Breaking from Tradition: Q&A with Heather O’Sullivan, President, Healthcare at Home, Mass General Brigham

The current healthcare system is fraught with challenges. Between workforce shortages, regulatory changes, and evolving consumer needs, the ecosystem is “just not sustainable the way it is today,” said Heather O’Sullivan.

The answer, she believes, is close to home. At least, that’s the case for Mass General Brigham, which developed a Healthcare at Home Division in 2022 to offer “a hybrid alternative to traditional care settings.” One of its four verticals, the Home Hospital, has made quite an impact, having served more than 3,500 episodes of care, which equates to some 19,000 bed days saved.

The ability to provide care in the patient home has resulted in “significant cost savings, reduced utilization, and improved patient experiences compared to traditional hospital settings,” said O’Sullivan during a recent interview with Kate Gamble, Managing Editor at healthsystemCIO. It has also meant fewer lab orders and imaging studies, along with lower readmission rates. The movement has been “resoundingly favorable,” both among patients and families and staff, she noted.

And there are no plans to stop. In fact, Mass General Brigham is looking to increase the eligible patient pool to 10 percent of all current inpatient medical volume. Not an easy feat, but the organization is committed to changing the landscape, according to O’Sullivan. During the interview, she talked about the success her team has achieved, as well as the hurdles they’ve overcome, and what it takes to build and sustain this type of model – from executive buy-in to vendor partnerships to the infrastructure piece.

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Q&A with Heather O’Sullivan, President, Healthcare at Home, Mass General Brigham

Gamble:  Hi Heather, thank you so much for taking the time to speak with us. We look forward to hearing about what your team is doing. Can you start by giving an overview of the organization?

O’Sullivan:  Sure. Mass General Brigham overall is a $18 billion non-profit academic medical center comprising three specialty hospitals, seven community hospitals, and two founding academic medical centers: Mass General Hospital and the Brigham and Women’s Hospital. And the system prioritizes patient-centered care; we’re actually the largest NIH recipient in the country for research. We employ over 80,000 colleagues.

The Healthcare at Home Division was established in 2022 to offer a hybrid alternative to traditional care settings. The Healthcare at Home Division has four service verticals. The first is our largest full acute episode home hospital in the country. We have five distinct CMS licenses for acute level care. The second vertical, which is also the chassis for all of Healthcare at Home, is our Legacy Home Care business. It was established in 2007 and is actually the largest home health entity in Massachusetts.

From a technology perspective, we offer personal emergency response systems [for] infusion care, phlebotomy, in addition to the traditional skilled nursing and therapy and home health aide support. And there are two more emerging verticals in the healthcare home portfolio that are interesting. One is the emergency care for urgent patient needs in the home setting, and the other is home-based palliative care.

And so, collectively, the array of home-based offerings really addresses our system’s key challenges around capacity constraints while emphasizing patient comfort and privacy.

Gamble:  So, the HAH Division was established in 2022, but obviously, the groundwork had been in place for quite a bit before then.

O’Sullivan:  Yes. Mass General Brigham Home Hospital has actually been a trailblazer since 2016 which predates the CMS acute care hospital at home waiver. We currently operate one of the largest full episode acute home hospital operations in the nation. We’ve served over 3,400 full episodes of acute care at home since November 2022. That actually equates to more than 19,000 bed days saved, which really showcases the effectiveness of our clinical model design.

 

Gamble:  Can you talk about some of benefits you’ve seen so far?

O’Sullivan:  Home-based services overall, which is a broad umbrella of healthcare at home and notably our novel home hospital service at Mass General Brigham, have demonstrated significant cost savings, reduced utilization, and improved patient experiences compared to traditional hospital settings. And studies have shown lower costs, fewer lab orders, imaging studies, and consultations, and lower readmissions rates for patients treated at home. We have emerging market analysis that’s so exciting for this growing movement of home-based clinical services. It’s resoundingly favorable; it has shown the desire for consumer choice in selecting how and where they seek their health care interventions.

Patients “overwhelmingly positive” about home hospital

A recent MGB qualitative research found that patients were overwhelmingly positive about home hospital. It actually felt that it was preferable to a traditional hospital stay.

And some of the reasons they applauded home hospital was that communication was clear, helpful, predictable, and assuring. Patients felt they received more personalized and immediate care, and the staff provided comfort. It warms my heart.

Safety is also a factor. Unlike traditional hospitals, with home hospital – and again, this is qualitative – patients said they felt cleaner, more secure, and efficient. This really is a quadruple win all the way around.

Also, patients reported that their trust in home hospital was due to being more relaxed knowing they can access their own bathroom and bed, and that they can return to the emergency department if needed. It speaks to Mass General Brigham’s world class reputation as well.

 

Gamble:  Really interesting about patient trust. How were you able to learn that?

O’Sullivan:  It’s very easy to see the financial opportunities and clinical outcome opportunities; those are traditional metrics that we were comfortable measuring. The qualitative feedback that’s emerging is so interesting and important to capture. As the entire healthcare ecosystem is changing – and with it, what we want for ourselves and our loved ones – we want to make sure we can measure these high-value items.

Recent research has actually shown that home hospital does not result in an increased caregiver burden; rather, the study that we completed emphasized that caregiver burden overall is an ever-growing issue in our country today regardless of setting.

Again, it’s important to understand the narrative that’s being built up and balancing that with what the facts really are.

 

Technical specs

Gamble:  Let’s talk a little bit about what is required from a technical perspective because obviously that’s a big part of it.

O’Sullivan:  Yes, it is. So, technical innovation is really crucial for delivering quality hybrid care models within highly variable settings. You’re over the threshold. You’re in individuals’ homes. And around that, to have an effective operating model, you need patient risk stratification. You need identification algorithms, telehealth services, integrated mobile records, patient monitoring, a fleet of digitally connected specialized vehicles, and broad logistics orchestration. It really requires a sophisticated digital enablement.

And then scaling home hospital services demands strategic planning, inter-professional collaboration, operational rigor, long-term investments in digital technology, and the ability to overcome core challenges such as distributed care, engagement strategies, and economic models. Technical integration is absolutely vital for program viability and sustainability.

 

Gamble:  A lot there, but one of the things you touched on was variability. It seems like that could be really challenging. What has been the key for your team in reaching these technical goals?

O’Sullivan:  Navigating the complexities of this novel approach to healthcare delivery within a large academic medical system has empowered us to drive innovation very rapidly in a highly variable environment. The unwavering strategic commitment from our executive team really enabled us to be positioned as a leader in defining the future of care at home.

Our system may be different from others with considerations like health plan intricacies, capacity challenges, and strong focus on research and innovation, but these factors really have uniquely positioned us to pioneer a playbook for future care models. In terms of workforce challenges, this novel home hospital model has actually helped attract and retain our clinical workforce by offering them the flexibility to engage in care for patients in their homes. This approach, coupled with remote clinical options, really contributes to workforce satisfaction and adaptability.

 

Gamble:  What are some of the challenges you’ve had to work through in terms of providing care in a non-traditional setting?

O’Sullivan:  Implementing and sustaining a home hospital program presents several challenges. They’re surmountable with the right strategic planning and investment. One primary challenge I would say revolves around the need for operational transformation. The home hospital model represents a significant departure from that traditional care delivery model. And what that means is that providers and staff have to adapt to new workflows and protocols to succeed at scale. To do that, it’s essential that this novel service line is understood as a credible extension of traditional inpatient services. It really requires flexibility in care planning and broad adoption among healthcare professionals.

 

Stepwise approach

Gamble:  You mentioned operational transformation, which so important. Can you talk about what’s required to make that happen?

O’Sullivan:  From a technology standpoint, there’s a substantial investment required. So, the health system needs to allocate resources toward infrastructure technology and staff training to really appreciate the full potential of home hospital services. Without adequate investment, sustainability and effectiveness may be compromised.

Where we’ve been successful in addressing these challenges is implementing a stepwise approach. Initially, we launched an MVP by leveraging existing IT platforms and technology that meet basic operational requirements and are common to our users.

But as we progress on this ambitious scale, we’re moving toward a more advanced version of these offerings. We’re strategically partnering with vendors to support our technological and operational needs. That includes optimizing our current tech platform by enhancing the EHR and then integrating with third-party vendors for additional functionality; improving communication channels between patient and clinicians; and implementing logistical enhancements to streamline service line operations. By taking this systematic approach and investing in the right resources, we’ve been able to overcome challenges associated with implementing and sustaining home hospital capabilities and ultimately improve patient outcomes and healthcare delivery efficiency.

 

Gamble:  One of those partnerships, of course, is with Best Buy. Can you talk about that arrangement, and how it can help meet some of those strategic goals?

O’Sullivan:  I’m going to frame that by sharing with you our plans for growth and expansion. So, Mass General Brigham is very ambitious and dedicated to expanding the healthcare home division overall to serve our patients and communities. Our strategic focus involves increasing the eligible patient pool to 10 percent of all current inpatient medical volume – that’s a lot. Research says you can go as high as 30, 40, 50 percent. We’re going for 10 percent. That’s just medical. In addition to medical, which would be like COPD, CHF, sepsis, pneumonia, etc., we are poised to expand surgical pathways. We’re designing controlled substance delivery procedures. We’re launching unique oncologic offerings. And so, this roadmap to growth must include building a sophisticated technology informed logistics solution, remote command center, advocacy for extension of permanence of the CMS waiver to solidify ongoing payment mechanisms to the provision of acute care and home settings.

And then across all stakeholder groups, including patient families, clinicians, and legislators, our goal at MGB is to raise awareness about the capabilities of home hospital, encourage adoption before the need arises, and then through technological advancements, strategic partnerships, and a commitment to innovation, we’re poised to drive growth and improve patient outcomes and shape the future of care delivery of care home. To do that, those build by partner, co-development decisions need to be made along the way.

We talked about a stepwise journey. At MGB, we made the decision to have a partnership with Best Buy around logistics sophistication. We appreciate their over-the-threshold expertise with the geek squad. We understand again that highly variable environment and the need to keep the clinicians focused on delivering that world-class care to be efficient and effective. Our Best Buy partnership enables the sophisticated logistics solution that we need to scale to those quantities, and brings us the savvy of in-home engagement for our clinical delivery model.

 

Gamble:  Where do you hope to see the program grow and expand?

O’Sullivan:  From an economic perspective, we know that the home hospital care model demonstrates improved outcomes at lower cost; therefore, payers have been receptive. Medicare reimbursement has been in effect since November of 2020. We also have support from State Medicaid, specifically in Massachusetts. There’s some interesting New Jersey legislation that was passed involving major commercial payers. That movement really underscores the recognition of the clinical and fiscal benefits of our services.

The regulatory involvement is still evolving, and our proactive approach ensures that we’re well prepared for future landscapes at the federal state and local levels. We need to continually refine what we call those foundational at-home capabilities. And so, regardless of the federal reimbursement or regulatory wins, we have established what foundational at home capabilities for excellence and care looks like and we can modulate as need be, because we’re incredibly committed to the evolving needs of consumers in the ecosystem. It’s just not sustainable way it is today.

 

Gamble:  No, it’s not. The regulation environment alone – it’s a lot to track all of that. And everything that we’re seeing with the reimbursement, where does that fall, do you know?

O’Sullivan:  We have a steadfast commitment. So, at Mass General Brigham, one of our system’s most strategic priorities is healthcare at home and specifically home hospital. So, again, we understand that it is the future of care. I actually believe it will likely be the default setting of care for many acute level episodes that are treated in a traditional brick and mortar today. That being said, we also recognize at Mass General Brigham that not all systems or integrated delivery networks have the ability to define this really ambitious offering as one of the top strategic priorities and make the investments that we have. And so, defining the playbook, being transparent with our metrics and our outcomes is incredibly important to share our learnings and our playbook, not only with CMS, but also to anyone else that understands the opportunity that is before all of us to provide care differently because of the tech enablement and maturity that exists.

 

Gamble:  There is still some hesitancy – does some of that stem from the fact that this is a break from tradition?

O’Sullivan:  There are also risks involved. But again, it’s the narrative that matters. What do consumers want? What technology is available to us and how can we make healthcare more affordable and closer to home for all?

We were one of the early pioneers of home health in 2016. So before federal reimbursement and any regulation, Mass General Brigham was building the foundation for what this model of care could look like. With the pandemic and the public health emergency, it enabled funding. We have full parity today for diagnostic-related groupings and full payment from CMS for treating patients in the home with those acute clinical needs. We were very fortunate that CMS decided to extend the public health emergency waiver. It has been extended because there is an understanding that there is quite a bit of value to unlock. And again, we believe our results and metrics will be able to justify how and why we should do different things differently for our care in the future.

 

Gamble:  So, for organizations that aren’t part of a larger health system, are there partnerships they can take advantage of?

O’Sullivan:  I’m so glad you brought that up. It’s important to point out that the Mass General Brigham model today is the Mass General Brigham model; it’s us defining what we think the foundational capabilities are in this favorable regulatory reimbursement environment. The ‘why’ is different for different systems, the build by partnership co-development co-design is not only for enabling the text services, but all the clinical services. And so, there are some excellent entities that exist today that have taken pieces and parts of what executing home hospital could look like in partnering with delivery systems.

What’s important to note is that today, CMS will grant a license only to a brick-and-mortar facility. And there’s not much beyond that. And so, how that brick-and-mortar facility decides to build out their model – with which partnerships and which clinical services is what’s really exciting and innovating. Look at Medically Home and Contessa. There are some really successful approaches out there. And I really believe we’ll get there better and faster together. It’s not about competition whatsoever. The more that we can share, the better we are throughout this exciting period.

 

Gamble:  I like how you touched on workforce satisfaction – that’s a huge struggle right now, which I’m sure you know. Anything that can generate higher engagement is so important in an industry challenged with retaining people.

O’Sullivan:  Workforce is a big topic for me. And actually, a big part of our relationship with Best Buy is the commitment to building the future workforce of tomorrow – the clinical workforce at home that has the expertise and wants to be in a highly variable environment. It’s another part of why we chose Best Buy Health.

It’s a pretty fantastic opportunity that we’ve created. And in giving Best Buy the MGB brand of clinical excellence and everything that carries, we are also focusing on digital entrants to the healthcare space and how we identify and support that learning from a grant or scholarship perspective. Because an academic curriculum for digital doesn’t exist within healthcare, nursing, PT, OT, or speech. There’s no at-home curriculum that exists today.

 

Gamble:  That’s mind blowing. It reminds me of some of the conversations we had during Covid when it became clear that physicians needed guidance on doing telehealth appointments. So, before we have to wrap up, I want to talk a little bit about your background and how you became involved in this space.

O’Sullivan:  Currently, I am very fortunate to lead the inaugural division of Health Care at Home for Mass General Brigham. I am an adult and geriatric nurse practitioner. I’ve had extensive experience in the post-acute space the majority of my career, both within payer and provider organizations. And then before joining Mass General Brigham, I led clinical innovation for Kindred at Home, which was recently acquired by Humana. In my current role, I’ve had the privilege of spearheading the design and leadership of Mass General Brigham’s Healthcare at Home division and really emphasizing what we’ve talked about today: home-based services as the critical imperative across the care continuum and as well as a key strategic asset.

 

Gamble:  There’s so much opportunity in this space. I can understand why you want to be involved in it.

O’Sullivan:  Honestly, Kate, it’s been really fun. This is the most exciting position that I’ve ever had the good fortune of leading.