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Always-on Models of Health Care

The traditional model of health care, which puts hospitals front and center, is changing rapidly. Care delivery is moving toward the patient, literally and figuratively.

Hospitals will still play a role in the continuum of patient care ― namely in critical and complex care ― but they’ll no longer be the main point of care. Health systems now use analytics to decide which setting will be the safest and the most effective ― and in many cases, it will be outside hospitals.

Our reliance on hospital care is declining because we’ve been able to move many medical procedures to outpatient settings: Urgent care clinics and expanded services at pharmacies are changing how we deliver health care. This trend has gained traction, thanks to advances in minimally invasive procedures, better supportive management and a shift toward value-based care, where payments are linked to good outcomes. It’s a win-win for making care more convenient for patients and family members, while also helping hospitals’ bottom line.

There’s also a move to create “health hubs” where patients can receive an array of services, including ambulatory procedures and diagnostics, services for social determinants of health such as food security and employment issues, and other holistic services such mental health, social emotional and areas for spiritual health, yoga etc.

Patients’ homes will also become hubs of care, a concept we call Hospital at Home (HaH). Researchers at the Johns Hopkins University schools of Medicine and Public Health created this model as an innovative way for health systems to treat acutely ill patients in the comfort of their own home rather than admitting them to the hospital.

HaH physicians evaluate patients during daily home visits and are available 24/7 for any urgent or emergent situation. Patients can receive diagnostic studies such as electrocardiograms, echocardiograms and X-rays at home, as well as treatments, including oxygen therapy, intravenous fluids and antibiotics, and skilled nursing services.

We have been using this approach to manage many chronic conditions such as congestive heart failure and chronic obstructive pulmonary disease. Not only do patients have better health outcomes, the cost of delivering these services is as much as 30% less expensive. This approach also reduces the pressure on the health care workforce because we can train family members to monitor and provide basic functions of patient care.

Homes are also an optimal care setting for patients with less complex health needs. Next time we’ll discuss telehealth and how a major part of care is going virtual.


Mohan Chellappa

Executive Vice President | President, Global Ventures Dr. Mohan Chellappa leads international clinical consultancy activities at Johns Hopkins Medicine International (JHI), especially in the areas of developing clinical care programs, implementing quality systems and using information technology in health care. As one of JHI’s founders, he has been instrumental in securing and establishing various Johns Hopkins Medicine clinical, management and enterprise developmental initiatives around the world. Click here to learn more about Mohan.

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