Missing links in the healthcare-at-home movement

Before COVID-19, virtual visits were more of a novelty than a norm. “Adoption hovered in the low single digits — around 3 to 6%,” shared Dr. Peter Schoch of Kno2 during his presentation at ViVE 2025. Most people hadn’t tried it, and many providers weren’t set up for it—even though the tech was there. Red tape, poor reimbursement, and disconnected systems made it hard to scale.

Then the pandemic hit. Practically overnight, everything changed. Virtual visits skyrocketed — hitting 60% in some health systems during peak pandemic years. It wasn’t just out of necessity — regulations loosened, reimbursements improved, and cross-state licensing barriers fell away. Suddenly, it became easy and worth it to offer care online. The shift revealed that when you remove the roadblocks, people want virtual care.

The promise of virtual care and healthcare-at-home is compelling: deliver hospital-level or longitudinal care in the comfort of patients’ homes, reduce overhead costs, improve patient satisfaction, and close gaps in access — especially for rural, elderly, or mobility-limited populations. And during the COVID-19 pandemic, that promise accelerated into action. But now, as we attempt to make healthcare-at-home a permanent part of the care delivery system, serious roadblocks remain.

Infrastructure: Home is not a hospital

While the technology to support remote care exists, the physical and operational infrastructure needed to treat patients at home is still lagging.

“You can’t just deliver a hospital bed to someone’s apartment and call it a care model,” said Dave Zimmerman, COO at Inbound Health at ViVE 2025. “You need an entire chassis — logistics, staffing models, EMR access, safety protocols, supply chains — all designed around the home environment.”

This infrastructure must also be interoperable with existing health systems. If data from a hospital-at-home episode can’t be accessed by a patient’s primary care provider or specialist, continuity breaks down.

Payment models haven’t caught up

While CMS’s Acute Hospital Care at Home waiver was a game-changer during the pandemic, its future remains uncertain. Without reliable reimbursement structures from both public and private payers, providers are reluctant to scale home-based programs.

“Payment models are foundational,” Zimmerman noted. “You can’t scale what you can’t sustain.”

Risk-based models offer a potential path forward—where health systems are reimbursed based on outcomes rather than site of service—but uptake is still uneven across states and health plans.

Workforce challenges: Right talent, right training

Healthcare-at-home changes not just where care is delivered, but who delivers it and how. Clinicians trained in hospital workflows aren’t always equipped for the improvisational, solo nature of home-based care.

“There’s something deeply meaningful about seeing a patient in their home,” said Dr. Lucas Goleb, Chief Medical Officer of Matter Health. “But it’s also a shift in mindset. You’re no longer walking into a controlled environment, you’re stepping into their world.”

That shift requires new training models, flexible licensure rules, and clearer career pathways to retain clinicians who choose this kind of work. It also requires support roles—dispatchers, virtual nurses, logistics coordinators—to ensure clinicians don’t burn out doing everything themselves.

Related Content: CompassionIT – Starting with a May 20 virtual summit on embracing innovation with empathy, DHI’s special focus on the evolving relationship between compassion and technology in healthcare includes articles and special events.

Data integration and interoperability

If healthcare-at-home is going to work, data can’t stay stuck in silos. Today, too many home-based visits live in separate platforms or third-party vendor systems.

“Did your primary care doctor even know you had that virtual or at-home visit?” Dr. Goleb asked. “Did they have any of the information that came from it?”

Without interoperability — true bidirectional data exchange — patients may end up repeating tests, missing follow-up care, or falling through the cracks. National frameworks like Carequality and TEFCA offer hope, but adoption is still patchy, especially among smaller home-based care providers.

Standardization without overreach

Another missing piece is a shared definition of quality for care-at-home. What does “good” look like? How do we know patients are getting safe, equitable, and effective care outside the hospital?

The field risks two extremes: rigid regulation that crushes innovation or unchecked variability that undermines outcomes and trust.

“To scale this nationally, we need standards,” Zimmerman said, “but they have to be flexible enough to allow for local adaptation and clinical judgment.”

Tech access and digital literacy

The tech gap is real—and not just for patients. While younger, urban populations may find app-based monitoring easy, many seniors or lower-income households lack internet access, devices, or the confidence to use them.

Bridging that gap will take education, human support, and the willingness to meet people where they are (sometimes with a phone call instead of a Zoom link).

Culture and trust

Perhaps the biggest hurdle is cultural. For decades, the hospital has been the symbol of serious medical care. Asking patients and providers to accept that high-quality care can happen at home means challenging deeply held assumptions.

“We have to stop treating care at home like a secondary option,” said Zimmerman. “It’s not plan B — it can be plan A. But we need to design for that reality, not just retrofit old models.”

The path forward

The tools to make healthcare-at-home work exist today. What’s missing is alignment: of systems, incentives, data, and cultural mindset.

“Seeing patients where they live isn’t just a logistics shift, it’s a human one. It brings back meaning to medicine,” said Dr. Goleb. 

But meaning alone won’t make the model work at scale. That will take investment, political will, and a commitment to build systems that are as smart and connected as the patients they serve.

Because if healthcare is going home, the house needs to be ready.