Home Heart Hospital Associated With Reduced Hospitalizations and Costs Among High‐Cost Patients With Cardiovascular Disease

Abstract

ABSTRACTBackgroundThere is no widely accepted care model for managing high‐need, high‐cost (HNHC) patients. We hypothesized that a Home Heart Hospital (H3), which provides longitudinal, hospital‐level at‐home care, would improve care quality and reduce costs for HNHC patients with cardiovascular disease (CVD).ObjectiveTo evaluate associations between enrollment in H3, which provides longitudinal, hospital‐level at‐home care, care quality, and costs for HNHC patients with CVD.MethodsThis retrospective within‐subject cohort study used insurance claims and electronic health records data to evaluate unadjusted and adjusted annualized hospitalization rates, total costs of care, part A costs, and mortality rates before, during, and following H3.ResultsNinety‐four patients were enrolled in H3 between February 2019 and October 2021. Patients' mean age was 75 years and 50% were female. Common comorbidities included congestive heart failure (50%), atrial fibrillation (37%), coronary artery disease (44%). Relative to pre‐enrollment, enrollment in H3 was associated with significant reductions in annualized hospitalization rates (absolute reduction (AR): 2.4 hospitalizations/year, 95% confidence interval [95% CI]: −0.8, −4.0; p < 0.001; total costs of care (AR: −$56 990, 95% CI: −$105 170, −$8810; p < 0.05; and part A costs (AR: −$78 210, 95% CI: −$114 770, −$41 640; p < 0.001). Annualized post‐H3 total costs and part A costs were significantly lower than pre‐enrollment costs (total costs of care: −$113 510, 95% CI: −$151 340, −$65 320; p < 0.001; part A costs: −$84 480, 95% CI: −$121 040, −$47 920; p < 0.001).ConclusionsLongitudinal home‐based care models hold promise for improving quality and reducing healthcare spending for HNHC patients with CVD.