Ten Trends for 2023: Hospital at Home and Integration of Behavioral Health and Primary Care

HealthStream recently published its annual white paper on the top ten trends healthcare leaders can expect in the coming year. The paper was authored by Robin Rose, MHA, Thought Leadership Consultant. This blog will focus on two of the ten trends identified. Future blogs will cover the remaining trends.

COVID-19 was and is the driver of a great deal of change in healthcare including some surprising innovations that were fast-tracked as a direct result of the pandemic.

Hospital at Home is catching on

The pandemic forced healthcare providers, including hospitals, to rethink how and where healthcare is delivered. Hospital at Home allows some acute care patients to receive that care at home. While this care model looks very new to the healthcare industry, The Johns Hopkins Schools of Medicine and Public Health developed the model in 1995 and introduced telemedicine-based models in 2011.

This care delivery model has significant advantages. The American Hospital Associations (AHA) research has shown that it can reduce costs and improve outcomes and the patient experience. 

Patients are carefully evaluated to ensure they meet the validated criteria to safely and effectively be cared for at home. The patient is then assessed by a physician daily and receives a visit from a physician once per day. Patients also receive extended nursing care for the initial portion of their hospital at home stay and then daily and sometimes more frequent visits, as necessary. Many diagnostic and therapeutic procedures like electrocardiograms, echocardiograms, x-rays, oxygen therapy, intravenous fluids, and others are performed at home.

The Centers for Medicare and Medicaid Services (CMS) created a waiver in response to the severe hospital overcrowding issues arising from the pandemic. The waiver allowed hospitals to apply for reimbursement for hospital at home care for the first time. The waiver has increased the number of hospital at home programs from just a few to over 250. This number will continue to grow if CMS supports reimbursement for this model.

The Integration of Behavioral Health and Primary Care

One of many unfortunate consequences of COVID-19 is a rise in mental illness and substance abuse numbers. Before the pandemic, an estimated 19.9% of adults (roughly 50 million) experienced some form of mental illness. Early reports suggest that the number has risen to approximately 66 million and that 6 in 10 of those experiencing mental illness did not get treatment or medication. 

Because behavioral and physical health services are delivered in separate, poorly coordinated systems, even those seeking mental health care can experience long delays in treatment. To provide better-integrated care, some providers are testing new models, including practices that integrate primary care and behavioral health. This model makes it easier for providers to collaborate with patients, families, and one another to address mental health, substance abuse, and other medical needs. This more holistic model allows for continuous coordination of care.

Rose shared that telehealth will be essential in integrating primary and mental health care. It is anticipated that telepsychology and telepsychiatry will become a normal means of delivering mental health care, as the demand for telehealth services remains strong.

HealthStream explores the shifts and trends on the horizon that may impact your organization in our Annual Ten Trends Series.