New Jersey became the first state this week to make home hospital care available to people with private insurance when they go to the emergency room as an alternative to being admitted to the hospital. Previously, home hospital benefits were restricted to Medicare patients, the federal government’s insurance program for people over the age of 65, under a federal program launched in late 2020 to relieve pressure on hospitals during the COVID-19 pandemic.
A new law makes it possible for more patients who seek emergency medical attention for conditions such as heart failure and urinary tract infections to return home immediately with close monitoring, instead of having to stay in the hospital. The New Jersey Home Hospital Act also makes this option available to the state’s Medicaid population.
New Jersey Broadens Hospital-at-Home Coverage for Medicaid Recipients
Virtua Health, the largest health system in South Jersey by revenue and number of hospitals, has already treated more than 900 Medicare patients in its Home Hospital program over the past two years and is eager to expand it, Virtua officials said.
The next step for Virtua is to reach an agreement with private insurers, such as Horizon, Aetna, and AmeriHealth New Jersey, to be paid appropriately for providing high-level care outside of the hospital. Those conversations are underway.
“It is mandatory that it be part of their coverage for the state of New Jersey. We are the first state to do that,” said Michael Capriotti, Virtua’s senior vice president of integration and strategic operations.
Virtua’s home hospitalized patients tend to need hospital care for shorter periods of time and end up with better health outcomes, said Raúl Berio-Dorta, a Virtua physician who is the medical director of the program. For example, they are less likely to experience hospital-acquired delirium, a confused state that can be especially concerning in older patients.
“When they are in their home, they are in an environment that they know,” he said. “They don’t get confused as much.”
The New Law to Save Money for Medicaid Users
The new law is expected to save the state money by reducing the number of hospital admissions. It is also expected to improve the quality of care for patients who are able to return home from the emergency room.
“This is a huge win for patients and for the health care system,” said Sen. Joseph Vitale, D-Middlesex, who sponsored the bill. “It will help to reduce costs and improve outcomes.” The law is expected to take effect in July 2024.