Advisory Board recently convened and collaborated with 15 senior executives from across the health care industry to explore the present and future state of home-based care. Leaders discussed how cross-industry partners can create sustainable models to lower costs, improve outcomes, and ensure equity. Throughout the conversations, breakout sessions, and guided activities, we heard a diverse range of perspectives. Here are our top takeaways from the event:
1. There are a lot of open questions—especially around reimbursement for hospital-at-home
One thing that stood out in our discussions was how many aspects of home-based care are currently unresolved. How can we solve the workforce and capacity challenges? What is the outlook for home-based care versus post-acute care? What do successful partnerships and programs look like? By far, however, the biggest questions our participants are wrestling with revolve around the future of reimbursement—especially for hospital-at-home.
Only recently under the CMS Acute Hospital at Home Waiver can hospitals receive inpatient, fee-for-service payment for acute level care to Medicare beneficiaries in their homes. So, many are wondering if the waiver will extend past the public health emergency (PHE), or if there will be an alternative solution.
Also, many participants are looking beyond fee-for-service and are closely following how the adoption of value-based care could further home-based care. Participants understand that creating a better and more efficient care delivery model is an effort towards better population health management.
Despite the ambiguity, there is pragmatic optimism around the variety of home-based care models and what services can be offered in the home. It's also evident that reimbursement is not a cure-all. To pave the way to success, home-based care providers and their partners will have to think about what they have direct control over, especially as it relates to the patient's journey.
2. Moving care to the home will have ripple effects across the industry
Stakeholders across health care have coalesced around the promise of home-based care to create positive changes like reduced spending and improved health outcomes. But it's important to remember that as care moves to the home, it can also dramatically change care delivery patterns.
Home-based primary care, for example, not only changes where and how patients receive their primary care, but also may impact downstream hospitalizations, post-acute care utilization, and specialty care needs. So, while home-based care has the potential to improve patient care, it may also create winners and losers among existing stakeholders.
Along with these ripples will come additional challenges. Compared to the hospital or office environment, caring for patients at home requires longer visits and smaller clinician panel sizes. Home-based care clinicians see, on average, just five to seven patients a day. Providers will need to implement strategies to address this, one of which can include a virtual strategy that combines in-person and remote visits to help providers see more patients in their homes—and in a way in which they prefer.
3. Leaders are looking to technology to solve challenges
During the day, we heard about several ways participants were hoping to seamlessly use technology to solve challenges in home-based care, especially staffing, monitoring, and communication issues. We discussed some specific use cases including:
- Staffing: How can we use a combination of telehealth visits and in-person visits to create efficiency around how many patients a nurse or clinician can see?
- Monitoring: How can we better capture and share patient data to detect early patient deterioration and predict outcomes?
- Communication: How can we use communications platforms to better explain and manage a patient's care plan, especially for older adults?
Answering these questions becomes even more important as leaders look to scale their programs to treat more patients with chronic illness and higher-acuity conditions. Although stakeholders are hopeful that technology can address these challenges, they also recognize the downsides: algorithms can exacerbate existing health equity issues, disparate devices don't always seamlessly integrate into the EHR, and there is clinician and staff wariness of new workflows.
4. We should be thinking about how to partner with—and bolster—traditional home health care
Participants recognized that there are unique opportunities for Medicare-certified home health providers to partner with programs like hospital-at-home or home-based primary care. Home health providers can offer staff support and services for models that don't already have these in place. Many of the components are already there. Home health agencies can provide pharmacy, infusion therapy, durable medical equipment, and special staff such as therapists or social workers.
Traditional home health providers should also be thinking about how to potentially bolster their current capabilities. Patients are typically much sicker in hospital-at-home than for home health, and agencies will need to be ready for that difference. Congestive heart failure, wound care and COPD are all areas where home health needs to improve clinically to be a strong partner in hospital-at-home. If they can bolster their capabilities, they might even be able to take patients directly from the ED, which could be better for the patient in hospital-to-home situations.
Our team will continue to publish research related to home-based care. Make sure to subscribe to our strategy, planning, and growth topic page to receive emails when the research is released.