What Best Buy, Inbound Health Moves in Hospital-at-Home Mean for Senior Living 

The rise of hospital-at-home and SNF-at-home models has been making headlines for the last month, with related opportunities and complications for senior living becoming clearer.

Best Buy (NYSE: BBY) generated some of these headlines by announcing a partnership with Advocate Health. The partnership aims to expand Advocate’s hospital-at-home offering, which the Charlotte, North Carolina-based health system describes as the nation’s largest.

The hospital-at-home play fits within Best Buy’s ambitious health strategy, which is focused on enabling at-home care and includes an “active aging” business.

“The role of technology within health care is becoming more important than ever, and our strategy is to enable care at home for everyone,” Best Buy CEO Corie Barry said during the company’s earnings call in early March.

Also in early March, hospital-at-home pioneer Dr. Bruce Leff spoke at the NIC conference in San Diego. He described how assisted living is “really well positioned” to seize opportunities as hospital and skilled nursing care increasingly are delivered in people’s homes.

And just this week, Inbound Health announced that it has exceeded 5,000 acute care-at-home episodes in partnership with Allina Health. Independent living “works out really well” as a setting for this type of care, Inbound Health Founding COO Julia Crist told me.

In this week’s exclusive, members-only SHN+ Update, I analyze this recent news and offer key takeaways, including:

• Independent living providers have opportunities to offer more hospital- and SNF-at-home
• The promise and impediments to growing hospital- and SNF-at-home in assisted living
• What investments from the likes of Best Buy signal about the pace of growth in this area of health care
• How hospital-at-home drives savings to the health care system, and the need for senior living providers to consider this as part of a value-based care strategy

Senior living opportunities, benefits

The growth of hospital-at-home and SNF-at-home is a legacy of Covid-19, as the Centers for Medicare & Medicaid Services (CMS) boosted these models by granting sweeping new flexibilities to help alleviate hospital capacity issues at the height of the pandemic.

It was against this backdrop that Crist and her colleagues launched a hospital-at-home program in May 2020, to help address the capacity crunch at Allina Health hospitals in the Twin Cities. That effort eventually became Inbound Health, which was incorporated in June 2022 and emerged from stealth mode the following November.

As Inbound has continued to expand, the organization’s alignment with senior living has become clear, particularly with regard to independent living communities, Crist told me.

“Our whole goal is to bring the patient home, and independent living is essentially an apartment, so that works out really well,” Crist said.

But she sees even greater promise with regard to assisted living, saying that it makes “a ton of sense” to bring hospital- and SNF-at-home services to this population. That’s because AL residents are particularly at risk of hospital-acquired infections, delirium and other negative outcomes associated with inpatient stays.

Furthermore, the ability to scale within assisted living is “really strong,” she believes, given that AL populations represent a large number of people living in close proximity who are likely to need hospital- or SNF-at-home services.

Inbound has cared for patients across 350 different disease states. And many of the conditions historically associated with hospital-at-home are common diagnoses within assisted living, including congestive heart failure and chronic obstructive pulmonary disease (COPD).

Leff — who is director of The Center for Transformative Geriatric Research and a professor of medicine at Johns Hopkins — also singled out assisted living in his comments at NIC.

“In the context of thinking about a skilled nursing facility model at home, I think AL is really well positioned for that, really well positioned,” he said.

SNF-at-home providers likely will be eager to partner with assisted living providers that can offer good physical environments for this type of care, he argued.

The benefits to senior living providers include increased length-of-stay, as residents do not have to leave the community for a hospital or SNF stay, Crist noted.

And the potential upside is even greater for senior living organizations that double as payers — for example, through ownership of a Medicare Advantage special needs plan. Providing hospital- or SNF-at-home services to beneficiaries can yield significant cost savings.

Consider that the Inbound Health program has lowered total cost-of-care by 30% to 40% on a risk-adjusted basis while achieving similar clinical outcomes as facility-based care, according to a company press release.

Crist also sees an opportunity to expand the addressable patient population of hospital-at-home by partnering more closely with assisted living providers.

“This model is capable of and best suited for very acute patients but with high enough functional scores to be safe in a home environment,” she said. “What’s exciting about the assisted living group is we could take patients with high severity of illness but lower functional status, as long as they’re receiving that functional status support from assisted living.”

Crist anticipates that Inbound will expand in the assisted living space within three to five years, but there are impediments to be addressed. The fact that there is care being delivered within assisted living — and that the staff at AL communities includes clinical positions such as registered nurses — creates some regulatory and reimbursement uncertainty with regard to hospital-at-home in these settings, she said.

Even beyond assisted living-specific issues, she also notes that a more standardized reimbursement model and clearer regulations are needed for hospital-at-home to achieve its full potential. While hospital- and SNF-at-home are relatively easy to implement in managed care frameworks, the fee-for-service reimbursement element is more up in the air, particularly given the temporary nature of the current CMS waivers.

“I don’t know where CMS is going to land on this,” Crist said. “What I would be looking for is a reimbursement model that is sustainable, allows providers to do well, and takes cost out of the system.”

Growth trajectory for hospital- and SNF-at-home

Contessa Health is among the leading U.S. providers of hospital- and SNF-at-home services, having partnered with 11 health systems and 30 health plans as of Oct. 2022. Speaking last fall at the RETHINK event held by Skilled Nursing News, Contessa SVP of Growth and Development Drake Jarman emphasized that SNF-at-home is in its very earliest stages:

“This is very early days here. It’s a very small subset of the SNF patients, specifically … The adage has been it’s the first inning of the at-home movement. I would disagree with that. I don’t think we’ve even reported for spring training.”

This might be true, but major league organizations have lined up behind the at-home movement, backing it with big bucks that could supercharge growth. Contessa itself was acquired in 2021 by home health giant Amedisys (Nasdaq: AMED) for $250 million. And now Best Buy is in the game.

In Best Buy’s recent earnings call, CEO Barrie struck similar notes as Jarman, emphasizing that hospital-at-home is a “nascent, emerging part of the health care industry,” and that the revenue contribution to Best Buy will be small as the space matures in “the coming years.”

These caveats aside, the fact remains that Best Buy and Advocate Health are massive organizations with significant resources to accelerate the growth of hospital- and SNF-at-home. Best Buy is a Fortune 100 company with a $16 billion market cap. And Advocate Health — created through the 2022 combination of Advocate Aurora Health and Atrium Health — serves 5.5 million patients across 1,000 care sites and 67 hospitals, with revenue of more than $27 billion.

For their hospital-at-home effort, Advocate will leverage clinical capabilities including “social workers, paramedics, nurses and physicians,” per a blog post, while Best Buy will bring in technological infrastructure, including remote monitoring and telehealth capabilities that it acquired through its purchase of Current Health, as well as specialized Geek Squad technicians to set up patients with the necessary tech in their homes.

“We are essentially nurturing a start-up within a large-scale organization and leveraging Best Buy’s core assets, including the Geek Squad, to incubate a new business,” Corrie said on the earnings call, of the hospital-at-home effort.

It’s worth keeping in mind that Best Buy already has a foothold in the senior living space thanks to its $800 million acquisition of GreatCall. That business provides mobile devices designed for older adult users as well as personal emergency response services, and counted senior living providers among its enterprise clients. Best Buy’s focus on what it calls the “active aging” segment could set the company up to go after the active adult and independent living market, both for the consumer-oriented communications tech like GreatCall and to enable more hospital- and SNF-at-home services in this communities.

Inbound Health also is poised for growth, backed by a $20 million round led by Allina and Flare Capital Partners. The company has created a model to make it easy for health systems in various markets to contract with their major payers, and a flexible approach in terms of what resources a health system needs to dedicate to at-home care versus what Inbound will provide, Crist said.

All this is to say that senior living providers should anticipate accelerating growth of hospital- and SNF-at-home, particularly given the ongoing access issues that hospitals are facing with regard to post-acute beds. As the staffing crisis has hit nursing homes and home health agencies hard, finding alternative routes to discharging patients and freeing up hospital beds is becoming imperative.

Connecting with local health systems is step one in exploring potential opportunities, Leff said at NIC. I believe such discussions will reveal that there is room for creativity in how senior living providers can play a role in hospital- and SNF-at-home, including through potentially taking direct admits from the hospital who might otherwise go to a more costly post-acute facility.

But senior living providers should carefully consider the role they will play in driving the success of hospital- and SNF-at-home programs, and how these models of care get adapted for assisted living.

A senior living provider has clinical capabilities and advantages — including 24/7 eyes on a patient — that I believe could drive even better outcomes and lower costs than is typical for hospital-at-home. As with other aspects of value-based care, providers will need to be savvy to collect the relevant data to prove their contributions if they have any hope of gaining appropriate financial upside.

Ultimately, the growth of hospital- and SNF-at-home models might be one more argument in favor of senior living providers taking ownership of Medicare Advantage plans themselves, to most closely manage care for residents through the aging process and control the flow of associated dollars, rather than ceding control and losing upside to large payers and their mega-corporation partners.

Finally, senior living providers should consider hospital- and SNF-at-home as customer satisfaction drivers. Inbound’s program has generated an average net promoter score of 86, signaling just how highly patients have rated the experience.

Senior living providers that can facilitate this type of care for existing residents, or provide a high-quality experience for short-stay patients who otherwise would be in a more institutional SNF, stand to benefit from a customer perception standpoint by differentiating the product from nursing homes in a positive way.

“SNF-at-home is not a prevalent care model right now, but the uptake rate of that model among [eligible] patients, it’s like ninety to ninety-five percent,” Leff said at NIC. “No one really wants to go to a skilled nursing facility. I haven’t met anyone who really wants to do that.”