Out of residency, Ramin was employed by a company called VisitingPhysiciansAssociation (VPA). It grew to be the nation’s largest ACO (Accountable Care Organization), and out of 504 ACOs nationally, it was ranked #4, being in the top 1%. As Medicare was researching new payment models and sponsored the Independence at Home Study (https://innovation.cms.gov/innovation-models/independence-at-home)- VPA had a significant role to play in that study. It proved that it was more cost effective to provide care in the home, and keeping ‘high utilizers’ out of the hospital/emergency rooms. It was keeping the 8% of Medicare’s population that cost it 80% of their budget, healthy at home. This was clearly demonstrated in a case study documented by Duke University:
It was in part due to these efforts and evidence that in 2019, Medicare passed a law, allowing all Medicare recipients to get a visiting physician, no longer limited to the homebound population. The Hospital @ Home (H@H) model of care was officially underway & evidence backed its legitimacy & financial viability. In 2020, when the Covid-19 pandemic started, it helped catalyze the H@H movement as it made more sense to keep hospitals for the more acutely ill patients and providing primary care in the home in the community was a better use of limited resources and precious healthcare dollars. Since then, many major academic medical centers and community hospitals have started their own H@H departments as Medicare now recognizes as care in the home as a viable place for healthcare.
As technology continues to improve, there is more opportunity for the H@H to advance. Today, there are portable digital X-rays available in the home, mobile U/S available done in the home and basic phlebotomy & EKGs can routinely be offered in the home. As RPM (Remote Patient Monitoring) gains tractions as well, it will further help catapult the H@H movement. Medicare started reimbursing for RPM in December 2021, (in the midst of the Covid 19 Pandemic). This also affords an area where AI/ML can help advance RPM as it can provide the engine to sift through all the data that RPM provides, highlighting the areas of concern to the clinician.
https://www.the-yuan.com/320/AI-is-set-to-revolutionize-the-concept-of-the-hospital-at-home.html