Living through a pandemic exposed serious flaws in our healthcare system. Hospitals were overwhelmed with sick patients, and fear of exposure to COVID-19 prevented many Americans from getting and seeking needed medical care. However, there is also a silver lining to the challenges the healthcare community faced. The pandemic created opportunities to rethink and re-engineer ways we provide healthcare to ensure everyone has access to high quality, affordable care on their own terms.
One of those approaches is in-home healthcare. While home-based care was already gaining traction prior to the pandemic, COVID-19 quickly accelerated and expanded demand for those services. A report by Milliman found that, since 2020, in-home support services offered by Medicare Advantage plans have grown more than any other supplemental benefit. The reasons that made this option even more desirable during the pandemic will persist long after this public health crisis is over.
Benefits of home-based care
The most obvious benefit of providing care in the home is that it limits exposure to illness and infection, especially among older adults who are particularly vulnerable when cared for in medical facilities. In fact, one in 31 hospital inpatients has at least one healthcare associated infection, with older adults being more susceptible to these risks than younger patients.
For some patients who are homebound, in-home care is a necessity. But for those who are more mobile, home-based healthcare offers convenience and reduces barriers, such as lack of transportation, which is especially important for individuals who have had difficulty accessing healthcare or need assistance with social determinants of health.
Additionally, the home setting is often more conducive to having in-depth conversations and building a more trusting relationships between patients and clinicians, as well as bringing caregivers into those discussions; all important elements for improving health outcomes. Being in the home allows for a much fuller understanding of their living environment and health circumstances, and helps to identify social determinants of health. Being able to identify and address those underlying causes of poor health is critical to improving a patient’s health and well-being.
Another reason, and probably the most important: home is where the vast majority of people want to remain and receive their care as they grow older and confront the health challenges of aging.
Expanded home-based health services
Home-based care has traditionally encompassed care involving non-medical assistance with daily living, as well as short-term nursing care and rehabilitation services following a hospital or facility stay. While those services, provided by companies such as CenterWell Home Health, continue to play a crucial role, especially in the care of seniors, home-based healthcare is evolving to cover a much wider continuum of care including primary, acute and higher acuity-hospital level care.
Home-based primary care
Physician house calls are making a comeback, and for good reasons. This new iteration, based on advances, approaches and evidence, is proving home-based primary care can produce better health and reduce costs.
An analysis of a Veterans Affairs’ home-based primary care (HBPC) program found that patients had high satisfaction with their care. Hospitalizations were 25.5% lower than expected, and fewer exacerbations and emergency department visits were reported. Additionally, Medicare’s Independence at Home (IAH) demonstration evaluating home-based primary care, generated over $100 million in savings over a five year period.
Acute care at home
As COVID-19, RSV and flu packs emergency rooms throughout the country, the case for home-based acute care is even more apparent. Avoiding the ER also reduces the chances of landing in the hospital. With 36.5% of ER visits by the elderly ending in hospitalization, intervening before patients go to an ER can substantially prevent unnecessary hospitalizations. ER at home models, like Humana’s partnership with DispatchHealth and other providers offering acute and emergency room home-based care, triage patients virtually, before they leave their home, to determine if an ER visit is necessary or the problem can be handled with an in-home visit instead.
Higher-acuity home-based care
We can also reduce in-hospital and skilled nursing facility (SNF) stays by providing those higher-acuity services in the home. Evidence shows that doing so can improve outcomes and reduce costs. A pilot study found that patients receiving SNF-level care in the home showed more functional improvement, were more satisfied with their care, and their care cost less when compared to patients in a SN facility. A Johns Hopkins hospital at home program is also proving the worth of this approach, with total at-home care costing 32% less than traditional hospital care.
Advances in technology, from monitoring and portable diagnostic devices to telehealth services, have made high quality home-based care possible. But, it’s human care that truly matters, which is why a value-based care team approach is foundational to home-based care. A team of clinicians and support staff can provide the full-spectrum of care, addressing a patient’s physical, emotional and social service needs.
Given the success of home-based care and the benefits it provides both patients and clinicians, Humana is working to make it a first-line option for those who prefer to be treated in the home-setting. We plan to make value-based home health services available to 40% of our Medicare Advantage members by 2025.
Patients should ask their physician if home-based care is appropriate for them given their individual condition and situation. And, physicians should familiarize themselves with care-in-the-home options that could be beneficial for their patients.