A new opportunity for home-based medical care: the value-based hospital-at-home payment model

The aging of populations is expected to drive an increased demand for acute hospitalization. For hospitals facing limited resource growth and capacity, hospitalization can be substituted with a hospital-at-home (HaH) model. Recent reforms to health-care systems have focused on designing value-based care models. High-value care models should be cost-effective, patient-centered, and integrated and should ensure intervention efficacy. The current review introduces HaH models in different countries and outlines their value-based payment designs. These models are then compared with the HaH model under Taiwan’s National Health Insurance scheme (the "Acute Care at Home" model). The HaH model in Taiwan is subject to six key challenges: 1) uncertainty regarding actual HaH care costs, 2) difficulty in quantifying nonclinical efficacy, 3) geographic variation in care effectiveness, 4) incomplete integration of essential professions within the current bundled payment design, 5) complexities in information system integration, and 6) challenges in integrating HaH with long-term care services. To ensure high-value, holistic care under Taiwan’s HaH model, health-care providers can leverage existing home-based care infrastructure. HaH care should be integrated with long-term care, care teams should be expanded to encompass a wider range of professions, and robust information technology solutions should be implemented.