcomes of care for patients. We are exploring how to leverage what we’ve learned in this project to move clinical care into patient homes where appropriate. 

Hospitals that participated in the Accelerator can now serve as peer leaders in providing acute patient care at home. Accelerator hospitals can also use knowledge products from the HHEAA more broadly to improve transitions of care from the hospital to home and improve communication with patients and family caregivers.