Tom Sullivan | July 15, 2020
Forward-looking CEOs have been brandishing phrases such as “the future of the hospital is in the home,” for some time now. And with so many digital tools and apps that enable mobile or remote modes of care, the shift to more health care taking place in the home was already underway in various forms.
During this pandemic, home-based care has a new sense of urgency given that so many people are essentially at home much of the time. That includes those with multiple chronic conditions at risk of suffering from health debt if they postpone care either due to fear of the pandemic or because their providers are operating at capacity.
“We are seeing digital enablement bursting. We’re seeing retailers get into health care and advanced primary care providers do a range of things in the home,” said Mary Langowski, Interim CEO, Solera Health and CEO of Rising Tide. “All of this is enabled by reimbursement infrastructure and a payment infrastructure that is beginning to provide incentives to recognize that care in the home may make a lot of sense.”
Langowski served as host in the Health Evolution webcast Home-based care: New models and new evidence. Joining Langowski were Kirk Allen, SVP of Home Care, Humana; Sarah Iselin, EVP Government Programs and Diversified Business, Guidewell; and Bill Miller, CEO, WellSky.
While COVID-19 has accelerated the use of tools such as telehealth and remote monitoring, the need for home-based care will continue beyond the pandemic, the experts agreed, presuming incentives become properly aligned.
A ‘pivot moment’
In combination with the rising costs of health care, widely believed to be unsustainable even before the pandemic, the ongoing economic recession will continue straining the industry into the future. As such, payers and providers will look to home-based care as a potentially less expensive option to in-person visits when possible.
“It’s this tricky kind of pivot moment around how do we enable the industry?” Guidewell’s Iselin said. “How do we change incentives to enable the industry to really respond with better patient experience and more efficient care?”
Innovators and investors have also been developing interest, WellSky’s Miller said.
“Now that the health care horizon is really reaching into the home and into intimate parts of consumerism, it’s intoxicating to investors to try to go figure that out and unlock it,” Miller added. “It is creating a lot of capital flowing toward this, which will improve what people get paid and will improve the talent. Capital is actually going to continue to get concentrated just by a function of scarcity in health care.”
That, in turn, will help to establish the infrastructure necessary for broader home care. But home-based care will not magically be solved by an app. Much of what the care delivery system does is in response to financial incentives, in fact, is set by payers. The expert speakers predicted that one or two payers will move first on proactively establishing home care programs in partnership with providers and the others will follow their lead.
“If everyone takes the long term view about what’s best for a patient and best for a member, and what really is driving a value-based service, I think you end up with an increased emphasis and focus on the value of what happens in the home and outside of facilities,” Humana’s Allen explained.
When considering the promise to address the inefficiency in health care, Guidewell’s Iselin said that the industry needs to be careful to both improve efficiencies and create better consumer experiences.
“As money flows in, we have to be the keepers of the gate making sure that it flows in a way that is smart and that creates more affordability and doesn’t just end up running up prices,” Iselin said.
Will home care work when the pandemic is behind us?
The business test for home-based care will be decided on whether it increases access, reduces costs, improves care quality or, ideally, a combination of all three.
Currently, having too little data about downstream claims makes it difficult to solve cost issues, Langowski said, let alone improve outcomes — and that’s only going to become more difficult in the near future.
“We’re going to see pressure from the rising number of uninsured people like we haven’t seen in terms of these publicly subsidized programs, the ACA Medicaid programs, and we’re just going to create even more pressure around the growth in healthcare costs,” Iselin said. “That’s an incredible opportunity because it’s going to create alignment across all of these people who pay for health care to really make it imperative to think about things differently. And so, I’m really optimistic that we’ll be able to use that to get some real step function level change and progress.”
Allen added that predictive analytics will be the holy grail for providers and payers when they can be leveraged to apply an intervention and avoid a hospitalization, but the best models right now are only about 60% effective. If providers and payers “can align around the data we can take risk together,” he said.
Payers and providers being transparent with data will also help everyone understand whether extending care into home is truly making the downstream impact it appears to have.
All of which means that challenges exist alongside the opportunities for substantive change to the health care system.
Whether conducted via remote monitoring, telehealth, video conferencing, apps, or other digital tools, home-based care is not just about COVID-19. It will continue to be instrumental as we learn to live with the coronavirus and, ultimately, there’s at least some reason to hold out hope that virtual care will be a key component in a future health system that is stronger and more equitable.
And with the industry likely to face widespread concern regarding consumers coming back into brick-and-mortar facilities to receive care, the acceleration of home care that occurred during the pandemic will likely continue for the foreseeable future.
“I wouldn’t wish this on any of us ever again. However, for those of us who believe that home-based care is an alternative and should be reimbursed in some capacity, maybe we needed a revolution for the evolution to happen,” Miller said. “It is sticky. I don’t think the genie is going back in the bottle.”
Watch the on demand recording of the Home-Based Care – New Models and New Evidence webcast here: