By Jeff Moser
The shift to care at home is markedly expanding with double-digit growth forecast over the next decade in evaluation and management, home hospice, and home physical and occupational therapy. While that shift is largely viewed through the lens of patient preference and satisfaction — which is, of course, the primary concern of any provider — there are several other benefits that make it a value add for healthcare organizations, including shorter length of stay, cost savings, health equity and even supplier innovation.
It's important to note that opportunities for care at home exist beyond the oft-discussed high-acuity care — in fact, solely focusing on acute care at home can be a much heavier lift for health systems, as it requires the most in-person delivery. To harness the greatest success, providers should focus on four primary categories, many of which can be highly leveraged through virtual and telemedicine:
- On-demand care: Encounter-based, low-acuity services such as lab at home, direct-to-consumer testing and urgent care at home
- Acute care: Hospital-level care such as observation at home and hospital at home
- Chronic care: Longitudinal low-acuity care management services over short or long timeframes, including primary care at home, mobile integrated health, oncology at home, dialysis at home and infusion at home
- Continuing care: Restorative and recovery care such as skilled nursing facility (SNF) at home, rehab at home, hospice at home and palliative care at home
Though there are obvious differences among these four categories, the overarching strategy is the same: reducing total cost of care and improving quality. Regardless of the reimbursement model, care at home is more efficient to deliver with invariably higher rates of patient satisfaction. For example, roughly 94% of Medicare recipients favor receiving SNF at home versus a facility, 61% of consumers prefer receiving inpatient hospital-level care at home, and one U.S. hospital recently earned 100% "would use again" patient satisfaction scores for home infusion.
Sg2's Impact of Change anticipates an 8% increase in hospital inpatient days due to chronic disease, and the national year-to-date average length of stay was 9% longer by October 2022 compared to the same period in 2019.
Length of stay
The current interest in developing care at home programs is in large part driven by tight inpatient capacity and rising length of stay. Sg2's Impact of Change anticipates an 8% increase in hospital inpatient days due to chronic disease, and the national year-to-date average LOS was 9% longer by October 2022 compared to the same period in 2019. The average length of stay for patients being discharged to any type of post-acute care provider has increased nearly 24% from 2019 to 2022 — meaning health systems must consider increased investment in care-at-home initiatives to safely speed discharge out of the hospital setting and to limit avoidable admissions. Failure to establish some level of care at home will likely result in hospitals finding themselves in an even worse financial position in the future.
Of course, it's those same margin pressures that make it challenging for healthcare organizations to launch new programs. Two approaches to consider include tapping into pre-existing traditional home health models (to build on the infrastructure and workforce that can enable more extensive programming) and partnering with market-disrupting vendors that can provide everything from labor to education to data. Think of these partnerships as "plug and play" — they're quick wins in speed to market and addressing infrastructure gaps.
For healthcare organizations, 2022 was the worst financial year since the start of the pandemic, with prolonged expense increases and 11 months of operational losses resulting in approximately half of U.S. hospitals ending the year with a negative margin.
The expansion of care at home programs represents a crucial opportunity for cost savings. Acute care at home, for example, reduces direct costs by 10-40% compared to facility-based admissions. These programs also positively impact readmissions, with data showing that hospital at home readmission rates are approximately one-third of those found in traditional in-hospital care. Meanwhile, chronic care at home reduces admissions and readmissions by increasing access to preventative care, particularly through virtual visits. The avoidance of hospital admissions often equates to reduced ED visits, creating further savings.
Take, for example, one Midwest-based health system's experience in expanding its hospital at home footprint. By building on the capabilities it already had in place — including remote patient monitoring, home health and virtual care — the system's newly launched program resulted in:
- 3.6% ED utilization compared to 7% for traditional hospital patients
- A 30-day readmission rate of 5.6% compared to 12.9% for traditional hospital patients
Similarly, another Midwestern system saved 3,000 bed days and saw a patient satisfaction rate of 92% with its hospital at home program.
The current financial environment illustrates the need for short-term revenue gains and cost reductions that care redesign can deliver. Not only do care at home services increase an organization's access to care and inpatient capacity for those receiving high-revenue procedures, but the popularity of these programs helps to attract new patients and retain existing ones.
More than 25% of Americans say an unmet social need prevented them from accessing healthcare in the past year, with roughly 3.6 million people citing lack of transportation as the primary reason they forgo medical care. Add to that the 13% of the over-65 population that are homebound and the value of care at home for better health equity becomes crystal clear.
Care at home allows providers to adapt treatment plans to the patient's daily environment and address living conditions that impact patient health. For instance, 44% of high-needs adults reported delaying care because of a lack of transportation or inconvenient office hours, and one in four consumers would be willing to switch to a PCP who uses telehealth.
Even consumers who don't fall into the high-needs classification see care at home as the more accessible avenue for treatment — and expect the option to be provided. That's why many systems are pursuing care at home programs even if they aren't experiencing capacity constraints. In a healthcare system that's increasingly defined by consumerism, the potential for greater patient loyalty cannot be ignored, nor can the opportunity to ensure every patient has equitable access to healthcare.
The success of care at home is enabled by foundational elements including virtual and remote monitoring capabilities, a strong digital platform, and the portability of crucial medical technologies. At last year's Vizient Innovative Technology Exchange, more than 50 suppliers displayed 70 technologies, including respirators and MRI machines that were more compact and mobile than previous iterations. There also were several innovations in remote monitoring, artificial intelligence and automation — all designed to meet increasing patient demand and provider needs.
After all, a robust digital strategy is crucial to the success of any care at home program, and partnerships with cutting-edge vendors can help hospitals develop an effective virtual triage/digital platform and remote patient monitoring. Accelerated by COVID-19, RPM technologies are growing in popularity by enabling improved patient outcomes and reduced costs. Such technologies — including devices such as continuous glucose monitors for diabetes patients and digital blood pressure monitors that send blood pressure and oxygen levels straight to physicians — are projected to be worth over $1.7 billion by 2027, up nearly 128% from the $745.7 million opportunity the market currently represents. What is vitally important for both hospitals and their supplier partners to consider moving forward is the continued creation of individualized remote monitoring experiences, which will increase patient adoption of these technologies.
Care at home is also driving an uptick in portable imaging technologies such as MRI machines. Traditional MRIs can often be unaffordable — and difficult to access, particularly without reliable transportation — for low-income patients. But portable MRIs offer the same services at a lower cost and are able to be carried into patients' homes. The global portable MRI market is estimated to increase annually at a compound annual growth rate of around 6.82% over the next seven years.
The increasing shift to care at home also presents opportunities for provider and supplier collaborations, particularly in areas in which gaps have been identified. Perhaps it's the creation of hospitals' "digital front doors," including the digitization of educational materials that are currently only available at in-person visits. Any area in which a supplier can help make a care at home program more efficient, effective and scalable is a prime avenue for innovation.
The Future Is Now
Care at home is no longer about "wait and see" — it's about "time to act." While there are challenges that must be considered, ranging from workforce to technology to infrastructure, it is critically important for health systems to devise a strategy to implement care at home programs to meet consumer demand and reduce cost within their organizations.
This article was originally posted by Healthcare Business Today.
About the author
As a thought leader on the shift to value-based care, Jeff Moser helps healthcare organizations understand the implications of both macro- and microlevel emerging trends impacting healthcare. He plays a key role in the development of Sg2 Intelligence resources and educational offerings and is a frequent presenter and educator on multiple topics, including healthcare reform, consumerism and patient engagement, ambulatory strategy and leading practices in care redesign. Moser has more than 20 years of healthcare advisory and consulting experience, with specific areas of expertise including strategic planning, process improvement, operational effectiveness and organizational change.