Redirecting care from long-term care facilities to the home would generate significant savings while improving clinical outcomes and increasing patient satisfaction. Unfortunately, the essential contributions offered by home care providers are often poorly understood.
The scope of the problem
There are $100B+ worth of wasted resources that could be saved by improving care coordination and reducing unnecessary acute care. More efficient care coordination could prevent 25 percent of readmissions. More than one-fifth of patients could go home directly from acute care facilities and as many as 47 percent of Medicare beneficiaries are sent home from the hospital with at least one unmet need related to activities of daily living. Effective home care is a solution to this problem.
The case for care at home
An increasing body of evidence suggests that care at home is financially advantageous. For example, an April 2018 study in the American Journal of Medicine found that discharge from acute care hospitals with home health care produced substantial reductions in utilization and decreased risk of hospital readmission and death. The authors observed:
“… significant financial and clinical benefits associated with hospital discharge to home with home health care relative to discharge home with ‘self-care’… [H]ome health care was associated with a mean savings of $6,433 per patient and significantly reduced the rate of readmission and death.”
A 2017 study in the Journal of the American Medical Association found that the use of inpatient rehabilitation for knee replacement compared with a monitored home-based program did not improve mobility at 26 weeks after surgery. The findings suggested that home care was just as good as inpatient rehabilitation in terms of clinical outcomes.
Challenges and barriers
Much healthcare spending can be attributed to care that is chaotic, confusing and wasteful: 50 percent of readmission expenses are spent on patients discharged from hospital to home without plans for post-acute care; 30 percent of patients discharged without physician orders would nevertheless benefit from post-acute care services. There are a number of systemic barriers that give rise to this phenomenon.
Common barriers for home services include confusion on the part of providers and discharge planners; who is supposed to write the discharge orders? The doctor? The nurse practitioner? Other barriers involve chaotic communication, lack of coordination and wasteful transition processes.
Preparing for the future
To meet these challenges, we must have a stronger, more compelling voice among physicians, providers, payors, government and patients. Together, we must amplify our critical role in the future of healthcare and work together to showcase the essential function of home health.
We must continue to use leading analytics to reduce the small number of bad actors in our industry who perpetrate fraud and generate waste. We must use data and analysis to prove the tenets of value-based care, and push for new, fair reimbursement mechanisms that recognize our role in improving outcomes. We must help ensure that no patient goes “home alone” if they would benefit from home services.
The future of healthcare will transition from episodic to continuous care. Today, care is low-frequency, acute-care focused and centered in brick and mortar institutions. Tomorrow, care will be continuous, connected, virtual, on-demand, and synchronous.
The current unidirectional nature of healthcare delivery (doctor to patient) will transform into a multidirectional system. Today, care plans exist along a single thread, with accountability only at the point of care. Tomorrow, consumers will be more informed and caregivers will be more accountable. Care will be team-based and interoperable.
Healthcare in the future will transform from the generic to the specific. Currently, care delivery is one-size-fits-all, and data is isolated in silos at single points in time. Eventually, care will be scalable and dynamic. The patient experience will become humanized, at long last.
The challenge to realizing these goals involves, among other things, harnessing technology. How will we engage with patients, plans, and other providers? How can we leverage technology to discover what patients really want and need? In this endeavor, we have a responsibility to educate all stakeholders in this evolving market.
We must remain open to the introduction of innovative technologies. Let us consider alternative payment methods. Let us embrace the “wearables revolution” and the exploding markets in cell phone-based health-related applications.
Finally, it is appropriate to remember that originally, health care was delivered only in the home, largely because acute-care hospitals did not exist. We have the opportunity now to return health care to its original location.