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Signify Premium Insight: Inbound Health Jumps into Hospital-at-Home Drive

This Insight is part of the Signify Premium Insights (SPI)-Digital Health service, which will launch on 9 January 2023. From that date, this and all SPI-Digital Health Insights will be available only by paid subscription.

Last month Allina Health, a US non-profit healthcare system, and Flare Capital Partners, a venture capitalist firm, announced the launch of a hospital-at-home-focused company. The $20M launch of Inbound Health comes as demand for hospital-level care in the home is rising steadily in the US. But what are the longer-term prospects for Inbound Health and other vendors in this crowded corner of remote care? 

The Signify View 

Inbound Health will provide at-home nursing care, plus virtual ‘visits’ and patient biometric monitoring. It will build on Allina’s Inbound Health-branded platform, which debuted in May 2022 and has since cared for more than 4,200 patients across 185 primary diagnoses in the state of Minnesota. Now, as a standalone commercial entity, Inbound Health will offer hospital-level acute and post-acute care at home on a nationwide basis. Tellingly, Allina says the service will lower the total cost of patient care, a core tenet of the US value-based care (VBC) model. 

Three Years in the Making 

Inbound Health’s launch coincides with growing demand for broader hospital-at-home care in the US. Historically, hospital-at-home has been provided on a small scale around chronic care. This then transitioned to acute care with the launch of the Acute Hospital Care at Home (AHCaH) initiative. The programme, which is still in place today, was launched in November as a response to the Covid pandemic. It enables Medicare-certified hospitals to treat patients with inpatient-level care at home. This represented the first example of payment for this level of care at home for beneficiaries with Medicare Fee-for-Service (FFS) and in certain states non–managed care Medicaid. While small-scale initiatives around hospital-at-home had been previously undertaken in the US, within the Medicare Advantage and managed care Medicaid markets, a lack of reimbursement prior to the pandemic had prevented any larger-scale uptake. 

The above developments have formed a cornerstone of the early, evolutionary phases of the US hospital-at-home market, and one which is an area of interest for many RPM vendors at present. 

As a result of the above, a large, yet fragmented and highly competitive ecosystem of vendors has emerged to serve the hospital-at-home market. 

Limited Lifespan 

One challenge facing these vendors is the fact that, at some point, the Public Health Emergency (PHE) legislation underpinning the (AHCaH) will end. The sword of Damocles hangs over those vendors whose business models and product strategies are built around this scheme. The PHE was recently extended until next March, but there is no guarantee it will be extended further. If and when the axe falls, some Hospital-at-Home companies will be hit hard, potentially fatally. 

A Different Tack 

The good news for Inbound Health is that it will be cushioned from any short-term shocks as and when the Department of Health and Human Services  wields the axe. We do know that Allina Health clearly has a vested interest in the Acute Hospital Care at Home Initiative being extended ad infinitum – their name appears, along with 20 or so other vendors, on lobbying letters to Congress on this matter.  

But Inbound Health will be looking at what lies beyond with justified confidence. Medicare Advantage/commercial VBC contracts are very much embracing broader hospital-at-home initiatives, and so there is strong medium- to long-term potential in this area. 

Strong Credentials  

Publicly, Inbound Health makes no reference to the Acute Hospital Care at Home waiver. Even if its product portfolio appears tailored to the program, it makes sense that the company does not publicly tie strategy, and product portfolio, to a scheme whose shelf life is coming to an end.  

Thus, although Inbound Health now enters a crowded, highly competitive acute care corner of RPM, we believe its future prospects are tied more closely to the ongoing VBC transition in the US.  

That Allina and Inbound Health are addressing demand not only for core RPM tools, but also a more future-focused VBC-type product functionality vital for hospital-level acute care at home – tools for risk stratification, care management workflows, enrolment support and clinical support – confirms a rounded RPM/PHM offering. These products will serve the companies well. 

Many RPM vendors are gearing up for this deeper move into hospital-at-home services, and in this respect Inbound Health has the ingredients to thrive: market-leading clinical, operational and technology assets developed alongside Allina Health; strong financial backing from Flare Capital Partners (whose impressive portfolio includes a host of VBC and PHM vendors) to advance its proprietary technology platform, including AI-powered analytic capabilities; and the fact it has powered one of the largest hospitals and skilled nurse facility (SNF)-at-home programmes in the US. In addition, the company has a CEO with a 20-year track record at the helm at Mount Sinai and Aetna. Inbound Health has a compelling back story, and is in good hands. 

Direction of Travel 

The overall direction of travel is towards acute hospital-at-home care, regardless of when the Acute Hospital Care at Home waiver is pulled. Uptake in that programme remains relatively limited to date. As of now, 114 health systems (including Allina) and 256 hospitals in the US are participating in the scheme, compared to 92 health systems and 203 hospitals in March 2021. Despite the risks that the programme might be shelved for good next year, participation is still growing, and large health systems such as Kaiser Permanente and Mayo Clinic have managed programmes with over 1,000 patients.  

In our 2022 RPM World Report, we noted that hospital-at-home models are likely to expand in the medium- to long-term. In June 2021 Amedisys, one of the largest home health and hospice care providers in the US, acquired Contessa Health, which provides risk-based hospital-at-home and in-home nursing services. In January 2022, Medically Home, another hospital-at-home company, announced a $110M funding round, led by Baxter, Global Medical Response and Cardinal Health. Mayo Clinic and Kaiser Permanente, who had led a previous funding round, also participated. The US Department of Veterans Affairs (VA), which runs the US’ largest integrated health system, is also a leading purchaser of RPM services in the country. Other RPM vendors leading the way in this market include Current Health, which is UK-based but heavily US-focused and who are owned by US retailer Best Buy, and Connect America, which established an RPM business in 2017 with a portfolio split quite evenly between managing chronic and acute conditions at home. 

Looking to the Future 

The prognosis for Inbound Health looks good in hospital-at-home. While a cloud clearly looms large over the Acute Hospital Care at Home scheme, the smart money is on what lies beyond that. With a future-focused VBC-type product functionality, and the backing of two healthcare heavyweights in Allina Health and Flare Capital, Inbound Health is well placed to blaze a trail in the evolving hospital-at-home market.