INTERVIEW TRANSCRIPt


My name is Itamar Offer. I'm a physician, pediatrician actually. And for the last 20 years I work all my years in Israel. For the last 20 years I'm running, heading healthcare organizations, and for the last seven years plus I'm promoting Hospital at Home initiatives in Israel, which got a huge boost in the last two and a half-three years.

What is the most accepted definition for Hospital at Home (HaH) in your country/ region/society? What words do you use to refer to HaH in your country?

In Israel we have well established home care services for many years, dozens of years, decades actually, and those services are being provided by the HMOs themselves. So we at Sabar Health and what we do is acute Hospital at Home. And if I have to define it, which is an issue, is that we talk about an episodic event as a direct substitute to short term hospitalization in internal general medicine hospital department. We usually call it in Israel, Hospital at Home or hospitalization at home.

How did you get involved with Hospital at Home (HaH) care/model/ecosystem? What is your HaH story?

So, during my career I managed hospitals, children's hospital, private surgical hospital, and other projects. And I think the main point that came to me, that many of the people who are staying at the hospital do not actually have to sleep in the hospital in order to get better, in order to get the service provided. And that understanding in parallel with the fact that in Israel then and it's almost the same today, the occupancy rate in Israel, in the hospitals is above 100% at any given time. So if you combine those issues, you say okay, it's above 100% but we believe that many people don't have to be there, there must be an alternative. And about seven to eight years ago I started looking for what's happening outside and what's the alternative and thinking about the patients as the people who need to get personalized approach to their problem, and not because the system is built in those silos, as in everywhere in the world, in the Western world at least.

What does a day in your life look like?

Busy. Until last year I was the CEO of Sabar Health and which is the largest Hospital at Home provider in Israel. Nowadays I'm a president and chairman, and I have two different or main tasks, two different main issues to deal with.

One is I'm advocating for Hospital at Home, scaling Hospital at Home in Israel, and I'll give you an example in a minute. And of course, I'm promoting the business development of Sabah Health, which is the company I'm responsible for these days.

Talking about the last few days, I spent most of my time as a chairman of the committee and Hospital at Home working to prepare the Israeli Health Policy annual event. There are two topics. One of them is Hospital at Home. We gather together the best professionals from across the system, hospitals and community, and physicians and nurses, and Ministry of Treasury, Ministry of Health. Altogether, people understand Hospital at Home to think in one zoom room in order to prepare the conference annual event book and discussions about where do we want to be in the coming five years or ten years in terms of Hospital at Home, what's the meaning, how does it affect a lot of work…

What motivates you in your work?

When I started seven to eight years back, I felt that Hospital at Home is a good idea and many of my colleagues said, well, it won't work, people prefer to be in the hospital and it's dangerous, people will die at home. And many more truths that they used to convince me that I'm wrong.

From day one when we started, the patients and the families preferred hospital at home even before there was any experience in Israel with that kind of service. And it continues day in and day out. And I hear it from the teams, we have dozens of physicians and nurses that are doing other things too. And every day they go into the homes of patients, and they get so much gratitude and thank you from the families and the patients themselves that I only feel that we need to push it forward and to make sure that any patient that can be treated at home will be treated at home and not be sent to a hospital because we are used to doing it.

Can you share a story from your time working in HaH?

So, I'm not treating patients personally, but I hear from our teams that in many families in Israel, hospitality when you come to the home is a major issue. So, they love to feed the team and they even try to schedule the visit for lunch or for dinner so the team member who is coming is having the food. And on the other hand, the teams know how to arrange their day to day between the visits to make sure that they are coming to the family with a good food, and they are building their relationship, of course, with the families. I think that it is always very warming in terms of relationship, and I think in the end it also helps to recover because we approach people at eye level and I think it's very nice and contributing to the treatment.

What are the greatest obstacles for the HaH ecosystem and how can we overcome them?

So modern management is talking about challenges, so maybe not obstacles, which is right, but let's call them challenges. So, number one challenge is to have a clear financial incentive for the payers to prefer the referral of patients to Hospital at Home when it is suitable. Nowadays, in Western countries, no health care system can work without a true financial incentive towards the direction that the system wants to grow. The second challenge, they are the habits of the family physicians or general practitioners to send patients to the ER, and then the habits and incentives of the ER physicians to hospitalize those patients. That's how people were educated. That's what they learned from their teacher, that's what they saw in their career. It's a huge challenge and it's working, but you know, it's not enough to know that something exists. You have to incorporate it into your day to day decision making and the same for the families. As I said in Israel at least, the patients and the families were pro Hospital at Home from day one and they were very happy and continue to be very happy to receive the care at home.

Fourth challenge is operational and Hospital at Home, as we all know, is a huge operational challenge, especially for the acute phase. It is more complex in peripheral and rural areas and we do struggle to provide acute care due to distances and lack of numbers, enough numbers to cover the costs in those areas. But we are finding solutions and it's getting better. And last but not least, shifting some of the Hospitals at Home visits to distant physicians visits - telemedicine is still not there. We’ll talk about it again in Barcelona in the conference, but it is still easier said than done. Some people studied it, and we have to continue and find the right way and the right mix that will allow us to get more efficient while keeping the patient’s safety and quality of care and communication between the team members. So that's still a challenge that is not fully recruited or exploited to make the Hospital at Home more efficient.

What are the most common misconceptions about HaH?

We are struggling with the exact definition of Hospital at Home, even within the committee of the World hospital at Home Congress and Community. It is very different in different countries, mainly due to the differences in the healthcare ecosystem. The reimbursement system in different countries is different and the evolution, the history of the development of the different services. There is a big debate that will continue to accompany us, I think in the coming years, whether hospital at home should be provided by hospitals and hospital teams or by community based medical organizations or a combination, a hybrid, as we say today, of those services. What's the right way. The debate is based on all the dichotomy that was created between hospitals, community health services and payers. My take on that is that we need to provide the best Hospital at Home service to the patients and develop the expected standards of care and safety and service, no matter who it's providing.

So I'm not coming to the point from the question whether it's a hospital physician or hospital teams or community teams and coming from what's best for the patient. Let's put the standards on and then whoever is meeting the standards can provide the care. Any patient who doesn't have to be in the hospital shouldn't be there. There is no question about it. And we all know that hospitals are the most expensive and dangerous and complex way to solve medical problems. So if we can do it without them, we should. I'm just stating here that I'm not talking doing it without the physicians of the hospital or without the teams or without the knowledge of the people in the hospital because that's usually very good and high. The problem is that the whole idea of the hospitality part of the person who needs to leave his home or her home and to go to another building to sleep there. In 2022, when we have all the communication issues and advantages and people are more educated, it doesn't fit anymore. And we must continue the movement towards treating people at the natural environment which is home.

What is something about HaH you would like everyone to know?

First, I would like everybody to know that patients and families prefer Hospital at Home whenever it's possible. It is our responsibility as providers and healthcare leaders to make sure that we do it right. We provide the right care to the right patient at the right venue, and we should include his personal, his or her personal preferences and of course, social aspects of care. I'll give you an example here. We started, we thought that people who are living alone cannot be treated at Hospital at Home. Which is actually an issue because there are many people who are living alone and on the move. We learned that some of the people who are living alone can be treated at Hospital at Home because they are self-sustained enough to provide for the food and the personal hygiene, etc and they still prefer to be at home and not to go to the hospital. So, we have to be very flexible in our thinking and make sure we do provide the right care and the safe care for the patient. And most important, we have to remember that the older people of our societies and the very old for them, the hospitals are really dangerous and to my eyes, unjustified, the hospitalization of an older person in my eyes, is malpractice.

What do you think is the value of attending WHAHC 2023?

First of all, we're going to Barcelona, and I hope the weather will be great and the city is wonderful. So that's the first we are going to meet with all the people that we missed in 2019 when we first met and Bruce called us a tribe, because all the people who came to that conference and all the people that will come in March are people who for them, Hospital at Home is in their blood. It's like freaks of Hospital at Home. So, it will be great to meet the tribe. And of course, I'll be happy to listen to peoples’ experiences, to people who worked hard and measured what they do and published, what they do, so we can be more educated and take home their ideas and results. And even though the ecosystems are so different between the countries, we are always learning from each other, and we can find new ideas to take home and to find the similarities. I think the one common trait of all the attendees of WHAHC is that all innovation is within their day to day. They innovate every time they go to a patient. They feel they need to innovate because the old ways of doing things is not enough.


Last modified: Tuesday, 22 November 2022, 3:43 PM