In Q1 of 2018, we saw major news coverage on strategic announcements from powerful companies expanding their footprint into healthcare. One example garnering national headlines is the Amazon, Berkshire Hathaway and JPMorgan Chase news. The alliance between these mega companies was built to provide more affordable health insurance to their employees.
With far less media attention, but equally interesting, are the rumblings around Verily—formerly known as Google Life Sciences. According to CNBC, Verily may be in talks with health insurers to jointly bid for contracts servicing hundreds of thousands of patients. Through the potential partnerships, Verily would share the risk of the contracts with the insurers already in the marketplace, as well as potential savings that could be achieved through the use of their technology in servicing the insurer’s customer base.
One way to achieve these savings is by identifying patients at highest risk through the use of data analytics. These patients stand to benefit the most from the early intervention of a health care provider (HCP)—such as a nurse, who can offer home care to help them adhere to treatment, achieve better health outcomes and avoid a crisis that will send them to the emergency room.
Why the trend to make the home the center of care?
The search to make healthcare more affordable has resulted in the adoption of care models that finally place patients at the center of care. This includes providing health services where patients need them—at home. The tools powered by the new technologies now widely available to patients and providers can make this a reality. These tools include platforms that make telehealth, telemedicine and remote patient monitoring not only theoretically possible, but achievable.
Payers are recognizing that moving health care services to the home not only drives costs down, but enhances patient services and improves outcomes. However, for the new model to work we need to be more thoughtful about what must happen before and after patients leave the hospital.
What needs to change for the home to be the center of care?
Four aspects require special attention from the industry if we want to change the post-acute care model to service patients at home.
Deeper, more sophisticated analytics
Identifying at-risk patients before they develop complications will help us anticipate their needs before they happen. This will also get them where they want to be—at home—improving their outcomes and reducing costs for providers and payers.Machine learning and artificial intelligence are helping us achieve this goal. These will only get better as we continue to refine the tools while leveraging richer and more comprehensive patient data that will make us smarter and better at identifying risks earlier.
In-home monitoring with real-time intervention
Monitoring patients remotely and feeding their data to HCPs in real-time is critically important.As in-home healthcare services continue to develop, technology and cost-saving measures allow greater numbers of seniors to get the services that they need at home while avoiding institutional care facilities. This is only possible when fail proof monitoring is in place—this is the key to delivering results and peace of mind.
Payment and benefit reform
The Centers for Medicare & Medicaid Services (CMS) recently approved the use of certain codes to cover telehealth services and decrease the burden on the physicians billing for these services. This allows for the reimbursement of services that don’t occur in face-to-face patient interactions, including various psychotherapy services, counseling services, interactive complexity, administration of health risk assessments, and assessments for patients requiring chronic care management services.The American Medical Association has been pushing for these changes through their Digital Medicine and Payment Advisory Group (DMPAG) which supports CMS’ adoption of telehealth codes along with the unbundling of remote monitoring payments to integrate digital medicine services into physician practices. Over time, we also need payers to design benefits that incentivize care in the home.
It’s no secret that the U.S. doesn’t have enough health care professionals to meet the demand of a growing and aging population with increasingly complex needs. Nurses are one of the providers in most demand, so licensing reform is needed to make sure these professionals are available to deliver the best home care options for patients everywhere. Legislative measures that allow professionals to operate at the top of their license—practicing to the full extent of their education and training—are part of the solution to address the need and remove this obstacle.