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Dr. Pippa Shulman, chief medical officer at Medically Home, believes that the home environment will ultimately become the linchpin of the U.S. healthcare system.

“We’re going to see the hospital completely shift to the concept of getting critical care, surgical care and emergency trauma care, but everything else can be done at home,” she recently told Home Health Care News.

At Medically Home, Shulman and her colleagues have worked to advance the hospital-at-home movement by helping numerous healthcare organizations enter and expand into the space.

Shulman discussed this during an interview with HHCN last week during the FUTURE conference. During the discussion, Shulman also touched on why it’s important to leverage technology that actually helps physicians solve problems and her predictions for the future of the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home waiver.

HHCN: Can you talk about how, in your experience, home hospital care has become established as an important care model in general health care and what this has meant for patients?

Schulman: What people don’t realize is that the hospital at home has been a model of care in this country for more than 20 years, but typically on a small scale and usually in health systems that have integrated payer networks or are like the VA. Interest was slow to build and really grew in 2017 and 2018. Around that time, CMMI offered a demonstration grant that Mount Sinai and Marshfield Clinic took advantage of.

Around that time, I was also building a program in Massachusetts. We all know what happened just a few years later, which was the Covid pandemic. Faced with the sudden need for space, the home hospital was ready. That was really the turning point.

The second turning point was when CMS granted the waiver that allowed reimbursement. That was a missing piece of the puzzle in this story, and then all sorts of interested parties started pushing into the space, which was wonderful. It allowed small and large systems to get involved where they might not have otherwise, and it allowed Medicare reimbursement, which really hadn’t been an issue up until then. Now there are 10 states where Medicaid reimburses for home health care. The results are great. The data continues to be very compelling. The pandemic was such a terrible moment for our health care system, but that moment allowed for this incredible time of innovation.

How do you think Medically Home has advanced the larger hospital-at-home movement?

I joined as a family physician, but I also provided home health care. I managed a home primary care program, a home post-acute care program, a SNF program, and worked for an organization whose goal was to keep my patients out of the hospital.

When we wanted to set up a home health program, we needed help with logistics and technology. Technology is a bit of a commodity. You can get it from anywhere, but how do I get oxygen to my patient’s bedside in the middle of the night? How do I get blood drawn when I need it, and how do I transport it? Home health nurses are a wonderful resource, but many of them only travel with the supplies they need that day and often cannot respond to an emergency situation, even though many of them would love to. So you have to retool an entire system.

That’s basically the idea behind Medically Home. How can we support the logistics and coordination of care so that a doctor in the hospital doesn’t have to worry about whether the care is getting there? It allows the hospital brand to extend into the home, so to speak. That’s the power of the model and the missing link for so many who want to scale and build, especially smaller or mid-sized health systems.

Partnerships are critical to the company as Medically Home helps other companies scale their hospital-at-home programs. What should companies looking to enter this space look for in a partner?

We’ve worked with a number of wonderful national partners in the home health space. I think it’s all about going beyond traditional home care.

We no longer talk about home health in the form of an OASIS. I know a lot of people say that, but I think that’s really the most important thing. It’s about thinking differently about your workforce. How do I need to upskill my workforce? How do I need to potentially add new competencies to my workforce and be able to respond to the dynamic demands of a home hospital program? The home hospital program may initially care for older patients with acute exacerbations of a chronic illness, but it will quickly change to want to care for post-operative patients, younger patients, and cancer patients as well.

Can you adapt with them to be able to provide these services? Can you develop cooperative education agreements? Can you help with sourcing supplies? Can you take care of more than one need? Maybe you brought nursing knowledge with you from the start, but are there skills you can add to your repertoire that you may not have had before? It’s still about solving problems and finding new solutions.

In your opinion, what clinical challenges should be focused on in hospital-at-home care?

One clinical challenge I think about a lot is that as people become more interested in home care, a lot of money is being invested in technology, sensors and remote patient monitoring. When we deploy something in a patient’s home, we need to make sure we’re getting clinically actionable, accurate data from it and that it’s safe to use.

I’m concerned about the proliferation of technologies that provide little benefit. I want to make sure we’re developing technologies that actually solve a problem that we have and that have the ability to replace and augment the home hospital environment, not just solve a doctor’s anxiety issues.

I see a similar situation with point-of-care testing, for example. If we really want to expand the services we can provide in the home, we need to ensure that we can provide tests and results as close to the patient as possible, to shorten the time from assessment to diagnosis to treatment.

We already know we can do X-rays and ultrasounds. There is already work being done on CT scans in trucks, but I hope there will be other technologies to be able to do more imaging and more point-of-care testing so we can detect infections earlier.

In 2023, Medically Home has entered the home emergency department space. Are there other ways Medically Home plans to work with providers to move care into the home setting? Things the company isn’t currently doing? How is Medically Home moving in that direction?

We are really thinking about all the elements of care that could be decentralized into the home environment.

The idea of ​​home emergency care is simple: a patient has an urgent need. Can we respond? Let’s take a step back.

If we have the ability to send a person or resource into the home 24/7 when needed, how can we link that to all the other care systems that already exist?

Think about the novel program you could develop for cancer patients – and we’ve done a lot of studies and trials with cancer patients and supporting them through their cancer journey. Imagine how the course of these cancer patients would change if we could say to cancer patients, “Hey, I’m not feeling well today,” knowing that they don’t have to go to the hospital, that we could come to their home and treat their symptoms right away. We’ve done studies that show that their course does change.

I’m really thinking about how we can send our services and a doctor on call to patients’ homes, with long-term care and chronic disease management programs, again targeted to the right patients. Patients want help when they have a problem, and if we know how to address it in that moment and avoid them having to go to the hospital, we’ve really completely broken that cycle of inpatient care.

Do you have a forecast for the home care sector in general over the next five years?

My prediction is that before the end of the year we will pass the exemption that allows for an extension of hospital home care. I’m very excited about that because it gives us a lot of breathing room. It will allow us to collect more data and create a path to permanent payment. That will give us the opportunity to try acute home care on a much larger scale and move into surgical care, cancer care – some of the other care models I’ve talked about.

What we are going to see is a complete shift away from the concept of the hospital as a place where you can get intensive care, surgical care and emergency trauma care, but everything else can be done at home.