Bringing Care Delivery Back to the Home

A patient we will call Sam starts experiencing a strong, persistent cough – followed by a fever. He takes an over-the-counter pain reliever and then realizes he’s having trouble breathing.

Instead of calling 911, Sam picks up his smartphone and opens an app from his healthcare provider. In moments, he is video chatting from home with a healthcare professional. After assessing symptoms, it is determined this is in fact an emergency – most likely pneumonia – and Sam is recommended to visit the emergency department.

When Sam arrives, his care team has already been briefed from Sam’s virtual pre-visit and is prepared to treat him. Pneumonia is confirmed, but instead of setting Sam up for a multiple day inpatient stay, his care team decides to discharge him – but not before handing him take-home tools to help him self-treat his pneumonia. Sam receives a fully loaded tablet, containing everything he needs to make a full recovery, such as a care plan and communications tools – which he’s taught how to use by staff before his departure. Sam is free to make his recovery at home, while in close contact with nurses through use of the tablet.

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In their latest report, Healthbox, a HIMSS Innovation Company, examined the substantial increase in outpatient healthcare delivery over the last two decades and predicted an even more significant shift outside of traditional care settings.

“Healthcare used to be about episodic, individual events where you went to the doctor’s office every six months, or you got hospitalized periodically for surgery or illness,” said Eric Louie, MD, chief medical officer at Healthbox.

“Right now, the way that a lot of patients think about their health is that you go to the place where everything can be solved: the emergency department,” added Neil Patel, president of Healthbox and executive vice president for HIMSS. “It’s not to say that we should never go to the emergency department, but that we should only go when it is appropriate to do so. Importantly, patients need to have access to alternatives.”

What’s Driving the Shift Back to Home Care?

Sometimes, embracing old norms isn’t such a bad thing. Healthbox identified three trends contributing to the reemergence of care delivery in the home:

1. The Aging Population

The silver tsunami headed towards healthcare puts a lot of pressure on healthcare professionals to start preparing for future care delivery in this population, and quickly. Dr. Louie ties in an interesting fact with this trend: “In Western society, the social fabric that used to support the elderly is declining; extended families just plain don’t exist anymore. And so we have to think about the challenges the elderly face without having the appropriate care or an infrastructure to support their ongoing self-help.”

 

2. The Transition to Value-Based Care

This transition’s doing a whole lot more than driving reimbursement. It’s also prompted health systems to completely realign priorities, putting more consideration on quality and reducing costs of outpatient care.

 

“We’re so deep in this sometimes, that we just look at all the problems – and sometimes, you have to take a step back and look how far we’ve come in just the past hundred years, with respect to the amazing care we receive in hospitals and homes today,” said Patel. “We just have to focus on the right things, like how do you change incentive mechanisms to drive care to the right place at the right time, with the right level of care – while helping people understand what it means to be healthy and what things they can do to take ownership of their health.”

3. Increase in the Consumer Focus

Patients are becoming more and more empowered as healthcare becomes more consumer-centric. They have more power than ever over where, when, how and from whom their care is delivered. “In one of our previous reports, we learned that over 325,000 health-focused applications were available to patients and consumers by the end of 2017,” stated Jessica Baker, innovation consultant at Healthbox. “As consumers get more and more power, we really need to improve the value of the care, reduce the costs with democratization of healthcare data and with technology that allows patients to look at the types of care they should be receiving – even monitoring or diagnosing themselves. This is pushing us towards rethinking the way that patients interact with healthcare systems.”

 

Maintaining More Focus on the Patient

Citing an analysis of a recent American Hospital Association Annual survey, Healthbox shared that over the past 20 years, 9 percent of total health spending in the U.S. has shifted from inpatient to outpatient.

“What’s happening now is we’re getting more patient-focused,” said Dr. Louie. “We’re realizing that this isn’t just about the science of medical care – it’s about what the patient cares about. What are the patient’s reported outcomes? What are the experiences that they want to have as a result of that healthcare?” This opens up potential for new kinds of technology that are truly optimized around patient-centered outcomes, which is what Dr. Louie says will really “flip the paradigm.”

“Often times we’ll say that we need to build technology into existing workflows. That’s not always the case,” said Patel. “Maybe the existing workflow isn’t set up to deliver care how it should be.”

“If you’re going to ask nurses or physicians to change the way they’ve been trained to do something, you need to figure out what motivates them at an individual level,” Patel continued. “If we’re truly hoping to see wide-scale adoption when technology is the right answer, we need to look at it at a more personal level.”

In terms of a personalized environment, delivering care in the home opens a wide realm of possibilities for patients. With the potential for better outpatient outcomes than inpatient, there’s no place like home to empower patients with their own healthcare maintenance.