Switching to fully remote operations during the pandemic was a rushed adventure into what was mostly uncharted territory. There were a lot of challenges and bugs to work out, but there were also plenty of advantages and unforeseen benefits. And it is thanks to those advantages and benefits that healthcare at home is continuing, even as there are still challenges to work on and in-person operations return. While our first big push into remote care was a leap into the unknown, this time we want to make sure that we are surveying the landscape to make this a safe, smart, and financially responsible decision.
So let’s take a moment to pause and evaluate healthcare at home to see where we are and where we need to go. We reached out to our incredible Healthcare IT Today community for their thoughts on the advantages, challenges, and costs of healthcare at home, here is what they had to say:
Joe Perekupka, CEO at Freespira
Advantages of home health: Home health provides an opportunity for patients in desperate need of care the opportunity to get access to a validated treatment that they normally would not have access to due to physician shortages, the inability to get to a clinic or office, or cost issues. It can be especially effective for patients in those underserved or rural areas where we see the largest issues with access to care due to health provider shortages. Currently, 100mm people live in primary care physician shortage areas and 160MM live in mental health provider shortage areas. For those individuals, the ability to access care is inordinate compared to other areas.
Challenges: The largest obstacle for digital therapeutics is the lack of reimbursement which limits the availability of these treatments, in most cases for those patients at greatest need. And secondly, the bar for digital therapeutics is set way higher than for other new health treatments for payer acceptance. Payors are comparing these new treatment modalities to the standard of care for the respective health disorders, but digital therapeutics serve as an opportunity to fill in the gaps where healthcare fails patients. In areas where there are significant physician shortages then the standard of care is not even an option. DTx can fill that void in care and provide patients with a much-needed treatment option.
Garheng Kong, Founder and Managing Partner at HealthQuest Capital
Hospital-at-home (HaH) and skilled nursing at home (SNaH) are two trends driving increased healthcare in the home for more acute patients. HaH is an innovative care model that provides hospital-level care in a patient’s home as a full substitute for acute hospital care. Compared to similar hospitalized patients, HaH patients experience better clinical outcomes, better satisfaction, less caregiver stress, and better functional outcomes.
SNaH provides 24-hour skilled nursing care, as well as related or rehabilitative services, such as dietary services, social services, pharmaceutical services, recreational therapy services, and access to dental care. Similar to HaH, being at home can offer a level of comfort, familiarity, and flexibility that facility-based care might not provide, leading to higher patient satisfaction and potentially better adherence to care plans.
Moving healthcare to the home has an attractive value proposition for all stakeholders. The health system gets reimbursed, has faster discharges, reduces length of stay, and can backfill that bed to another patient. For patients, this is a better experience and can be a competitive differentiator for hospitals that offer this. For health plans, it is beneficial as this is typically a cheaper option compared to the hospital and has demonstrated on average lower readmission rates.
These models gained significant traction during the COVID-19 outbreak, especially with the introduction of the CMS Acute Hospital Care at Home waiver, which allowed health systems to earn similar reimbursements for home-based patient care as they would for in-hospital treatments. By March 2023, the waiver had been employed by 123 health systems, covering 277 hospitals across 37 states. While this waiver is set to expire at the end of 2024, we expect the waiver to be replaced with a more appropriate payment model that provides immediate savings for commercial and MA payers while still enabling a financially sustainable model for health systems.
CMS recently published encouraging data demonstrating patients in HaH settings showed low mortality rates and “minimal complications related to escalations back to the brick-and-mortar hospital,” and we expect CMS to conduct a more comprehensive study through Q3 of this year which will ultimately inform the future of the waiver. Assuming this data continues to show positive outcomes from HaH, we expect this will encourage more health systems to pursue these programs.
While these models are encouraging, they do not come without challenges for health systems to set up themselves. These challenges range from patient selection to the technology required to monitor patients and are further impacted by staffing shortages plaguing many systems still today. Due to these hurdles, many health systems opt to partner with vendors who specialize in enabling hospital-at-home.
Larry Cohen, CEO at Health2047
The shift towards digital, home-based healthcare systems is closing the chronic care gap for some groups, mainly those with reliable internet, flexible schedules, and sufficient funds. However, patients lacking these advantages risk falling behind. Collaboration between technology companies, healthcare providers, and government agencies is vital to creating an integrated system that ensures equitable access to healthcare-at-home services for all demographics, including those traditionally underserved.
COVID-19 expanded the industry’s understanding of telemedicine to include asynchronous services like self-service and messaging, but also gave rise to synchronous methods and remote monitoring. The spike in usage of these new services also highlighted a significant digital divide. The 2022 ACS data from the U.S. Census Bureau shows 11.7 million U.S. households without in-home internet and about 5.5 million without a computer. Contributing factors to this gap include socioeconomic status, geographic location, broadband access, and digital literacy, particularly among older adults.
Addressing the digital literacy gap is crucial, especially for older adults who may be less familiar with technology. Providing education and support can make telemedicine more accessible and effective for these populations. Companies like Best Buy Health have entered the market with services similar to Geek Squad for at-home concierge and remote monitoring setup, but challenges persist in homes without Wi-Fi access.
Virtual care is complementary to traditional care, not a replacement. Routine physical exams remain essential despite advances in remote monitoring. A balanced approach is necessary, avoiding the “either-or” fallacy, where digital health companies and traditional providers collaborate to create care models that leverage the strengths of both remote and in-person care without compromising clinical quality. We’ve seen strides in accomplishing this for primary and acute care, but chronic care remains a challenge.
Dr. Kevin Ramotar, Head of Clinical Care & Quality at Rula Health
Within the past ten or so years, digital mental health platforms have become more widely accessible, available to anyone with a smartphone or computer from the convenience of just about anywhere. While receiving care at home has become more accessible post-COVID, the increase of digital solutions has presented a new challenge of ensuring that care quality remains exceptional and consistent in a wide range of care settings. Both accessibility and quality of care are goals that should be addressed in tandem as care at home continues.
To address quality, digital health platforms are now being uniquely designed to produce actionable insights to monitor and improve quality. These platforms provide a plethora of data and useful insights — in real-time — on the care experience, ranging from client retention to therapeutic alliance and meaningful patient improvement. With this data, technology partners can provide the necessary support and resources to enhance clinical decision-making that helps providers improve care, thus fostering a better and safer patient experience, which is – or should be – the care system’s goal overall.
David McCormick, Chief Operating Officer at Carium
In the past few years, delivering care in the home has become increasingly attractive and prevalent across a variety of health conditions. Home care benefits are well documented and significant (increased patient satisfaction, reduced costs, improved outcomes, access, etc.), but delivering high-quality, consistent care presents numerous operational challenges.
An increasing number of health systems and clinician groups are partnering with technology providers to develop highly sophisticated, personalized programs that engage patients across their entire care journey to not only ensure positive long-term outcomes but also reduce the cost of care. The more advanced initiatives involve disease-specific approaches to care management with patient-specific resources and support to help overcome social and functional determinants of health. They also incorporate tools that enhance digital communication between patients and providers and enable close to real-time coaching to help ensure patients remain adherent to treatment plans while streamlining administrative tasks and increasing provider efficiency.
Chris Darland, CEO at Peerbridge Health
With close to 1 million new cases of heart failure diagnosed each year and 75% of disadvantaged patients diagnosed in the ER, advancements in at-home monitoring and diagnostics have never been more critical. Recent technological advances in wearable devices that harness AI technology to deliver hospital-grade data from home without causing undue inconvenience to patients present the greatest potential for early detection and treatment.
Alaina Victoria, PT, DPT, Marketing and Sales Enablement Manager at OneStep
Healthcare at home offers convenient, accessible treatment options that reach more patients and drive engagement and adherence to their plan of care. Additionally, providers gain insight into patient health and risk status during everyday life which improves clinical decision making. These factors combined ultimately improve outcomes and the care experience for patients and providers alike. However, with any delivery model, there are challenges that must be addressed. Ensuring patients have the proper technology is paramount, and why many organizations are opting for easy-to-use, low-maintenance solutions that don’t require wearables or additional equipment.
Karl Ulfers, Co-Founder and CEO at DUOS
Healthcare at home is a component of multiple aspects of the continuum of care. It serves a very specific purpose and should be utilized as a location for care to be delivered to members with the greatest needs. The house is a great place to get care for members who lack mobility due to recent treatment, are permanently disabled, or face substantial SDOH barriers. Delivering care in the home helps these patients access the services they need to avoid unnecessary hospitalizations and healthcare costs. As it is one cog in the complex landscape of the care continuum, it’s critical that proactive upstream care be delivered to members to manage their chronic conditions and prevent acute medical needs from becoming debilitating.
Furthermore, healthcare services at home should also be preceded by management with a primary care physician and subsequently coordinated care following the delivery of healthcare services at home. This not only ensures compliance but the best possible outcomes and follow-through for members. We want to help these patients recover and prevent the exclusive need of home-based care because coordinating care among various healthcare providers, caregivers, and family members can be challenging in a home setting, potentially leading to gaps in care or communication breakdowns.
Vikie Spulak, EVP, Strategic Accounts at Carenet Health
As we move forward, we expect more specialty doctors to find new ways to facilitate at-home care, meaning more people with specific health needs can connect directly with the right doctor for support. For the provider, this also means greater access to more cases to draw insights, identify patterns, and improve the long-term state of care. All of this leads to more constant streams of data that can be leveraged to improve health outcomes.
The challenge, as expected, is focused on how to make these new offerings cost-effective. Reimbursement has been difficult to navigate for providers, payers, and other entities that are taking on risks by providing new services. This becomes even more difficult when you consider how to scale up these offerings – adding more technology and more services, available in an at-home care model. Finding the balance between improving health outcomes while managing costs across a diverse ecosystem of healthcare businesses is a constant challenge in our industry and at-home care is no exception.
Compliance also becomes more challenging with at-home care. In a health facility, providers have a great deal of control, but in the home environment, there are factors that health providers can’t fully monitor. It’s harder to ensure patients are using at-home tools properly and adhering to recommended treatment plans.
Paul Mastrapa, CEO and President at Interim HealthCare
Between the pandemic, inflation, labor availability, and payment rate cuts, the last few years have been challenging for providers in home healthcare. At the same time, there’s a rapidly growing patient demand for care at home. This necessitates more efficient operations and that’s why leveraging technology, such as telehealth visits and remote patient monitoring, is a key part of enabling around-the-clock, personalized care and improving patient outcomes. Fortunately, home health is in the right place with the right services to answer healthcare’s persistent question of how to provide high-quality, cost-effective care.
Vince Baiera, Partner, Post Acute Care at Relias
Over 90% of seniors prefer to age at home, and advancements in technology are making this option more feasible and cost-effective. Telehealth and artificial intelligence are poised to enhance the accessibility of healthcare, requiring an unprecedented level of technological adoption among seniors and their families. Although changing habits and embracing new technologies can be challenging, the tangible benefits and simplicity of use are likely to encourage a shift towards more open attitudes. However, integrating these innovative technologies and ensuring the absence of immediate clinical support doesn’t detract from care quality are two main hurdles. Despite Americans over the age of 55 holding 72% of the nation’s wealth, convincing them to invest in services that improve their quality of life can be a complex and daunting conversation. Nonetheless, the push towards technology-enhanced home care represents a promising frontier for aging with dignity and independence.
David Stein, Co-Founder and CEO at Ash Wellness
The shift to home healthcare has been a game changer for so many patient groups. Parents on childcare duty, employees who work 9-5, and people without reliable transportation to a clinic can now conveniently take charge of their health. Specifically at-home tests, and those beyond just COVID-19, have the potential to improve outcomes and lower costs beyond what’s possible with in-person testing. This adoption means patients are taking tests more consistently, catching cancers and chronic diseases earlier to offset health costs. The benefits for patients, payers, and providers are immense, and we’ll only continue to see healthcare trend in this direction.
Michelle Carnahan, President at Thirty Madison
While care at home is beneficial for all populations, one particular demographic has seen a major shift over the last few years: women. Women have long been left behind in healthcare, despite making up to 80% of healthcare decisions. With digital health and asynchronous care readily available to support smooth delivery and personalized treatment options, women can now take charge of their own health, whether that be reproductive healthcare, mental healthcare, or dermatology.
One example in particular is the delivery of birth control. In the past, and for some in the present, menstruating women have to take time out of their lives to access a pharmacy each month, find a provider to fill the prescription, make an appointment (which in a post-COVID world can take anywhere from two days to two weeks) and travel to that provider and to the pharmacy for pick up. In a new age of digital health tech and asynchronous care models, this entire process has now evolved to become a seamless workflow of connecting online with a care provider to identify the appropriate medications and then opening a package on a doorstep.
It’s worth noting that a major gap still exists for too many women in the U.S. as it relates to home healthcare. Many women still live in medically underserved areas without primary care providers or the appropriate care specialists for their health concerns. Direct-to-consumer home healthcare options make it possible for these patients to receive care regardless of their zip code. We’re meeting women where they are – no matter where that is.
Alaina Victoria, PT, DPT, Marketing and Sales Enablement Manager at OneStep
While there has been progress in reimbursement models to support home-based care, further revisions are necessary as digital care becomes a critical part of our healthcare ecosystem. Challenges include ensuring adequate reimbursement rates that cover the costs of home-based services, addressing regulatory barriers, and expanding coverage for a broader range of services. Additionally, advocating for policies that promote value-based care and incentivize outcomes over volume could help align reimbursement with the goals of home-based care, fostering its sustainability.
Brenden Hayden, Chief Operating Officer at Estella Health
Mobile Integrated Health (MIH) teams (typically paramedics) are currently compensated through relationships with health systems or third-party managers of Hospital at Home programs. While this model is a step in the right direction, I would advocate for CMS to develop a payment structure that covers ALL MIH care delivery, including Hospital at Home, so as to fairly compensate and track the progress of this emerging EMS specialty. MIH has already demonstrated its ability to decrease hospitalizations, improve outcomes, and produce exceedingly high patient satisfaction. Let’s create a payment structure to support continued growth and improved outcomes in the future.
Joe Perekupka, CEO at Freespira
Unfortunately, healthcare at-home reimbursement is lagging significantly behind in-person medical visits. This is a major barrier to greater adoption and utilization. Specific to behavioral health home treatments provide several advantages over the traditional treatment paradigm including broader access to much needed care, earlier intervention than the traditional treatment paradigm, and significant short-term and long-term cost savings. Broadly speaking, at-home treatments will reduce costs and improve care for all patients.
So many good insights here! Huge thank you to everyone who took the time out of their day to submit a quote and thank you to all of you for reading this article! We could not do this without all of your support. What do you think the advantages and challenges of healthcare services at home are? What are your thoughts on the costs of these services? Let us know either in the comments down below or over on social media. We’d love to hear from all of you!
