The best way to bend the cost curve in the U.S. healthcare system is to shift care from hospitals and skilled nursing facilities to the home. It’s totally feasible from a medical, safety, and technology standpoint to provide all kinds of care at home, including rehabilitation, infusion of medications, cardiac monitoring, and post-surgical recovery. But this shift to the home assumes that the patient’s home is safe, accessible, and spacious enough to accommodate a caregiver, with clean air and reliable utilities. It assumes that other residents –family or non-family– are ready to live with a patient.
These assumptions don’t always hold true in practice, and this is especially so for Medicare and Medicaid patients, who are more likely than those with commercial coverage to have significant medical needs. To date, the absence of suitable home environments has been a major impediment to the realization of the quality, patient experience and cost savings advantages of home-based cared.
But if we use our imagination and look at the world around us, the potential answers are right there for us to see. Only a few years ago the average person would have considered it crazy to ride in a random person’s car or stay in a stranger’s home. But today ride-sharing services like Uber and Lyft, and home-sharing sites like Airbnb and HomeAway have not only entered the mainstream, they have radically disrupted the transportation and lodging industries and have given individuals the opportunity to turn their underused assets into money-making opportunities. Innovators have found ways to ensure quality and increase trust and safety, and have generated many billions of dollars in economic value.
Now, imagine the sharing economy model adapted to home health. Consider the following scenario: A Medicare Advantage member “Mary” has a knee replacement. She is in good health and has surgery with no complications. Based on her medical condition she is eligible to skip the skilled nursing facility and head home. But Mary’s apartment is on the second floor of a building with no elevator, it’s kind of small, and her husband – who’s always been taken care of by his wife, not the other way around– is uncomfortable and unprepared to be in charge.
Meanwhile, after raising three kids, “Jane” and her husband are empty nesters with a nice home across town. Jane worked as a nurse years ago, and while she’s not ready to go back to work, she is looking for some extra income, enjoys helping people, and has extra space in her home. She completes a course on how to care for post-surgical patients, passes an online exam, and lists her services on the equivalent of Airbnb.
Mary’s Medicare Advantage plan contracts with Jane to take Mary in. Jane performs the functions that a typical family member would do – cooking, cleaning, keeping Mary company, helping track medications, notifying the doctor if anything goes wrong – and Mary receives services from physical therapists and visiting nurses sent by an agency. Mary’s husband is free to visit as well. After a week or two, Mary heads home. She rates Jane on various attributes and writes an online review for future patients to see. Mary avoids the SNF, Jane earns an income, and the Medicare Advantage plan saves thousands of dollars. What’s not to like?
As robots and Artificial Intelligence reduce the need for labor in many parts of the economy, there are likely to be more and more Janes out there looking for opportunities like this one. And as the sharing economy expands and people continue to gain comfort with ride-sharing, home-sharing and more, ideas like this one will seem natural.
It’s easy to poke holes in this concept: What if something happens to Mary? Will health plans be willing to pay for informal providers? What if the Mary and Jane don’t like each other, or their husbands get into a fight? What if Jane’s husband steals Mary’s painkillers?
But the economics of these types of arrangements are likely to be very compelling, and the Ubers and Airbnbs of the world have proved that seemingly intractable issues can be overcome when the idea is good enough and when early adopters lead the way.
Yes, healthcare is different and in some ways more complex. That explains why healthcare has lagged behind; but it doesn’t mean ideas like this won’t work.