Home Heart Hospital Model Lowers Costs, Enhances Care for High-Cost Patients With CVD

Adopting a Home Heart Hospital (H3) care model may provide better patient care and support, as well as reduce costs for high-need, high-cost (HNHC) patients with cardiovascular disease (CVD), according to a study published in Clinical Cardiology.¹

The primary outcomes were the average number of hospitalizations per patient for each period, and the average number of inpatient days per patient period

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“In this study, we show that enrolling HNHC patients with cardiovascular comorbidities in an intensive longitudinal home-based care model is associated with significant and clinically and financially meaningful reductions in hospitalization rates, inpatient days, total costs of care, and part A spending,” wrote the researchers of the study. “Collectively, these data suggest that models like H3 hold promise for improving health outcomes, reducing hospital-based health care utilization, and reducing health expenditures for medically complex patients with substantial health care utilization.”

There are many medical and financial challenges for HNHC patients, who comprise approximately 5% of the US adult population and 50% of total US health care spending. However, there is no widely accepted care model for managing these patients.

Cardiometabolic virtual-first care programs for prevention and management of cardiometabolic conditions were found to be associated with greater health and economic benefit, according to a study published in The American Journal of Managed Care^®.²

In this study, the researchers utilized the H3 model, which includes in-home and caregiver education from a nurse practitioner supervised by a cardiologist, 24/7 access to diagnostic labs and imaging, medications and oxygen, and common hospital treatments. The model was first launched in 2019 by Novolink Health.

Patients included in the study were 18 years and older; had at least 3 chronic medical problems, including at least 1 CVD; had at least 2 CVD-related hospitalizations within the prior year; and provided informed consent. Study outcomes were grouped into 3 time periods: conventional care, which included 180 days before H3 enrollment; H3 enrollment; and the post-H3 period, which included the 180 days following discharge. The primary outcomes were the average number of hospitalizations per patient for each period and the average number of inpatient days per patient period.

Clinical and demographic data were collected from electronic medical record chart abstraction. Between February 2019 and October 2021, 94 patients were admitted to H3. Humana was the primary insurance carrier for all study participants, in which 71 of the 94 patients had data on hospitalizations, inpatient length of stay, and Medicare Part A/B/D cost data for the 3 time periods.

Enrollment in H3 was associated with significant reductions in annualized hospitalization rates (absolute reduction [AR], 2.4 hospitalizations/year; 95% CI, −0.8 to −4.0; P < .001), total costs of care (AR, −$56,990; 95% CI, −$105,170 to −$8810; P < .05), and part A costs (AR, −$78,210; 95% CI, −$144,770 to −$41,640; P < .001).

Additionally, annualized post-H3 total costs (−$113,510; 95% CI, −$151,340 to −$65,3210; P < .001) and part A costs (−$84,480; 95% CI, −$121,040 to −$47,920; P < .001) were significantly lower than pre-enrollment costs.

The researchers acknowledged some limitations to the study, including being retrospective in design, the possibility for patient selection bias, it taking place only in urban and suburban regions of Southeast Florida, and the possibility that regression to the mean accounted for some of the reductions in hospitalizations and costs associated with H3 enrollment.

Despite these limitations, the researchers believe the study findings support the use of this in-home care model to reduce hospitalization rates, inpatient days, and total and part A costs of care in HNHC patients with CVD.

“The rates and patterns of mortality observed in this study—including 5% observed mortality rate during H3, with zero deaths at home, 2 deaths in the inpatient setting, and 3 deaths among patients referred to hospice—is comparable in magnitude and pattern to previously published estimates of inpatient outcomes among HNHC populations, which have estimated in-hospital mortality at 3%,” wrote the researchers.

References

1. Shen M, Osman K, Blumenthal DM, et al. Home heart hospital associated with reduced hospitalizations and costs among high-cost patients with cardiovascular disease. Clin Cardiol. 2024;47(6):e24302. doi:10.1002/clc.24302

2. Noble M, Chen F, Linke S, et al. Modeling the economic value of cardiometabolic virtual-first care programs. Am J Manag Care. 2024;30(Spec Issue No. 6):SP430-SP436. https://www.ajmc.com/view/modeling-the-economic-value-of-cardiometabolic-virtual-first-care-programs