Bridging Boundaries: A Research Consortium to Advance Hospital-at-Home Care Delivery

ABSTRACT

The COVID-19 pandemic accelerated the adoption of the hospital at home (HAH) model, driven by the 2020 CMS Acute Hospital Care at Home waiver that removed financial barriers to reimbursement. With more than 330 hospitals across 130 health systems implementing HAH, this care model offers promising outcomes and experiences while addressing rising health care costs and an aging population. However, further research is needed to define its scalability, appropriate patient populations, and long-term viability. To address these gaps, Cleveland Clinic and Mayo Clinic established the Cleveland Clinic–Mayo Clinic (CCMC) Home-Based Care Research Consortium. The consortium focuses on creating a national registry, standardizing data, and developing evidence-based care pathways to evaluate the impact of HAH on patient safety, outcomes, and costs. Additionally, it aims to identify which populations and conditions can benefit most, ensuring equitable and high-quality care delivery. The consortium also prioritizes caregiver well-being, exploring virtual and hybrid models to address workforce challenges and enhance provider satisfaction. Recognizing health equity as essential, it emphasizes enrolling diverse populations and collaborating with community organizations to address social determinants of health. The consortium will also focus on true cost savings, workforce efficiency, and integration with home-based care programs, taking into account recent advances in technology and artificial intelligence. By fostering collaboration and rigorous research, the CCMC Consortium seeks to refine HAH into a scalable, sustainable, and equitable care model that meets the evolving demands of modern health care.

Am J Manag Care. 2025;31(10):In Press

Takeaway Points

The hospital-at-home (HAH) model provides cost-effective, high-quality care while addressing workforce challenges, equity, and health care system demands. The Cleveland Clinic–Mayo Clinic Home-Based Care Research Consortium aims to refine and scale this model by focusing on the following:

• Cost-efficiency: HAH reduces the need for physical hospital infrastructure, supports value-based care, and can improve operational efficiency for health care systems.
• Improved care outcomes: Evidence-based pathways ensure safety, positive patient experiences, and better health outcomes for appropriate populations.
• Workforce retention: Virtual and hybrid models promote caregiver satisfaction and address staffing shortages.
• Health equity: HAH focuses on diverse patient enrollment and addressing social determinants of health through community partnerships.

The COVID-19 pandemic accelerated the growth of home-based care, driven by pressure to free up hospital capacity and growing patient preferences to avoid institutional care settings when alternatives are available.¹ With the 2020 CMS Acute Hospital Care at Home (AHCAH) waiver removing financial barriers to reimbursement for hospital at home (HAH), more than 330 hospitals across 130 health systems have subsequently embraced this novel care model.² The rise of HAH is set against a backdrop of increasing health care costs, an aging population, and a shift across the care continuum toward provision of more home-based care.^3,4 Preliminary evidence shows that HAH can deliver improved outcomes and patient experiences relative to traditional brick-and-mortar settings.^1,5,6 However, further research is needed to determine the illness spectrum that can be managed safely at home and to identify patient populations that will benefit most.

With legislation pending to extend the AHCAH waiver and commercial payers evaluating reimbursement policies, there is growing urgency for domestic research across diverse settings to define HAH’s role in health care. In response, Cleveland Clinic and Mayo Clinic have partnered to form the Cleveland Clinic–Mayo Clinic (CCMC) Home-Based Care Research Consortium. The consortium aims to support research that ensures scalability, sustainability, and innovation in high-acuity home-based care delivery (Figure 1). As learning health systems,⁷ Cleveland Clinic and Mayo Clinic are committed to this initiative, recognizing that HAH and the home-care continuum will play crucial roles in the future of health care (Figure 2).

The consortium is motivated to continuously improve care for patients, caregivers, communities, and the health care system. Its goal is to personalize care for patients, support caregivers, foster healthier communities, and reinforce the broader health care infrastructure. By creating a strong research foundation, the consortium seeks to maximize the potential of high-acuity home-based care and ensure it meets modern health care demands.

The Power of Collaboration and Data Sharing

HAH programs vary significantly in structure, making it difficult to evaluate their impact across different settings and populations. Some HAH programs focus on full acute care substitution, whereas others aim to reduce inpatient stays or facilitate early discharge through postacute care.^8,9 This variation leads to fragmented and unstandardized data on operational, clinical, and quality measures, limiting external validity. Moreover, the lack of transparency around workforce composition and program design complicates comparisons between programs with little in common.

The consortium was formed to address these challenges by developing common terminology and data standards to enable meaningful comparisons and research. Through standardized definitions, patient-centered metrics, and data sharing via a national registry, the consortium aims to improve the reliability and comparability of HAH research and operations. The large patient registry will help answer critical questions about best practices, patient outcomes, and the role of sociodemographic factors in care delivery, as well as inform policy and reimbursement decisions.

Framework for Study Prioritization and Investment

The consortium has identified key research priorities for the next 5 years, focusing on improving care for patients, caregivers, communities, and health care systems.

Care for our patients. The primary goal of the consortium is to understand the impact of the HAH model on patient outcomes, safety, and experience. By creating a large multisite registry, the consortium aims to better characterize the adoption of different HAH models and assess whether HAH can deliver outcomes comparable to, or better than, brick-and-mortar care at lower costs. This research will also help identify appropriate patient populations for HAH programs across the continuum of care. Engaging with patients and their families will be critical to defining meaningful patient-centered outcomes and understanding caregiver burden. Moreover, analyzing aggregate and disease-specific outcomes will facilitate the development of evidence-based care pathways, enhancing clinician confidence in HAH’s safety and quality for increasingly complex patient populations.

Care for our caregivers. As hospital admissions rise amid staffing shortages, workforce departures, and facility closures, reimagining the care environment and reengaging the workforce are critical. The consortium prioritizes defining, measuring, and improving caregiver outcomes in more flexible work environments. Virtual and hybrid HAH models offer an opportunity for workforce development and retention. The consortium has observed high demand for these positions, with improved retention rates compared with brick-and-mortar settings. This has been accompanied by increases in staff satisfaction, particularly among providers working in virtual command centers focused on communication with patients and families.

Although the HAH care environment has the potential to enhance provider satisfaction and retention, further research is needed to understand the impact of staffing models and safety. Supporting research in this domain will help identify caregiver needs and guide investments in training and resources that reimagine and support the acute care workforce.

Care for our communities. HAH is deeply rooted in communities, but the home-based continuum has been criticized for potentially exacerbating disparities among vulnerable populations.^10-12 Promoting health equity through diverse patient enrollment, data pooling, and community-based research is a key priority for the consortium.

The ecosystem of care delivery outside the brick-and-mortar setting relies heavily on partnerships with community-based organizations and informal caregivers. These collaborations enhance care delivery by upskilling community health care workers, promoting consistency and standardization, facilitating data exchange, and improving patient outcomes.

Moreover, the intimacy of home-based care brings social needs such as food insecurity, substance use, and family dynamics to the forefront. Addressing these needs will be essential to ensuring equitable access to home-based acute care.

Care for health systems and health care infrastructure. As health systems face tightening budgets, many questions remain about the investment in home-based acute care programs. HAH has the potential to meet the increasing demand for acute care without requiring acquisition of additional physical facilities, improve nursing efficiency, and transition targeted medical admissions to less expensive settings. However, understanding unanticipated implications of changing provider models and care settings is crucial for HAH’s long-term viability.¹

Population-level research is needed to demonstrate the financial sustainability of HAH, especially as payment models shift from fee-for-service to value-based arrangements. Commercial payers have been reluctant to reimburse HAH at parity with brick-and-mortar admissions, making rigorous analysis necessary to convince them that HAH admits patients with comparable complexity
and acuity.

The consortium also seeks to integrate HAH with other home-based programs, such as postacute care and emergency medicine, while fostering innovation through remote patient monitoring and artificial intelligence. These technologies can support patient-centered care and drive future advancements in the home-based continuum, where fragmentation has been a too-common reality.

Conclusions

Amid rising health care costs and provider shortages, finding sustainable, high-value care models is essential. The shift toward home-based care and workforce preferences for hybrid environments position HAH as a potential new standard of care. The CCMC Hospital Care at Home Research Consortium represents a significant step in improving the quality and safety of HAH programs. By fostering collaboration, standardizing data, and focusing on key research areas, the consortium will help build a research ecosystem that supports the scalability of home-based care. Through comprehensive research and investment, the consortium aims to answer critical questions about HAH’s effectiveness, cost, and role in health care, ultimately benefiting patients, caregivers, communities, and health systems alike.

Author Affiliations: The Cleveland Clinic–Mayo Clinic (CCMC) Home-Based Care Research Consortium (JAH, RDR, MJM); Primary Care Institute and the Cleveland Clinic Center for Value-Based Care Research, Cleveland Clinic Foundation (JAH), Cleveland, OH; Integrated Hospital Care Institute, Cleveland Clinic Foundation (RDR), Weston, FL; Division of Hospital Internal Medicine, Mayo Clinic (MJM), Jacksonville, FL.

Source of Funding: Clinical research for Cleveland Clinic Hospital Care at Home is made possible by a philanthropic gift from Karen Richardson and Jon Rubinstein.

Author Disclosures: Dr Rothman serves as a paid physician adviser to Medically Home. Dr Maniaci serves as an unpaid board observer for Medically Home, and his employer, Mayo Clinic, has an investment in Medically Home. Dr Hohman reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JAH, RDR, MJM); acquisition of data (JAH, RDR, MJM); analysis and interpretation of data (JAH, RDR, MJM); drafting of the manuscript (JAH, RDR, MJM); critical revision of the manuscript for important intellectual content (JAH, RDR, MJM); statistical analysis (JAH); provision of patients or study materials (JAH); obtaining funding (JAH); administrative, technical, or logistic support (JAH); and supervision (JAH, MJM).

Address Correspondence to: Michael J. Maniaci, MD, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224. Email: maniaci.michael@mayo.edu.

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