The favourable, unintended consequences of the pandemic
Hospital-at-home programmes emerge worldwide, freeing up hospital beds and providing huge cost savings for patients
Within health-care systems, the Covid pandemic’s pressures have been akin to colliding tectonic plates. Two years in, we’ve seen seismic shifts in the burden of disease, in the nature of care, and in where patients access care.
Care is fast moving away from traditional settings in large hospitals to same-day surgery centres and to care in the home.
While these were pre-Covid trends, they have been enormously accelerated over the past two years. Care at home has been enabled particularly by the swing to online and the growth in cutting-edge, remote-monitoring technologies.
Health systems are also creating platform ecosystems, including multidisciplinary professional teams and sophisticated artificial intelligence (AI) to develop “care-as-a-service”. It’s similar to the revolutionary move from on-premise technology to software-as-a-service, with plug-in cloud-based solutions.
Since 2020, health-care providers worldwide have had to innovate, at speed, amid the pressures brought to bear by the pandemic. Hospitals were overburdened in waves by the sheer volume of acute Covid-related admission, while consumers became reticent to visit hospitals, afraid of contracting Covid.
Covid patients were consequently cared for at home in large numbers, receiving oxygenation, monitoring and nursing, with superb outcomes. The unexpected, external force of the pandemic has upended the status quo, and led to a realisation of the benefits of care at home. In the process, hospital-at-home offerings have acquired credibility and relevance.
We now know that selected eligible patients who are offered cutting-edge, hospital-level care at home can recover well.
Broadly speaking, moving care to the home holds huge potential for dealing with many long-standing challenges threatening the sustainability of health care globally — those posed by ageing populations, increasing chronic morbidity and health-care demand, together with rising costs of care.
Hospital-at-home offerings allow selected patients to potentially avoid admission entirely, or to be discharged earlier, limiting exposure to hospital-acquired infections and allowing for care in the comfort of one’s home.
It is the responsibility of the treating senior clinician to select which patients are safely admitted at home.
And to ensure the care at home is holistic and safe, multidisciplinary health-care teams visit the home to set up monitoring systems, supported by an array of cutting-edge digital tech, for everything from virtual consultations to remote monitoring devices that report in real time on a patient’s vitals, 24/7.
These devices are monitored by specialised teams and supported by AI algorithms that predict and detect complications, ensuring any possibly serious events are foreseen.
Brigham and Women’s Hospital — Harvard’s world-renowned teaching hospital — in the US established Brigham Health Home Hospital in 2016, providing at-home care for 300 patients annually.
Its 2019 pilot randomised control trial found patients cared for at home were happier, were readmitted less and ended up moving around more, preserving their strength. The average direct cost for acute care episodes at home was up to half the cost of hospitalised control patients.
From November 2020, this facility also freed up Covid hospital beds by caring for 65 nonCovid patients at home. Published results show it saved 419 hospital-bed days in the process.
In Tel Aviv, during 2020, the 1,700-bed Sheba Medical Centre partnered with local providers of remote monitoring technology to develop telehealth-facilitated care delivery for Covid patients.
Sheba Beyond, Israel’s first virtual hospital, was created. Over the course of the pandemic, its providers completed more than 50,000 consultations for patients in Israel and around the world. It now operates more than 130 virtual clinics with more than 1,300 clinical staff members, handling hundreds of virtual visits daily.
Sheba has reduced the numbers of beds in its wards, with existing nursing and doctor teams caring for a combination of in-person and virtual patients.
The National Health Service (NHS) in the UK has increasingly employed virtual wards to support people at home and at care homes, and treats more than 2,500 patients this way, each week.
At scale, the NHS aims to be able to provide 50 virtual beds per 100,000 members of the population — an ambitious milestone. In these virtual wards, support includes the use of remote monitoring apps, technology platforms and wearables, with face-to-face care from multidisciplinary teams.
Discovery Health has launched a Hospital at Home capability, in partnership with Biofourmis (provider of digital therapeutics and virtual platforms that power personalised predictive care) and various health professional groups.
While health professional teams provide remote monitoring, patients can monitor their own metrics through an app linked to the remote monitoring Biofourmis device.
Worn on the arm, it continuously monitors multiple physiological signals, sharing these in real time with the patient, care team and our 24/7 control centre. AI algorithms applied to the readings provide an additional predictive view of a patient’s disease trajectory.
Hospital at Home can 'admit' up to 800 patients at a time, making it the largest single private hospital in our country
Closer to home, Reona Naidoo, a Discovery Health medical scheme member, recently sent through a voice note (which I shared in a LinkedIn post) about being cared for through Discovery Hospital at Home. Her two little girls played noisily in the background. Naidoo developed pneumonia post-surgery and her physician motivated for her admission to Discovery Health Hospital at Home so she could be discharged early, but still access hospital-level care. Naidoo made a complete recovery.
Hospital at Home can “admit” up to 800 patients at a time, making it the largest single private hospital in our country. In addition to the patient benefits, our analysis also shows that home-based hospital care reduces costs by about 20% per admission.
All services offered as part of Discovery’s Hospital at Home programme are funded from the member’s hospital benefit where there is a valid preauthorisation in lieu of hospitalisation.
It’s been more than a year since we joined the home Hospital Early Adopters Accelerator programme launched by Ariadne Labs and CaroNova. Ariadne Labs is a collaboration between Brigham and Women’s Hospital and the Harvard School of Public Health, while CaroNova is an “incubator” for health-care innovation.
The accelerator programme provides expertise in designing and managing home hospital offerings via a network of 20 hospitals that collectively learn, create and implement. It’s about promoting opportunities for knowledge-share. Discovery Health is the only member on the platform that is not in the US.
At Discovery Health, we are likewise partnering with multiple organisations across digital health care, technology platforms and knowledge-sharing networks. Our focus is on strategic investment in the health-care value chain to improve quality of care, while shifting care to lower-cost settings.
We’re addressing all three pillars of the “iron triangle” of health care. It’s formed by access to, cost of and quality of care. Traditionally, improvement in one or two of the pillars happens at the expense of the third.
I believe that digitisation and the move to remote care have huge potential for breaking this triangle’s trade-offs, for the good of the patient and the health-care ecosystem at large.
• Dr Noach is CEO of Discovery Health
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