Home sweet home: Patients want convenient care options

Editor’s note: This is the first installment of a five-article series that will explore the evolution of care to more patient-centric, virtual, and in-home models.  Additional articles will look at home-based care from various perspectives, including the role of cybersecurity, the impact on home health care workers, the scope of digital tools and devices required, and how health IT officers are leading the healthcare to home charge.

Health care in patients’ homes is not a new concept, but the pandemic amplified demand for such care, and innovative technologies are helping providers offer more virtual and remote services. Improved health outcomes is a mainstay goal of any care model, but surging patient demand for at home care is also driven by comfort, cost, access, and continuity.

Historically, home care patients tended to be older, sicker, and poorer. Thus, a huge portion of care at home has focused on Medicaid and Medicare patients. The most recent Home Care Chartbook from the Research Institute for Home Care (RIHC) reported almost 88% of Medicare home health patients were aged 65 years or older. The chartbook, based on research by KNG Health Consulting, found 45% of Medicare home health users are managing five or more chronic conditions, while only 22% of all Medicare beneficiaries have five or more chronic conditions. Further, nearly half of all Medicare home health users live on an annual income of $25,000 or less, while more than 67% of all Medicare beneficiaries have annual incomes higher than $25,000.

Comfort and convenience

Patient engagement and experience are leading targets for new models of care designed to meet patients where they are.

“Home-based care has the potential to deliver higher quality care and a better patient experience because they can stay surrounded by loved ones, eat the food they like, pets, familiarity of home,” said Laura Rogers, senior director of healthcare strategy for SHI. Further, they can avoid the stress and inconvenience of traveling to a health care facility, parking, navigating the floor plan, and waiting around to be seen. For many older patients, it’s safer and easier to stay at home than head out to a facility.

Reducing the cost and burden of care

Avoiding unnecessary trips to the hospital or doctor’s office can save patients not only time and stress, but also money. Having the cost of home health covered under Medicare and other payers helped boost the number of patients using home care services like telehealth, nurse visits, and remote monitoring. Up to $265 billion worth of care services for Medicare fee-for-service (FFS) and Medicare Advantage (MA) patients will likely shift from traditional facilities to home health care by 2025, according to research from McKinsey and Company.

A recent study by Moving Health Home, an alliance to advance home-based care policy, showed that a bipartisan majority of adults (73% of Democrats and 61% of Republicans) placed a high priority on the federal government to expand care in the home. Legislators have introduced bills (e.g. H.R.2853 – Expanding Care in the Home Act) to protect and expand coverage for home care.

Governments can also help reduce health at home costs via public service or economic stimulus grants, which can be used by healthcare organizations to invest in technologies (e.g. hardware, software, cybersecurity, cloud etc.) that contribute to improving the health of the community.

Improved access to quality care

Removing barriers is also a pathway to health equity, improving access to high quality care for all patients regardless of their social determinants of health (SDOH). Rural patients, who comprise about 9% of Medicare home health users, often have fewer health care choices, especially specialists, in a reasonable driving distance.

The greatest access challenge to technology-driven home care may be techquity, having adequate internet, devices, and knowledge to participate in telemedicine and virtual services. During the pandemic many school districts were able to provide basic tablets (see Microsoft Surface case study) and internet access to students in need. Similarly, devices can rolled out as ready-to-use workplace solutions for virtual care (see pharma iPad case study).

Seamless transitions between facility and home

Recovery is still a big part of home health care, and patients are looking for providers that can facilitate continuity of care by providing a seamless transition from a hospital or other healthcare setting to the home. This would help patients feel confident they won’t fall into any gaps in treatment.

Home health care has a good track record for lowering readmissions. The RIHC Chartbook reported 30-day readmission rates for home health care (average 19-20%) were lower than those for both skilled nursing facilities (average 23%) and inpatient recovery facilities (average28-29%).

Homing in on challenges, success

Patients love the idea of personalized, quality care in their homes, but there are some hurdles to providers successfully meeting this demand. Technology can enable many remote and virtual services, but it can also widen access disparities and create new cybersecurity risks.

Integrating EHRs into virtual and remote care is a big project from a technological perspective, but there is also a heightened challenge to secure this personal health information (PHI) when receiving care at home or virtually.

Tracking patient engagement and satisfaction with home care will help providers gauge the success of these services. Comparing key health metrics — including admissions, ER visits, and readmissions — will help determine the impact of home health care on health outcomes.

As evidenced by moves into primary care by Amazon and CVS, there is increasing competition to meet growing patient demand for in-home, virtual care.  Rogers advised, “In order to stay ahead of the curve, health systems need to determine how they can effectively, equitably, and securely implement home-based care options for their patients.”

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