Preparing for the Shift to Care in the Home

By Matt Phillion

Integrated Home Care Services recently released a report finding growing recognition of and interest in healthcare at home. Roughly 80% of respondents stated that they believe this increase in home care utilization is here to stay. But that confidence doesn’t carry over to preparation and performance: Only 38% said their organizations were performing “very well” when it comes to supporting the home care needs of their patients (60% said they were performing moderately well).

Christopher Bradbury, CEO of Integrated Home Care Services, puts the findings into two camps. “One, we were surprised a bit at how many plan executives are underestimating the magnitude and potential implications of the shift to home care, both the increase in utilization as well as the cost inflation that’s going on,” he says. “And second, we were surprised at the small amount of time many are spending on home care and home care strategies. We do have some really interesting market shifts and dynamics that are going on.”

Those shifts are stark: Not only do we have an aging population, but we have a majority of patients who now want to be and stay in their homes as much as possible when recovering from or receiving care. Add to this capacity restraints, not just at the height of COVID-19 but continuing for post-acute care, long-term care, and more.

“These things are happening that drive increased use,” says Bradbury. “This is a good thing, because as the leading home care benefit manager, we focus on delivering insights to our plan partners and providers that result in better patient outcomes. Our model brings value-based care into the home. Since we conducted the survey, we have seen an uptick in interest across health plans.”

Having the right incentives that offer the right checks and balances, that encourage and enable people to provide and receive care in the home—the industry is doing well with this in some areas, Bradbury says. It’s about approaching the opportunity at the correct moment for the patient and acknowledging when the time isn’t right.

“There are some patients for whom care in the home is spot on, while others need to have more intensive care in a facility, and we need to make sure that all of us contribute to the right care in the right setting,” says Bradbury.

Again, the incentives question comes into play: When someone is receiving care in the home, what are the incentives needed to ensure a home care patient gets the right clinician support and the right kind of care outcomes, regardless of how many visits it may take?

“We also need the right incentives to deliver cost-effective care while also achieving that level of quality,” he says. “And lastly, ensuring an excellent patient experience. That one is the real challenge and opportunity, as transitions in care from the hospital or facility to the home can be complex. And, for the patient, [transitions are] often confusing and hard to navigate on their own.”

Almost everyone has gone through the experience either for themselves or with family members: a medical event like an elderly patient breaking their hip, and the follow-up surgery, rehab, and home care.

“You need a trusted ally, somebody holding their hand, guiding them, working with the many players involved including supporting the physician’s care plan,” says Bradbury. “They might need a home health aide, a nurse, medical equipment—how do you coordinate all that? And how do you ensure that when they’re ready to leave the hospital, they don’t have to wait because one or two or three of the other legs of the stool aren’t ready? When I get home, is it set up for me and has it been coordinated?”

Lessening the administrative burden

The lion’s share of care is still using a fee-for-service model, Bradbury notes, which typically has some siloes between areas of care.

“What we are offering is an integrated model helping to manage the benefits across it all and do it in a coordinated fashion where one person is supporting the discharge nurse, the patient, coordinating that care so you don’t have to wait. It’s not just about integration of care, it’s about timeliness of care and making the transition to the home easy,” he says.

We’ve still got work to do to see the majority of patients experience this kind of care, as most of the industry still operates in traditional fee-for-service models and with multiple service providers, Bradbury says.

“The core principle we’re thinking about is how do we make healthcare easier,” he says. “One way is that coordination. … We need to wrap the care around the patient.”

A second way is to take a fresh look at how we understand and personalize care plans. “We’re there to support the provider’s care plan, and when we get you into the home, [we’re looking at] how do we continue to support that and provide feedback and coordination with physicians and physician offices,” says Bradbury.

Home care can offer unique ways to enhance and maintain the physician’s plan of care through observation. “It’s amazing what you see in the home,” says Bradbury. “What you hear, what you sense, where claims data just provides a sliver of a window for what’s going on.”

Care in the home provides windows into social determinants of health, food insecurities, lack of transportation, any number of factors that can interfere with a care plan. These challenges can often be addressed by educating patients about programs or resources in their communities. “The average patient isn’t necessarily aware of these programs, and it’s a chance to educate and get them engaged,” says Bradbury.

Home health also enables the leveraging of data to support the care plan and the provider and build a greater understanding of what’s going on with the patient. “Whether it’s the comprehensive OASIS-E assessment or things we pick up because we’re spending time in the home, we pick up on things,” says Bradbury. “And with a more integrated, shared-risk model, you’re encouraged and incentivized to look for those additional opportunities to help, to spend extra time and build that connection.”

There’s a real chance to improve care with those at-home connections by picking up on smaller details that get missed elsewhere, says Bradbury. “I go out regularly with teams to visit patients, and those experiences are eye-opening,” he says. “What’s working well, what needs improvement, and what needs the patients have, not just from a clinical standpoint but a listening standpoint.”

These interactions can be extremely simple: Bradbury relates a story about an elderly patient in need of a specific type of walker that happened to come in different colors. The team was able to give her the color she wanted, a burgundy that matched a lot of her wardrobe. “It became an extension of her wardrobe and brought a smile to her face,” he says. “There are clinical aspects to home care, and teaching aspects, but there are small aspects that make a difference in the person’s life.”

But on a more clinical side, another team was able to discover that a different patient with multiple comorbidities was working with an incomplete list of medications. “There’s opportunity to identify things like that, or if they need training with injections, or even hazards in the home that can be improved to make their home a safer environment,” says Bradbury. “Taking the time to listen, hear, sense, can all make a big impact on their lives.”

The future of home care and healthcare

The U.S. is poised to see significant growth in home care not just because of shifts resulting from the pandemic, but also based on technological advances, personal choice, and even capacity constraints for organizations. “We’ve got to be prepared, and that will take a village,” says Bradbury.

Challenges we can anticipate include advances in technology that will require not only cost-effectiveness, but also education for patients to make those technologies easy to use and understand from home. And more technology will enable more data collection, which healthcare must be prepared to process.

“How do we move to better data insights and appropriate data sharing?” says Bradbury. “Each of us has a window: There’s data through claims, through labs, and then the host of other data that exists through observation and other technology. How do we harness it in a way for these individuals receiving care in the home when it can be complex and have multiple players involved in supporting their care?” This requires the right types of relationships between those caregivers, as well as the right technology infrastructure to share information.

We also must consider how to continue to attract people to home care career paths, he says. “Whether it’s nurses, personal care aides, respiratory therapists, physical therapists, we want people to see these can be outstanding career paths not just today but for their whole lives,” says Bradbury.

And lastly, the industry needs to align incentives around delivering great outcomes, experiences, and affordability. “It has to be all of those. As a system, healthcare is still in the early innings of a nine-inning game, but we’ve got to move the game along,” says Bradbury. “Businesses often talk about numbers, but behind every number is a patient counting on us to be their trusted ally to help them achieve their goals in one of their biggest moments of need.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.