Introduction: A New Phase for Home-Based Care
Hospital-at-home programs are no longer experimental pilots. Across the United States, health systems are moving these initiatives from startup mode to full-scale strategic programs. By 2025, acute home-care models have become firmly embedded across dozens of organizations. Moreover, leaders across the industry agree: a second innovation wave is now underway.
At Philadelphia-based Penn Medicine, two initiatives are actively reshaping care delivery — hospital-at-home and ambient AI documentation. Together, they form the core of an enterprise-wide care transformation strategy. This dual focus reflects a broader national trend: health systems are not just expanding home care volumes, they are reinventing how care itself is organized and delivered.
What Is Driving the Expansion?
Several powerful forces are pushing hospital-at-home programs into a new growth cycle.
Federal Policy Support: The Centers for Medicare and Medicaid Services launched the Acute Hospital Care at Home waiver in 2020. This waiver allowed hospitals to receive reimbursement for treating patients at home at the same rate as in-facility care. Its extension in 2026 gave health systems the policy certainty they needed to invest confidently in scaling.
Proven Outcomes: Research consistently shows that home-based hospital care costs roughly one-third less than traditional inpatient treatment — without requiring new facility construction. Additionally, readmission rates in home-care programs are lower than those seen in standard inpatient settings. Patient satisfaction scores, in several programs, run more than 10 points higher than in-hospital benchmarks.
Patient Preference: Patients consistently prefer receiving care at home. They remain in a familiar environment, surrounded by family, and avoid the disorientation and infection risks common in hospitals. Furthermore, outcomes data supports this preference — not just comfort.
Health Systems Leading the Charge
Mass General Brigham — From Survival to Growth Mode
Somerville, Mass.-based Mass General Brigham operates one of the country’s largest acute care-at-home programs. After the CMS waiver extension, the conversation inside the organization shifted dramatically. “We’re not in survival mode anymore,” said Daniel Metzger-Traber, vice president of strategic business operations. “We’re in thrive-and-growth mode.”
In 2026, the program targets expansion in oncology, postoperative care, and behavioral health. Leaders are also evaluating machine-learning tools to identify eligible patients earlier and speed their transition to home-based acute care.
Allegheny Health Network — Rapid Volume Growth
At Pittsburgh-based Allegheny Health Network, admissions climbed from roughly seven to eight per month in January 2024 to approximately 40 per month by mid-2025. The program targets specific diagnosis groups, starting with congestive heart failure. Mona Siddiqui, MD, senior vice president of home and community care at Highmark Health — of which Allegheny is part — noted the system’s profitability as a key advantage. “Unlike many others in this space, we were actually profitable this year,” she said. “Now we can think thoughtfully about growth.”
Mayo Clinic — Rethinking the Hospital Entirely
Mayo Clinic partnered with Kaiser Permanente to develop a hospital-at-home model now deployed by 21 health systems nationwide. Pre-pandemic, Mayo’s CEO asked whether 15% to 25% of hospitalized patients could safely receive care at home. Years of data now suggest the answer is yes. “The outcomes are better because we know what’s actually happening with the patient,” said Maneesh Goyal, COO of Mayo Clinic Platform.
Cleveland Clinic — Scaling Safely in Florida
Cleveland Clinic launched its acute hospital care at home program in April 2023 across four Florida hospitals. The program treated roughly 1,000 patients in its first year. A 24/7 virtual command center, staffed by hospitalists, nurses, and pharmacists, manages patients remotely. The system’s ultimate goal is for 10% of all inpatient admissions to be treated at home.
Technology and Staffing: The Backbone of Growth
Growth at scale requires strong operational infrastructure. Across programs, health systems are investing in three key areas:
Hybrid and Virtual-First Staffing Models: Early programs sent clinicians directly into patients’ homes. Today, many systems use a hybrid approach — combining virtual oversight with targeted in-person visits. ChristianaCare, for example, created a dedicated nursing role to guide patients into the program, calling it “essential for growth.” Meanwhile, Allegheny Health Network embeds advanced practice providers in hospitals and runs direct outreach to emergency departments to generate referrals.
Command Centers and Analytics: A 24/7 virtual command center is now a standard feature of leading programs. Backend analytics tools flag eligible patients automatically, reducing reliance on manual identification. University of Chicago Medicine, as it scales, is also investing in administrative and logistical support infrastructure.
AI and Machine Learning: Several systems are piloting AI tools to identify eligible patients sooner. Mass General Brigham is among them, aiming to accelerate the transition from in-hospital to home-based acute care. Ambient AI documentation, as seen at Penn Medicine, is another frontier — reducing clinician burden and improving care continuity.
Reimbursement, Outcomes, and the Road Ahead
Reimbursement remains the most critical policy variable. The CMS waiver has been the financial foundation of hospital-at-home programs nationwide. Its continuation enables systems to integrate home hospital care into broader, long-term care frameworks and to pursue commercial payer partnerships.
“With greater certainty, we can integrate Home Hospital into a broader longitudinal care framework and partner with commercial payers to reduce total cost of care over time,” said Metzger-Traber of Mass General Brigham.
The industry is also working to standardize what “hospital at home” actually means. Clear definitions help patients, clinicians, and payers understand what the model entails — and builds the trust needed for wider adoption.
Key Takeaways
Hospital-at-home programs have graduated from pilots to proven care delivery infrastructure. Health systems that invested early are now profitable, scalable, and positioned to expand. Technology — from AI-powered patient identification to ambient documentation — is accelerating this transition. Meanwhile, federal reimbursement stability has unlocked a new cycle of innovation.
As Mass General Brigham’s Metzger-Traber put it: “When the first waiver launched, there was an explosion of innovation. I believe we’re entering another phase of that innovation cycle.”
