ROCHESTER, Minn. — The in-home hospitalization partnership announced last summer between Rochester-based Mayo Clinic and Boston-based Medically Home is becoming supersized with the news it is partnering with the California health care giant Kaiser Permanente.

The Bay Area health system operates 39 hospitals in eight states, serving more than 12 million members.

The venture will seek to deliver acute care in the home via remote command centers, reducing pressure for patients to travel to distant hospitals, while addressing the needs of underserved communities and isolated rural populations. Executives say the goal is a decentralization of care delivery, with a vantage point on the social determinants of health.

"When a physician writes an order in a central hospital they can reliably expect it will be delivered," said Raphael Rakowski, executive chairman, Medically Home in a media call Wednesday, May 12. "To actually create that reliability in a community is a major challenge, and that's the vision behind what we are trying to do."

The two health systems expect to invest a combined $100 million in the venture.

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A remaking of acute car, it hopes to deliver as much as a third of what is now provided in-hospital in bedrooms, family rooms and home offices, utilizing mobile teams and remote command centers staffed with doctors and nurses.

The components that go into the home are typically set up in under 40 minutes, Rakowski said.

"There is a communications platform that consists of a custom-designed iPad and software to interact with the patient and family around the clock. There's something that looks like a phone, but it's actually a walkie-talkie that the patient can pick up 24-7 and access their care team around the clock without a dial," he said.

Rakowski also described backup capabilities for power, cell signal and internet connection.

"A suite of integrated technologies can provide real time and intermittent vitals monitoring, and there is an emergency response system ... All of that is in a kit. It gets set up rapidly in the home, and its connected to the command center around the clock," he said.

"Many of the hospital at home models have been built on the concept of putting doctors and nurses in cars traveling to patients' homes," said Dr. Margaret Paulson, chief clinical officer for advanced care at home unit now used by Mayo Clinic Health System, Northwest Wisconsin Region. "We have a command center in Florida (where) the doctors and nurses care for the patients virtually, utilizing teams in the field who bring the needed service to patients in their homes."

"We assess if they are appropriate," she said. "We also do a social stability screen — we talk with the patients and their families to make sure that their home really is an environment that can support their treatment and recovery, and that it is safe for our staff to go into. But there are a vast majority of patients who can be treated safely at home."

A call three months in the making

"My dream was to get to the two of them on the phone together," Rakowski said of the Mayo-Kaiser partnership, "which took three months."

"Where Kaiser has gone, at a scale larger than anyone else," he added, "is the recognition that to sustain the health system, you have to have real value." The executive lauded Mayo for "their medical knowledge and 150-year history of complex care," saying the partnership "will help other systems feel confident enough to move forward and bring this to their patients."

"We see tremendous opportunity to scale this model together," said Dr. Stephen Parodi, executive vice president, The Permanente Federation. "We have different footprints in the country and we have different types of populations."

Lower acuity at-home care holds the potential to absorb roughly 5-10% of patients currently hospitalized, Rakowski said. The high-acuity patients envisioned in the Mayo-Kaiser partnership could potentially domesticate about 30% of current hospitalizations.

Officials denied the transition would make thousands of new hospital beds now in use across Rochester and elsewhere less relevant.

"We are going to see different kinds of patients in our bricks and mortar facilities," said Dr. John Halamka, president, Mayo Clinic Platform.

"We are essentially right-sizing for the future," Parodi said. "When I think about the 12.8 million patients we are responsible for across the country, and when I talk about this program with Kaiser Permanente physicians and clinicians ....we believe this is a way to improve access, whether in an underserved, or rural setting."

"We have a very strong interest in underserved patients and particularly rural underserved patients," said Rakowski, who described Medically Home as "a very not-for-profit type of vision, of serving patients needs, the social good and for social impact."

Though the Mayo service is currently offered only in Wisconsin and Florida, the next rollout will be in Arizona, Halamka said, with discussions underway in Minnesota about what is the right clinical specialty to address first.

"We are looking to expand the kinds of offering to other clinical conditions."

This story has been updated to include the detail that Mayo Clinic provides Medically Home services in Florida.