Technology and hospital-at-home programs are paving the way for in-home treatments to be the new frontier in cancer care — if reimbursement and other challenges can be worked out.
Mayo Clinic, Huntsman Cancer Institute, Mount Sinai and Memorial Sloan Kettering Cancer Center are among the providers leveraging acute care at-home programs and telehealth to treat certain patients outside of traditional care settings as the number of cancer diagnoses in the U.S. climbs. But patient safety, regulatory and reimbursement challenges are obstacles to expanding in-home cancer care.
More than 2 million Americans were newly diagnosed with the disease in 2024 — the highest number of new diagnoses the American Cancer Society said it has ever recorded. For many cancer patients, treatment often involves chemotherapy or immunotherapy several hours a week over several months. Some health systems, including the University of Chicago Medicine, Intermountain Health and the University of Nebraska Medical Center are investing in new facilities that will expand the number of infusion chairs they have to meet the growing demand.
Mayo Clinic is hoping to take a different tack. The system’s Cancer Care Beyond Walls program lets some patients within 75 miles of its Jacksonville, Florida, medical center get chemotherapy and immunotherapy treatments at home.
Sixty patients are taking part in two separate research studies that have been underway since late 2023 and could determine the future of the program, Cancer Care Beyond Walls director Dr. Roxana Dronca said. The studies will evaluate patient satisfaction, outcomes, safety, quality of life and costs associated with home-based treatment, Dronca said.
Mayo Clinic’s hospital-at-home program helped set the stage for Cancer Care Beyond Walls, Dronca said.
Home health nurses administer the treatments under the remote supervision of oncology nurses and physicians at a command center. Patients are also supported through telehealth and vital sign monitoring equipment.
Dronca said there are early indications that home-based treatment could save health systems money by freeing up space at infusion centers for sicker patients. She also said home-based cancer patients have been quicker than others to report side effects before they escalate, and that has reduced hospital visits.
“When cancer patients come to the ER, 95% of them get admitted because they have so much going on. So, anything we can do to decrease that need could result in significant cost savings,” Dronca said.
Still, Dronca said there are significant hurdles to scaling the program. For example, many chemotherapy and immunotherapy drugs are unstable and cannot be delivered to patients at home.
Reimbursement is another challenge.
Most insurers won’t pay for home-based chemotherapy and immunotherapy. Dronca said Mayo Clinic Cancer Center and pharmaceutical company Bristol Myers Squibb are bearing the costs for treatments patients are getting as part of the studies.
Reimbursement has also been a sticking point for other home-based cancer programs.
At Memorial Sloan Kettering Cancer Center in New York City, approximately 50 patients with prostate and breast cancer are bypassing clinic visits and self-administering hormone treatments at home as part of a study funded by the National Cancer Institute, said Dr. Robert Daly, a thoracic oncologist heading the study.
Daly said patients receive training on how to inject the drug, which they need to administer every one to three months. They get additional support through telehealth visits and remote patient monitoring.
Patients like the convenience of self-administered treatments and, so far, none have experienced complications, according to Daly. But the program can be too costly for some health plans as the cost of treatments changes when used in the home.
“If you start to move hormonal therapies from the clinic to the home setting, patients have to pick up the drugs from their pharmacy and there can be high copays,” Daly explained. “For some patients, this model is not feasible.”
Huntsman Cancer Institute is hopeful the success of its home-based cancer care program will convince health insurers to pick up more of the tab for patients getting care where they live.
Huntsman’s program provides intravenous medications, lab work, imaging and other services to homebound cancer patients in the Salt Lake City area through an outside home health service, said Kathleen Stahl, director of Huntsman at Home. She said Huntsman nurse practitioners provide additional care through in-home and telehealth visits.
Stahl said Medicare and private insurance cover home health services, but not nurse practitioner costs. She said Huntsman is bearing that expense, while negotiating with health insurers to help pay for it.
“The data that we have shows that we can save payers money and we have better outcomes and patients can stay in their homes,” Stahl said. “If we can work with a third-party payer to do some shared cost-savings, that would be ideal.”
Huntsman estimates about 15,000 cancer patients who have received home-based care over the past five years spent about 2.5 fewer days hospitalized than other cancer patients, saving about $20,000 per patient.
Reimagine Care is also hopeful its success providing home-based services to cancer patients will eventually allow it to offer more services.
The Nashville, Tennessee-based company partners with health systems, such as Houston-based Memorial Hermann and Tampa, Florida-based Moffitt Cancer Center, to provide symptom and medication management to about 5,000 patients last year.
Reimagine Care’s virtual platform allows patients to get questions answered about symptoms. A virtual assistant can refer patients to their providers or direct them to the hospital if they need urgent help. The company can also deploy emergency medical technicians through a third-party vendor to patients’ homes to provide intravenous fluids or perform lab work. The company estimates it has reduced emergency department visits among some cancer patients by nearly 40%.
CEO Dan Nardi said the three-year-old company would like to provide other in-home services such as chemotherapy, but he said reimbursement and regulatory barriers must be cleared first.
“We can’t just keep building clinics,” Nardi said. “We have to be able to support patients on multiple modalities no matter where they’re at.”
Some hospitals are leveraging the Medicare Acute Hospital Care at Home waiver to treat certain cancer patients at home.
New York City’s Mount Sinai Hospital is admitting cancer patients to its hospital-at-home program who need monitoring after chemotherapy or intravenous fluids, said Dr. Ania Wajnberg, professor of geriatrics and palliative medicine at Mount Sinai’s Icahn School of Medicine.
Wajnberg said the program has reduced emergency room visits and hospital admissions among a few hundred cancer patients over the last two years, but she could not estimate how much money Mount Sinai has saved.
But even offering hospital-at home care to cancer patients under the Medicare waiver could be in jeopardy, as the waiver expires at the end of March and Congress still must decide if it will extend it.
