From Beds to Living Rooms: Lessons in Acute Care at Home

Summary

Becker’s Healthcare Podcast: From Beds to Living Rooms – Lessons in Acute Care at Home

Date: September 25, 2025
Host: Lucas Voss, Becker’s Healthcare
Guest: Doug Lang, Vice President of Strategic Accounts, Health Recovery Solutions

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Episode Overview

This episode explores the evolution and operationalization of acute care at home—programs designed to bring hospital-level care into patients’ homes. Lucas Voss interviews Doug Lang for an in-depth conversation on how organizations can transition to these models, lessons learned from implementations across the country, and strategic considerations from leadership alignment to scalability and financial sustainability. Doug shares practical advice from his national vantage point, addressing both opportunities and hurdles.

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Key Discussion Points & Insights

1. The Criticality of Alignment & Change Management

Timestamps: 01:00 – 02:45

• Big Picture: Implementing acute care at home is described as a “huge change management project” that requires strategic, organization-wide buy-in.
• Leadership Commitment: Success is driven by top-down commitment, starting at the CEO level and cascading across departments (clinical, executive, IT, revenue cycle).
• Actionable Tip: Establish a cross-departmental steering committee to maintain alignment, meet regularly, and shepherd the effort.
• Quote:

  “You really need…a steering committee and all the different departments have to be represented. So that’s executive, that’s clinical, that’s IT, that’s revenue cycle, and they all have to meet on a regular basis to make sure that they’re all aligned and moving forward.” — Doug Lang (02:12)

2. Clinical & Financial Outcomes: What the Data Actually Says

Timestamps: 03:21 – 05:27

• Clinical Outcomes: Most research finds at-home acute care offers similar patient outcomes to hospital-based care—sometimes improving on factors like exposure to infectious disease, but not radically differing in main measures.
• Cost Considerations: Cost-effectiveness hinges on scale. Programs can be expensive until they reach a certain volume, but substantial savings are possible—especially when compared to capital expenses of building new inpatient capacity.
• Simple Metrics: “Bed days saved” is a compelling, easy-to-calculate metric for financial impact.
• Notable Example: A Boston health system weighed $100M for building a bed tower vs. $1M to launch a home hospital program.
• Contextual Caveat: Benefits are maximized in systems at or over capacity; where beds sit empty, the value proposition is less clear.
• Quote:

  “If you can say that we’ve saved a thousand bed days and finance has told you specifically that each bed day is worth $10,000, you can do the math and figure out how much the program has saved the health system.” — Doug Lang (04:13)

3. Navigating the Post-Pandemic Landscape: Sustainability & Balance

Timestamps: 05:47 – 06:42

• COVID-19’s Role: The pandemic accelerated acute care at home due to necessity, but as the crisis wanes, scrutiny on cost and sustainability increases.
• Critical Juncture: Health systems now need to prove financial advantages to warrant expansion system-wide.
• Quote:

  “I really think we’re here at this critical juncture right now where we have to prove that these systems are beneficial economically for the health systems to expand.” — Doug Lang (06:19)

4. Patient Eligibility & Expanding Program Scope

Timestamps: 07:13 – 08:41

• Approach: Shift from treating specific diagnoses to assessing holistic patient appropriateness (“treat the patient, not the condition”).
• Innovative Use Cases:
  • Expansion into transplant and oncology, with technologies enabling home care for CAR-T, BMT, and sepsis patients.
  • Real-time monitoring is expanding what’s possible safely—in-home infusions, close temperature surveillance, etc.
• Traditional vs. Advanced: Initially reserved for CHF, COPD, cellulitis, pneumonia; now seeing momentum in complex chronic and acute conditions.
• Quote:

  “If health systems come into this conversation thinking we’re going to treat heart failure, you just made the funnel very, very small...So treat the patient.” — Doug Lang (07:23)

5. Words of Wisdom: Implementation & Collaboration

Timestamps: 09:06 – 10:04

• Analysis vs. Paralysis: Don’t let perfectionism or exhaustive workflow mapping stall deployment—go live, learn, and iterate.
• Collaboration is Key: The acute care at home space is uniquely collaborative, with knowledge-sharing between providers and organizations being critical to collective growth and program success.
• Quote:

  “Eventually you have to go live and put a patient through the program and just identify your gaps…if you sit there for years...you may never go live or never scale.” — Doug Lang (09:20)
  “This is the most collaborative initiative that I’ve seen in healthcare...Just make sure you’re reaching out to people within your industry and trying to figure out what are they doing, what are you doing, and try and copy best practices.” — Doug Lang (09:34)

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Memorable Quotes & Moments

• On the organizational imperative:

  “This is not a nice to have, this is a must have.” — Doug Lang (01:44)

• On system-wide learning:

  “The best use case is when your hospital capacity is at risk and you need to increase throughput.” — Doug Lang (05:16)

• On program evolution:

  “Cases becoming more complicated. And now we can also treat them, which again…is that big advancement.” — Lucas Voss (08:41)

• Actionable encouragement:

  “Go live. And secondly, it’s collaborate.” — Doug Lang (09:18)

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Key Timestamps

• 01:00 – Alignment strategies for leadership and clinicians
• 03:21 – Cost-savings examples and bed days calculation
• 05:47 – Balancing clinical outcomes and financial sustainability
• 07:13 – Expanding eligibility beyond traditional conditions
• 09:06 – Final advice: implementation and collaboration

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Summary Tone

• Practical, candid, and forward-looking, the conversation blends real-world lessons with optimism for continued innovation, emphasizing collaboration and a willingness to launch and learn. Doug Lang grounds the dialogue in direct experience, offering advice both strategic and operational for leaders working to bring acute care home.

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Transcript

[A]

Hi everyone, this is Lucas Voss with Becker's Healthcare. Thanks so much for tuning into the Becker's Healthcare podcast series. It's great to have you. We're going to talk about From Beds to Living Rooms, lessons in acute care at home. And joining me for today's discussion, very excited to have him, Doug Lang, Vice President of Strategic Accounts at Health Recovery Solutions. Doug, thanks so much for being here today. It's great to have you.

[B]

Thanks for having me, Lucas. I appreciate it.

[A]

Yeah, absolutely. To kick us off for our audience, could you just share a little bit about yourself and your work in healthcare?

[B]

Yeah. My name is Doug Lang. I'm the Vice President of Strategic Accounts at HRS and my job is to work with our existing partners in thinking through new programs, new solutions, new models of care to take them really to the next level. I take over once a customer has really deployed RPM somewhere in the system and they're thinking about what's next and I can come in and consult them on how RPM can drive more values across.

[A]

I feel like next level is a good point here because again, if you talk about acute care at home, it does require some cultural shifts and most certainly operational shifts as well. For organizations, based on your experience, what has proven most critical in aligning leadership and clinicians and what's one practical step organizations can take right now to smooth out that process to get to that next level?

[B]

A few items. I was actually just at a summit and we talked about this and I think it's really important from the get go to have the right reason to go into this initiative. This is a huge change management project. It takes a lot of time, energy and resources and everyone has to make sure that they're in it for the right reasons. And that best reason that I've really heard is just that the hospital is at capacity, their beds are full, their ED is overflowing with people and they have to find beds for those patients. So getting patients either out of the hospital sooner or admitting them directly from the ED into the hospital at home program is critical. And with that comes a very strong leadership. I think this is a top down initiative all the way from the CEO on down. They have to communicate that this is a strategic initiative for the health system. So this is not a nice to have, this is a must have. And from that it goes into all the various departments. And lastly, what you really need have is a steering committee and all the different departments have to be represented. So that's executive, that's clinical, that's it, that's revenue. Cycle and they all have to meet on a regular basis to make sure that they're all aligned and moving forward. Without all those three items in place, unfortunately, I think the program will either struggle to ever go live or especially scale.

[A]

Yeah, we talk so much about cross functional alignment and change management, but it truly does make or break initiatives. Right? Especially on a large scale. When we talk about scalability, you've talked about the fact that you just spoke at a large summit about this topic. You certainly work with organizations across the country. I'm really curious what results you've seen. Cost savings, right? Examples that stand out to you. What are some of those that really have made a difference for you? Where you've seen, okay, this really made a difference. And what are some of the lessons that you've also learned in that process?

[B]

So that's interesting. Some of this is a bit debatable. Most of the research says that the clinical outcomes are the same and that's a good thing. I don't think anyone is really expecting that caring for the patients at home would have a major clinical outcome impact. Some people would argue that they're avoiding any kind of infectious disease or any kind of hospital based issues. But again, most of the clinical outcomes seem somewhat similar. So a lot of people now are looking at other metrics. Now financial. I've heard it two ways. I've heard it that sometimes times this is expensive services to deliver within the home. Until you reach economies of scale. Once you reach economies of scale, there can be cost savings. We've looked at this from a couple different ways. The simple back of the napkin math that I like to use with some of my programs is to talk about bed days saved. Everyone really tracks this in their emr. So if you can say that we've saved a thousand bed days and finance has told you specifically that each bed day is worth $10,000, you can do the math and figure out how much program has saved the health system. Now I heard a very compelling argument from another health system in Boston that talked about really developing hospital home program versus building a bed tower. So when you talk about that, they were saying it would cost us $100 million to build a bed tower with 50 to 100 beds in it, something to that effect. And it cost us about $1 million to start a hospital home program. So when you start factoring all of that, then you can see the savings are really significant. So again, you know, I think it's pretty easy to do back of the envelope math here and show that this is a Good program financially, but again, there's a lot that can go into it above and beyond bed days saved. I will repeat, though, if you don't have a crowded hospital, if you have empty beds, a CFO is going to come around and be like, explain this program to me. If we have empty beds, why are we discharging patients home? Why are we caring from the home? So again, all the leaders this summit agreed the best use cases when your hospital capacity is at risk and you need to increase throughput.

[A]

When I think you've touched a little bit on a very important point, which is also that aspect of creating balance. Right. And I'd love to know how important it is to create that balance, to strike the right balance between improved patient outcomes. And as you've talked about the financial sustainability part, how important is that balance?

[B]

That's interesting. I think programs get started especially during COVID Listen, they just had to start these programs to care for patients outside the hospital. Bringing patients in the hospital, hospital with COVID let alone other illnesses were just not sustainable. The numbers were too large. So people rolled out these programs pretty quickly after the waiver, and they would run them for a couple years. And now that the pandemic is behind us and people are starting to take a closer look at this and the extension of the waiver, I think the economic output really is important. Again, there's been some research around the clinical outcomes. Maybe they're equal or a little bit better. But I think CFOs are trying to understand what is the economic model around this and if it is advantageous to us, let's expand it system wide. So I really think we're here at this critical juncture right now where we have to prove that these systems are beneficial economically for the health systems to expand.

[A]

Yeah. And you mentioned COVID 19 and obviously the COVID pandemic has really, again, sort of moved this forward quite a bit on where we're at today. And hospital at home programs are really now managing a wide variety of conditions. Really? What are some of those factors that should guide health systems as they decide how to expand, how to safely expand patient eligibility to and expand their programs? And for you too, what's next? How is this going to further evolve as we look to the future?

[B]

That's a great question. It's something I discussed in my presentation and I'm going to quote a doctor. He said, treat the patient, not the condition. I think if health systems come into this conversation thinking we're going to treat heart failure, you just made the funnel Very, very small. And you'll never really get to that point of scaling. So treat the patient. Think of the patient. Say, can we treat this patient at home? Can we deliver all the services that are necessary? If not, maybe exclude from the program or think of how can you deliver those services so the patient can be included in the program? Above and beyond that, word of advice. Some conditions that I really heard that really got my mind spinning at this summit were transplant, which I thought was very interest oncology. I feel like oncology and cancer patients is really starting to take off, especially when you can start doing real time monitoring of things like core body temperature. You are now starting to take care of CAR T BMT patients. Things of that nature we're talking about in home infusions. I think as technology catches up, we can treat a lot more cancer patients and then sepsis. Sepsis really has poor outcomes and it is a big driver of cost throughout the system. Now they're looking at sepsis patients and again, I think there's technology that enables these health systems to start monitoring and caring for patients above and beyond. You know, chf, copd, cellulitis, pneumonia, some of the traditional conditions that were in acute care at home programs.

[A]

Yeah. Cases becoming more complicated. And now we can also treat them, which again, as you've mentioned, is that big advancement. Specifically, I love that you mentioned the oncology piece to it and the cancer patient part, which is certainly very important. Doug, fantastic insights here. I want to leave the floor to you here as we, as we sign off. Anything else that we didn't touch on that you'd like to mention that might be important for our audience or general in this area that we haven't touched on.

[B]

Two things. And again, I think the benefit that I have as a vendor is actually good to see across many programs where providers essentially live on their own little island. And the two words of advice that I gave to the providers at the summit and I got a lot of head nods, it was one analysis versus paralysis. I think eventually you have to go live and put a patient through the program and just identify your gaps. Never sacrifice patient care. But if you sit there for years, which I've seen, and just try and build out workflows for every possible scenario, you may never go live or never scale. So my word of advice is go live. And secondly, it's collaborate. I think this is the most collaborative initiative that I've seen in healthcare and lots of people are willing to share and learn from others, especially like summits or user groups or things like this. Just make sure that you're reaching out to people within your industry and trying to figure out what are they doing, what are you doing? And try and copy Best Practices.

[A]

This podcast is your reminder to reach out to Doug. You've heard it here first. Doug, thanks so much for being here. Thanks for your time.

[B]

Thanks for having me.

[A]

Absolutely. And we also want to thank our podcast sponsor, Health Recovery Solutions. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page at beckershospitalreview. Com.