The market for Hospital-at-Home services was a hot topic in 2020 during the initial rollout of Medicare’s Acute Hospital Care at Home waiver program. However, health system interest has receded somewhat since then. The market has divided into haves and have-nots: while some health systems (like ProMedica and Adventist Health) have closed their programs because of meager uptake, a select few have reached mature scale.

For this week’s Key Market Dive, we spoke with program leaders from Mass General Brigham, Mayo Clinic, Advocate Health, and Mount Sinai Health System to understand the factors that have helped their programs endure and scale. Each of these systems have continued to grow their programs’ average daily census to sustainable levels, with a clear strategic vision for how advanced home care capabilities can meet clinical and financial needs. We’ll share snapshots of several of these models below.

In many ways, these systems are outliers: the vast majority of home hospital programs have not reached critical mass with average daily censuses of just 10-20 patients. While the experiences of the top programs are atypical, we think their success offers lessons for other programs that are still struggling to achieve scale.

But before we get into these lessons, let’s first address the elephant in the room: uncertainty about the long-term fate of the Medicare H@H waiver.