A PATH to hospital at home

Deep in the heart of Penn Presbyterian Medical Center, in a dimly lit room there is a cubicle. Lined with cases of soup and protein drinks, the space has the feel of a doomsday prepper den.  For a period of time over the last year, most mornings, Advanced Practice Provider Julia Borgesi, PA-C, could be found sitting in that cubicle looking at a pair of monitors. She wasn’t prepping for the end of the world; she was on morning rounds for the PATH program. 

“Can we have her recheck her oxygen … do we think his weight is accurate … I’ll have the meds couriered over today …”  

A team of a half a dozen nurses and social workers sounded off from a virtual meeting each morning. Borgesi tuned in, asking and answering questions while clicking and scrolling through the charts of the patients under the team’s care on her second monitor. They formed a virtual hospital unit of about 10 to 15 patients, but not actually located in the hospital. All of these patients were already back in their own homes. (The supplies surrounding Borgesi’s desk were care package items she provided to newly enrolled patients.) In the PATH program, Borgesi was the air traffic controller pulling everything together to ensure all of these patients received acute care similar to what is typically provided in a hospital, but in the comfort of their own homes.  

“Our goal is to replace all or part of what would normally be a medical admission, either an observation stay or an admission stay, move that into the home setting, and follow patients for up to two weeks,” said emergency medicine physician Angela Cai, MD, MBA, medical director of the PATH program.   

After a successful nine-month pilot of PATH, Penn Medicine is now gearing up for a new, specialized model of providing acute care at home starting in early 2026. 

Bringing hospital-level care to patients’ homes 

The idea of PATH, which stands for Practical Alternatives to Hospitalization, was built in response to an urgent crisis affecting hospitals across the country: Emergency departments are overflowing, and hospitals are at capacity. This means that some people wait for hours to be seen, and if they require hospitalization, hours to receive an inpatient bed. These delays cause problems for both clinicians and patients.   

PATH bears some similarities to another program already available at other hospitals, and coming to Penn Medicine in 2026, called Hospital at Home. Hospital at Home is a program first established during the COVID-19 pandemic, when the Centers for Medicare and Medicaid Services (CMS) started providing waivers allowing health care systems to be reimbursed for providing hospital-level acute care in patients’ homes as a way to ensure more patients could receive such care even when demand surged. The waiver opened the door to more insurance companies covering the cost of acute-level care in the home. 

Regardless of the specific program model, the ability to deliver many types of advanced treatments and remote patient monitoring at home owes a great deal to advances in telehealth, especially since the COVID-19 pandemic. Penn Medicine is able to leverage this technology alongside an already mighty foundation of home care excellence and innovation: Penn Medicine at Home has been delivering care to patients across the region for years, continually advancing into more areas of acute care, and with a single electronic health record fully integrated with the rest of the health system. Penn Medicine at Home therefore provided a structure of providers at the ready to partner with hospital-based teams through PATH. 

“Penn Medicine has a lot of resources that we were able to leverage already. That’s the beauty of Penn Medicine, we’re a very rich system in terms of expertise in a lot of different areas,” said Anna Morgan, MD, MSHP, physician lead for population health initiatives for the Center for Health Care Transformation and Innovation at Penn Medicine. 

PATH initially ran as a small-scale pilot before the COVID-19 pandemic. From September 2024 to June 2025, it relaunched and ran at Penn Presbyterian Medical Center with an aim to scale up to additional Penn Medicine hospitals. During that time, clinicians reviewed charts of patients in the emergency department and inpatient units to find those who could be treated at home; if a patient agreed, they returned home under the care of a remote team. The program earned high marks from patients and consistently positive outcomes. 

The program is now on hold, but for a good reason. The team members who stood up PATH are focusing their attention on standing up a Hospital at Home program, after CMS granted approval this summer for Penn Medicine to provide Hospital at Home acute care operated by all seven of its hospitals.  

As Penn Medicine teams work toward an initial rollout of a Hospital at Home program based at three hospitals in early 2026, before scaling up to the entire system, lessons learned from PATH will be essential to shaping that program. And ultimately, leaders say that PATH and Hospital at Home can coexist and serve complementary needs for more patients. 

In Borgesi’s cubicle one spring morning in the thick of the active pilot of PATH, she pulled a bag with a drawstring from a box and held it up, revealing why she’s equipped like a doomsday prepper.  

“We give the patients a little care package when I enroll them,” said Borgesi.  

Such interactions served as a key moment because, even though Borgesi would soon be coordinating their care, this meeting was typically the first and last time she ever saw her patients in person. For Borgesi, enrollment was a time to set expectations and get to know each patient a little better.  

“I try to spend a little more time with them, so they do trust us and want to understand where we’re coming from and participate in feeling better,” she said. 

Mohamed Aboulemon is one patient who saw the results of PATH after some initial doubts. Aboulemon had been battling an infection in the spring that put him in and out of the hospital multiple times. Once, when his fever spiked and he went back to the ED at Penn Presbyterian, he stayed in the hospital for two days as doctors worked on the right course of antibiotics. That’s when he learned about the PATH program. His initial skepticism lost out to a more powerful desire: Aboulemon so badly wanted to put the infection past him that he didn’t want to go home if it meant he might again boomerang back to the hospital.  

“When they explained the program, I thought, I’ll give it a shot,” said Aboulemon. After a couple of days at home under the care of PATH nurses, he was a believer.  

“It was the same thing as the hospital, but you make your own coffee, eat whatever food you wanted. The only difference is being comfortable being at home,” said Aboulemon. 

Nurses checked in daily virtually, a nurse visited his house every other day, and his vitals were monitored remotely to ensure the antibiotics were doing their job. Aboulemon finally beat the infection after two weeks of care in the PATH program. 

For some patients, there are advantages that go beyond the comfort and convenience of staying at home. When seeing a patient in their home setting, the PATH team can identify potential issues that may be contributing to poor health outcomes. It might be food insecurity. Or it might be something more mechanical. 

Austin Kilaru, MD, an assistant professor of Emergency Medicine at Penn Medicine, who initially developed the PATH model, shares an example: A patient with chronic obstructive pulmonary disease (COPD) kept returning to hospital with trouble breathing. After being treated in the hospital, the symptoms would abate, only to flare up a few days after the patient was sent home. Eventually, that patient ended up in the PATH program. The home health team discovered a problem with the air conditioner at the patient’s home that was aggravating the COPD. The team arranged a fix that ensured the patient could breathe easier. 

“We can actually spend more time with patients and families, really understand the context of what is making the patient sick,” said Kilaru. 

PATH is proof of the principle that there are some people who come into the ED with acute problems for which their medical interventions can be delivered at home instead of in a hospital. Finding these specific people and helping them get that care at home can free up space in the hospital and make for a more comfortable experience for the patients.  

The numbers bear out that this program can do so successfully. In the nine months that PATH was operational, it enrolled 177 patients. Among these patients, 90 percent avoided being admitted to the hospital within a month of enrolling in PATH, and 82 percent avoided another ED visit within a month of enrollment—meeting or exceeding the program’s benchmark goals. Preliminary estimates show that the program saved 2.6 hospital days per patient.  

Multiple models for hospital-level care at home 

As Penn Medicine works to roll out a Hospital at Home program at the beginning of next year, leaders will learn from the experiences of PATH, while envisioning that eventually both programs may run side by side. 

That is because Hospital at Home and PATH serve patients with somewhat different needs. Under the waiver from CMS that allows Medicare and Medicaid (and potentially also private insurers who follow their lead) to cover Hospital at Home care, there are specific, strict requirements for staff and patients. The CMS criteria require that patients remain in a controlled care setting for Hospital at Home. That means Hospital at Home programs must offer patients three meals per day and provide at least two in-home nursing visits per day, and the patients must remain in their homes during the course of treatment.  

Those rules make sense for people who are dealing with the most serious health conditions. But patients who enrolled in PATH required less vigorous care than those who would qualify for Hospital at Home. In fact, many patients who received care under PATH reported that they valued being able to potentially work, care for their loved ones, and move freely while receiving home-based health care.  

These distinctions make PATH an appealing program to stand up alongside Hospital at Home to serve more patients at different levels of illness severity. 

“Can we find those patients in the middle and create a new model for delivering the right care to them?” said Kilaru. 

To successfully stand up this “middle” option for acute-level care at home long-term, the PATH program will need to solve the problem of funding. The initial proof-of-concept pilot was largely funded through a grant from Independence Blue Cross. When the program relaunched in September 2024, it was powered through an innovation fund at Penn Medicine. Now, planners are selling the idea to insurers, arguing the model should be covered care. 

The work moved forward the idea of using a more precise approach to pivot patients from the hospital and deliver care to the home, while also freeing some precious space in the hospital in real time. PATH demonstrated that the tools and practical care models have caught up with some of health care’s most ambitious thinking. 

“Without this year of work, we wouldn’t be able to move things forward,” Cai said. “And this is really a model that we’re trying to set for the nation.”