The hospital of the future won’t be what you expect

Close your eyes for a few seconds and imagine what a hospital will look like 10 years in the future. If medical robots, artificial intelligence, and other technologies come to mind, you are on the right track. But if you picture these innovations happening in a sprawling hospital campus, think again.

Radical changes afoot in health care philosophy, medical technology, and treatment capability will lead to hospital-quality care being administered outside of hospitals — in primary care and urgent care center and in people’s homes. These changes will create more comfortable conditions for patients, yield better outcomes, and be more affordable.

Hospitalization is expensive — and dangerous

American health care costs are astronomical: The average American spends about $12,000 on health care each year, and the average hospital stay runs $2,607 per day. There should be little wonder that 2 out of every 3 bankruptcies in the U.S. have health care costs at their root.

What’s more, the stress of hospitalization, the presence of antibiotic-resistant microbes, and other issues increase the risk of infection the longer someone is hospitalized. Unless hospitalization is absolutely imperative to receiving proper care, people are almost always better off avoiding a hospital stay.

Health care is shifting to a value-based model

Due to the health risks and economic burdens involved, doctors and insurance companies prefer to keep patients out of hospitals for conditions that are not life-threatening. Payers increasingly financially reward health care providers for delivering high-quality care that keeps their patients healthy at a reasonable cost and relying on inpatient treatment only when absolutely necessary.

But this so-called value-based care ethos has its own challenges. Failing to admit people to the hospital who do need inpatient care can have life-threatening consequences, as can discharging patients too soon. At least one in seven people are readmitted to the hospital within 30 days of being discharged. Clearly, health care providers need a way to deliver value-based care for acute and chronic conditions without compromising patient safety and breaking the bank.

What is the solution? Give patients hospital-quality care without the hospital.

Hospital care is going remote

Before Covid-19, telemedicine was seen by many as a niche service that would remain irrelevant to most patients and health care providers. The pandemic changed that entirely, driving 3,800% growth in telemedicine, now well on its way to $250 billion of market value, according to a report by McKinsey & Company. Video calls and asynchronous texts with health care providers have become commonplace health care modalities for everything from skin rashes to more serious conditions.

Diagnosing health conditions can also be done via devices that are portable, wearable, and affordable, such as the FDA-cleared Apple smartwatch and Owlstone Medical’s cancer-detecting breathalyzers, which are now being tested in clinical trials. As devices like these continue to evolve, early diagnosis and preventive care for conditions such as heart disease, diabetes, and even pancreatic cancer will be done in the home during daily activities instead of in hospitals only after patients experience symptoms. This will save countless lives.

Care after hospital discharge is also now increasingly handled through digital devices. Remote continuous monitoring technology is used to observe breathing and heart rates, blood sugar, and other indicators, identifying early warning signs of relapse for stroke, heart failure, and other serious conditions. Digital health care company KenSci, for example, conducts remote monitoring of chronic obstructive pulmonary disease in people who have been discharged from the hospital. The ability to prevent “bounce back” return hospital visits for conditions like this saves both lives and money, and will soon make post-acute care in clinical settings like long-term hospitals and inpatient nursing facilities the exception rather than the rule.

Hospital care is coming to the home

The most impressive element of the hospital of the future does not involve hospitals at all. Johns Hopkins, Mount Sinai, and other health care organizations will furnish an individual or family with the equipment needed to administer hospital-level care in the home. In this hospital-at-home model, doctors and nurses treat patients through a combination of telemedicine, digital diagnostics, and in-person visits by medics or registered nurses to administer medicine or draw blood, for example.

In addition to the added convenience and comfort, a review of nine hospital-at-home trials shows that people treated with this modality had a 26% lower risk of readmission, a lower need for long-term care, and lower rates of anxiety and depression, all at a cost of up to 38% less than conventional hospital inpatient care.

Obstacles to overcome

Most hospitals today are monolithic facilities made up of multiple buildings and floors where patients are admitted, treated, and monitored until they are well enough to go home. Going forward, nonemergency services will be pushed horizontally to outpatient clinics, patients’ homes, and remote devices. This is reminiscent of what happened to financial services, which migrated from bank tellers to drive-thru windows to far-flung ATMs and then to mobile apps on the smartphones so many people carry that now take care of almost any financial transaction.

Before that can happen to hospital care, however, several things need to change:

• Patient records must be migrated from siloed medical records systems and securely into the hands (and phones) of patients themselves.
• Payers must complete their shift to value-based care using the Goldilocks principle that incentivizes health care providers to administer just the right amount of care.
• Doctors must relearn which patients to admit to the hospital, which ones can receive acute care at home, which ones can be treated by telemedicine, and which ones to discharge.

Work has gone remote. So has banking, grocery shopping, notary services, and pretty much everything else. Hospitalization is next. It won’t be easy, but it will happen. Once health care providers, payers, and regulators catch up with the technology that already exists, the hospitals of tomorrow will expand to the home as they become smaller, more affordable, and better versions of what we have today.

Rob Rohatsch is an emergency medicine physician, chief medical officer of Solv Health, former CEO for the Banner Health System Urgent Care platform, and a faculty member at the Haslam School of Business at the University of Tennessee.