Hospital-at-Home Model Yields Lower Costs, Fewer Hospitalizations for Cancer Patients

Cancer patients who receive hospital-at-home care are less likely to experience unplanned hospitalizations, new research suggests. Those individuals likewise account for lower health care costs.

The new findings — focused on Huntsman at Home, a cancer hospital-at-home model operated by the Huntsman Cancer Institute at the University of Utah — were published online May 17, 2021, in the Journal of Clinical Oncology.

Specifically, researchers examined Huntsman at Home’s rate of unplanned hospitalizations, health care costs, emergency department utilization and hospital length of stays. The prospective, nonrandomized study compared 169 patients who received Huntsman at Home care after hospital discharge with 198 patients receiving usual care. All 367 met the program’s clinical criteria; patients in the usual-care group lived outside its service area.

Overall, the study found 55% lower adjusted odds of unplanned hospitalization and 45% lower adjusted odds of an emergency department visit in the Huntsman at Home group during the following 30 days. Hospital stays were shorter by an average of 1.1 days. Because the study was nonrandomized, these findings do not establish cause and effect.

Additionally, researchers found that health care costs were 47% lower for Huntsman at Home patients.

“Although cancer treatment is largely provided in the ambulatory setting, unplanned hospitalizations and emergency department visits are common, particularly for symptoms and toxicities such as pain, dehydration, and neutropenic fever, and contribute to substantial costs,” researchers wrote in the Journal of Clinical Oncology.

These findings are significant because there are few models that address the home-based care needs of cancer patients, or provide an alternative to traditional brick-and-mortar settings.

In that sense, the Huntsman at Home program — which originally launched in 2018 — is an anomaly. The program was one of the first in the U.S. to deliver acute level cancer care in the home setting.

To pull this off, Huntsman at Home combines in-person care, caregiver support, remote patient monitoring and clinical care provided by nurse practitioners. The program also offers symptom management, post-surgical care, palliative care and end-of-life care.

The care team includes nurse practitioners and oncologists. The team also includes registered nurses, social workers and physical therapists, through a partnership with home health and hospice provider Community Nursing Services.

The results suggest that this particular oncology hospital-at-home program may reduce unplanned care and costs for appropriately selected patients. A nonrandomized comparison does not establish that all hospital-at-home programs are equally effective or safe for every patient.

“Such programs could keep patients at home, provide services that would otherwise require hospitalization, and better control symptom fluctuations while protecting immunosuppressed and frail patients with cancer from exposure to hospital-acquired bacterial and viral infections,” researchers wrote. “Such programs also have the potential to reduce costs.”

In general, the findings fall in line with past studies that have highlighted the benefits of the hospital-at-home model.

In light of the COVID-19 emergency, health systems and hospitals have more readily embraced the hospital-at-home model. This is, partly, the result of the U.S. Centers for Medicare & Medicaid Services (CMS)’s “Acute Hospital Care At Home” waiver program, which was first introduced in November.

The waiver program, a CMS COVID-19 relief measure, has created room for providers to receive compensation for delivering acute care in the home. Historically, reimbursement has been a major roadblock for providers.

As more health systems and hospitals apply for CMS’s waiver, it’s likely more programs similar to Huntsman at Home will spring up.

As of mid-May 2021, 56 health systems and 129 hospitals were reported as participating in CMS’s Acute Hospital Care at Home initiative. Policy update (November 2026): Congress subsequently extended this initiative through September 30, 2030. Participation requires a hospital-specific CMS waiver and compliance with applicable program requirements. See current CMS guidance.