Hospital at Home: A New Model of Care for Acutely Ill Patients

Michael J. Maniaci, MD, Director of Enterprise Virtual Care, Mayo Clinic

Summary

Hospital at Home programs have the potential to reduce costs, improve outcomes, and expand access, especially for Medicaid and low socioeconomic status patients. However, savings must be balanced with the cost of investments.

The concept of “Hospital at Home” (HaH) is a transformative model that delivers inpatient-level care to patients in the comfort of their own homes as an alternative to traditional brick-and-mortar hospital care.

What Is Hospital at Home?

The HaH concept begins with us asking: “What is a hospital, and what is hospital care?” It’s similar to asking: “What is a church? Is it the building, or is it the community and people in it?” Hospital care consists of assessments, treatments, and outcomes. For example, if you have pneumonia and you go to a hospital, you expect somebody to physically assess you. You expect to get antibiotics, usually through an IV. And you expect to get better.

The care is not the physical space: Whether you are in a new state-of-the-art hospital room or a 150-year-old hospital room, you’re getting the same care for your condition. That’s why HaH is not simply home health or outpatient care; it is the provision of full inpatient treatment—assessments, IV medications, and monitoring—delivered in a patient’s home with the same results. The core idea is that “different” does not mean “less.” Whether care is provided in a hospital room or a patient’s living room, the essential components remain. The physical environment is secondary to the quality and outcomes of care.

Why Shift Hospital Care to the Home?

Hospitals are not great places to get better, given the high rate of unintended adverse clinical events, including delirium (occurring in 1 of 5 hospitalized patients) and healthcare-associated infections (occurring in 1.7 million patients a year in the U.S.). Many patients require rehabilitation simply due to inactivity during their hospital stay. In addition, the U.S. faces a shortage of hospital beds and personnel, with the cost of building and staffing new facilities skyrocketing. A three-day hospital stay costs on average $30,000, and 66 percent of bankruptcies in this country are tied to medical care.

Common patient complaints about hospital care include:

“I can’t see my family.”
“The food is terrible.”
“No one tells me what’s going on.”
“I can’t sleep in this bed.”

Home care provides comfort, convenience, control, and freedom. Hospital care provides expertise and technology. Ideally, HaH would combine the benefits of both. Studies show that patients recover faster, experience fewer complications, and have lower readmission rates when treated at home. HaH can make healthcare more accessible, especially for patients in remote or underserved areas.

The Evolution of Hospital at Home

While the concept of HaH has existed globally for decades, its U.S. adoption accelerated in the 1990s and again during the COVID-19 pandemic. Early models involved physicians and nurses making home visits, but today’s “HaH 2.0” leverages technology to virtualize expensive resources and build scalable supply chains. Most care is now delivered by a mix of in-person and virtual teams, often partnering with external vendors to ensure quality and coverage.

As of September 2025, across 147 systems and 39 states, 419 hospitals have been approved by CMS to provide HaH services to patients. CMS has these requirements for HaH programs:

Patients must be physically seen, assessed, and admitted to the program from an emergency department or inpatient hospital department.
Patients must meet inpatient criteria by utilization review standards (InterQual, MCG Health, Dragonfly, etc.).
Patients must be assessed daily by a physician or an advanced practice clinician (in person or virtually).
Patients must be assessed in person twice daily by an RN or a paramedic overseen by a virtual RN.
The program must have a rapid response system that meets CMS standards, and patients must receive inpatient-level treatments.

The recent resolution to fund the federal government through January 30, 2026, extends the acute HaH programs that lapsed when the shutdown began. The package allows for retroactive payments for services provided since the waivers lapsed. On December 1, 2025, the U.S. House of Representatives passed a bill to extend the CMS waiver to provide acute HaH care for five years.

Four Pillars of the Hospital-at-Home Model

There are four essential components for successful HaH programs:

Connection through biometric data collection: Patients are equipped with tablets and Bluetooth devices to transmit vital signs and other health data in real time.
Enablement through smart software: Managing dozens of patients and hundreds of daily orders requires sophisticated software for logistics, scheduling, and clinical decision support.
Clinical care management through command centers: Centralized hubs—physical or virtual—coordinate care, oversee clinical decisions, and ensure safety.
Care plan execution through supply chain management: Delivering medications, labs, and meals to homes and disposing of medical waste requires robust logistics and partnerships.

Technological Innovations and Artificial Intelligence Enable Hospital at Home

Advances in point-of-care labs, wearable devices, and secure medication dispensers make remote care safer and more responsive. Drones are being explored for rapid delivery of supplies, and “digital hugs”—smart cameras and sensors—help maintain patient safety and peace of mind. These technologies are rapidly evolving. At the same time, artificial intelligence (AI) is revolutionizing triage and resource allocation. Algorithms can quickly identify suitable candidates for home hospital care, assess acuity, and even automate routine clinical decisions, such as those related to blood sugar management. By leveraging vast datasets, AI can help clinicians focus on the most complex cases and streamline care for lower-risk patients.

Barriers to Scale for Hospital at Home

Despite the promise of HaH, scaling these programs remains challenging. Key obstacles include:

Change management: The HaH model is counterintuitive to decades of hospital-focused thinking, which emphasized centralization of care. Clinicians, nurses, and patients must overcome ingrained habits and skepticism.
Delivery optimization: Unlike linear supply chains in retail, healthcare delivery is nonlinear and unpredictable, requiring flexible protocols and rapid adaptation.
Workforce development: Training “virtualists” and multipurpose staff is essential.
Regulatory and payment models: State-by-state licensing, evolving CMS waivers, and payer negotiations complicate implementation. Sustainable payment models must reflect the true value of the care, not just cost savings.

The success of HaH programs depends on early education and buy-in from both patients and families. Conversations about HaH options should start in primary care, not during acute crises. Family members must be integrated into care plans without becoming de facto nurses, and safety and convenience must be prioritized to ensure positive experiences.

The Road Ahead

HaH programs have the potential to reduce costs, improve outcomes, and expand access, especially for Medicaid and low socioeconomic status patients. However, savings must be balanced with the cost of investments in technology, supply chains, and the workforce. Ideally, we would have payment parity for basic care, regardless of setting, to avoid incentives that favor hospital admissions over home care. The future of HaH lies in building decentralized ecosystems that support a range of services, from acute care to chemotherapy, urgent care, and palliative care. Regulatory reforms, technological advances, and cultural shifts will be necessary to realize its full potential. Ultimately, the goal is to make HaH not just acceptable, but preferable—a standard of care that patients and practitioners choose for its quality, convenience, and value.

Our thanks to Michael J. Maniaci, MD. Dr. Maniaci is the Enterprise Physician Lead for the Advanced Care at Home program, the Medical Director of Consumer Digital Product in the Center for Digital Health, and the current Medical Director of Mayo Clinic Hospital in Florida. Dr. Maniaci’s previous leadership positions include the Chair of the Division of Hospital Internal Medicine and the Associate Medical Director of the Mayo Clinic Multidisciplinary Simulation Center in Florida. He received his doctor of medicine (MD) degree from Saint Louis University Medical School in 2003. Dr. Maniaci completed his residency training at the Mayo Graduate School of Medicine in 2006 and then completed a one-year chief residency program at the Mayo Graduate School of Medicine in 2007. He currently holds the academic rank of Professor of Medicine in Mayo Clinic College of Medicine and Science. Dr. Maniaci leads Mayo Clinic’s efforts in hospital-at-home care, known as advanced care at home, and is seen as an expert on high-acuity virtual care delivery throughout the United States and Europe. He has helped lead hospital-at-home advocacy efforts on a national scale, speaking to multiple congressional senators and representatives in Washington, D.C., on the subject. His advocacy and educational efforts have been displayed on multiple media platforms, including Becker’s Healthcare, CNN, NPR, and The Today Show.

The opinions expressed here do not necessarily reflect the views of The Doctors Company. We provide a platform for diverse perspectives and healthcare information, and the opinions expressed are solely those of the author.

The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.

The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.

The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

The Doctor’s Advocate is published quarterly by Corporate Communications, The Doctors Company. Letters and articles, to be edited and published at the editor’s discretion, are welcome. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of The Doctors Company. Please sign your letters, and address them to the editor.