In recent years, a slew of models have been developed and tested for providing care in the home: home and community-based services, long-term services and supports, palliative care, hospital-at-home care, skilled nursing facility care, and even emergency department care at home. However, the challenge of creating an integrated spectrum of care that is centered around the patient in their own home remains unsolved.

HBHI brought together a group of experts working in the field to share what they’ve learned in their years of experience designing and implementing home-based care programs. The panel, moderated by Bruce Leff, MD, Professor of Medicine at Johns Hopkins, included Ali Khan, MD, MPP, FACP, Vice President and Chief Medical Officer – Aetna Medicare, Aetna/CVS Health Company; Eliza Pippa Shulman, DO, MPH, Chief Medical Officer at Medically Home; and Kristofer L. Smith, MD, MPP, Past-Chief Medical Officer at Optum at Home.

Here are 8 insights about the future of providing medical care at home:

  1. We’re still in the early stages of creating a full spectrum of home-based care. Providers are still struggling to address certain persistent gaps in the system. For example, acute needs still lead patients to end up in the emergency room, which defeats the goal of avoiding care transitions. “Often patients in home-based care programs have an acute need, and we end up sending them into hospital because there isn't a way to respond,” said Shulman. “So, one of the things we’re thinking about as we evolve is: how can we respond across a continuum?”
  2. The potential impact on patient outcomes is huge. The implications of a truly comprehensive home-based care system will affect a population far beyond the typical homebound patients. “Home care, by definition, is the omni-channel that we actually need, right? It is a mix of digital, analog, and shoe leather care that seeks to become a single source of truth. It's the kind of care we all want for our parents and grandparents, put very simply,” said Khan.
  3. Careful weighing of patient eligibility is critical for making the economics work. Several companies entering the space have mistakenly sought to serve too broad of a patient population when the appropriate cohort of patients needs to be comprised of individuals with high levels of medical expenses to make the potential cost savings work. “The ‘for who’ part is incredibly important. If we get the wrong patients in, we won't have a financially sustainable model,” said Smith. “It's very nice for consumers, having the expectation that you can call and be seen in the home on demand for low-acuity issues, but I don't think it's the right expectation to be giving to the general public,” Shulman added
  4. We should broaden our thinking on who’s qualified to address patient needs.
    To help stretch the available workforce, non-clinical staff like paramedics and community health workers can take on a wider range of care coordination, patient education, and basic clinical tasks. “If we don't broaden that workforce, and we don't think about this differently, we are just creating the same shortages and the same burnout problems that we have in our brick-and-mortar facilities,” said Khan.
  5. The potential burden on the family requires careful consideration. Panelists noted that certain types of interventions that once seemed promising, such as home dialysis, have been discontinued because they proved to be overly complex and burdensome on patients’ families and caregivers.
  6. Gathering real-time data remains a significant challenge. The current systems rely on retrospective information, making it impossible to accurately assess patient risk and need at the moment. “We often lack real-time data to truly assess someone's risk at the moment, and that lack of ability to stratify well in the moment becomes a big challenge for what we're up against,” said Smith.
  7. The profit model must become more predictable to get the health system's buy-in. Several panelists discussed how the lack of predictable financial returns is a major barrier to progress, as healthcare leaders are hesitant to disrupt revenue streams without a clear business case. “If decanting patients from facilities is not part of their future business plans, then you're not going to win the game,” said Shulman.
  8. Despite the challenges, a new paradigm is possible. By creating buy-in with clinical leaders and sharing evidence of repeatable successful outcomes, even the largest health systems can and will shift to adopt home-based care models. “Sometimes we get really cynical, but traditional health systems are not beyond hope,” said Shulman. “Just pushing past the status quo is the biggest hurdle.”

Watch the full conversation here.