New Jersey has expanded hospital-at-home care to people with Medicaid and commercial insurance

New Jersey this week became the first state to make people with private insurance eligible for hospital-level treatment at home when they come to the emergency department as an alternative to being admitted to the hospital.

Previously, hospital-at-home benefits were restricted to patients with Medicare, the federal government’s insurance for people 65 and older, under a federal program launched in late 2020 to relieve pressure on hospitals during the COVID-19 pandemic.

A new law makes it possible for more patients seeking emergency medical care for conditions such as heart failure and urinary tract infections to immediately return home with close monitoring, rather than having to stay at the hospital. New Jersey’s Hospital at Home Act also makes this option available to the state’s Medicaid population.

Virtua Health, South Jersey’s largest health system by revenue and number of hospitals, has already treated more than 900 Medicare patients in its Hospital at Home program during the last two years and is eager to expand it, Virtua officials said.

The next step for Virtua is working out terms with private insurers, such as Horizon, Aetna, and AmeriHealth New Jersey to get paid appropriately for delivering high-level medical care outside of the hospital. Those talks are underway.

“It’s mandated that it’s part of their coverage for the state of New Jersey. We’re the first state to do that,” said Michael Capriotti, a senior vice president of integration and strategic operations for Virtua.

Virtua’s hospital-at-home patients have tended to need hospital-level care for shorter periods and end up with better health outcomes, said Raul Berio-Dorta, a Virtua physician who is the program’s medical director. For example, these patients are less likely to experience hospital-induced delirium, a confused state that can be especially concerning in older patients.

“When they are in their home, they’re in an environment that they know,” he said. “They don’t get as confused.”

To be eligible for the hospital-at-home program, a patient must be admitted through the emergency department. Berio-Dorta said the most common diagnoses are congestive heart failure, chronic obstructive pulmonary disease, pneumonia, urinary tract infection, cellulitis, and COVID.

One of those diagnoses cues the emergency room physician to evaluate the patient for a hospital-at-home admission, instead of the traditional hospital room. Factors include how sick they are and if they have a safe home environment.

Nurses meet the patients when they arrive at home for a hospital-at-home episode.

Virtua uses equipment to monitor the patients, including an armband that provides 24-7 data on heart rate, respiratory rate, body temperature, and steps taken. Additional supplies include a scale, a device to measure blood pressure, and a spirometer, which is used to measure how well a person’s lungs are working. The technology is supplied by a Best Buy subsidiary, Current Health.

The equipment includes a device that creates an independent WiFi network in the patient’s home, so the nurses can work as if they were in the hospital.

Meal deliveries are also an option.

Candy Luthe, 72, of Blackwood spent two days as a hospital patient at home last April when she had COVID. During this time, she experienced how carefully Virtua nurses monitor hospital-at-home patients.

Nurses at the Virtua monitoring center got alarmed when she was scrubbing her grandson’s baseball pants to get clay stains out before putting them in the clothes washer.

“They called me and said, ‘We noticed there was a lot of interference with your vital signs. Are you doing something?’ I’m like, uh, scrubbing laundry,” Luthe said.

During her hospital-at-home experience, Luthe was on an IV medication. She received two nurses’ visits per day and spoke to a doctor once a day.

“It was awesome to be home with my family,” said Luthe, who worked for 47 years as an neonatal intensive care nurse at Voorhees Hospital. She hopes the program spreads.

“Being a nurse, I definitely know that people heal better at home. It’s a familiar environment. Their family, their dogs, their cats, whatever all around them, and on their own couch.”

Hospital-at-home programs have been around on a relatively small scale since the 1990s at places like Johns Hopkins and the Mayo Clinic, but they never took off because hospitals found it hard to get paid, said Capriotti, Virtua’s senior leader for strategy.

That changed during the pandemic, he said, when regulators at the Centers for Medicare and Medicaid Services decided to pay the same Medicare rate for hospital stays and hospital-at-home care.

“That opened the door for Virtua; we can do the investment,” he said. He called the investment significant but he declined to say how much money was involved. About 40 people work in Virtua’s hospital-at-home program, he said.

Health systems must be enrolled in the Medicare hospital-at-home program to participate in the state expansion. Other South Jersey hospitals in the federal program are Cooper University Hospital in Camden, Salem Medical Center, Jefferson Cherry Hill, and Inspira Health, according the most recent federal list, which does not specify which Inspira hospitals.

Virtua’s hospitals are Virtua Marlton, Virtua Mount Holly, Virtua Our Lady of Lourdes in Camden, and Virtua Voorhees.

Horizon Blue Cross Blue Shield of New Jersey said it is in discussions with New Jersey health systems that have the Medicare hospital-at-home waiver, but hasn’t yet executed contracts covering commercial customers.