It’s intuitive; when we get sick, we bundle ourselves into our cars and go to the doctor.
The American healthcare system concentrates its care providers in hospitals, clinics and practices for the sake of efficiency, service quality, and equipment availability. It’s far more convenient to provide care in a centralized facility than it is to schlep doctors, nurses and devices to a patient’s home. In this context, home healthcare appears to be a rarity intended for patients for whom travel is difficult — the last vestige of a care delivery system that fell out of vogue in the early 20th century.
But now, homecare is on the rise.
Understanding the drive toward home healthcare
Since the 1930s, we’ve relied on private nursing homes to support seniors who need regular care for chronic conditions, citing the efficiency and quality that centralized care centers offer. But now, seniors’ preferences are changing — and unlike our counterparts in the 1900s, we now have the technology and resources necessary to make a comprehensive, centrally-coordinated approach to home healthcare effective.
Modern home-based services aren’t limited to old-school house calls. Today, skilled home healthcare delivers treatments and therapies that were once only accessible in facilities directly into a patient’s home. As defined by writers for the Partnership for Quality Home Healthcare, a home-based approach “utilizes an interdisciplinary team of nurses, therapists, social workers and aides, with care overseen by a physician, to ensure a patient’s complete recovery from an acute hospital stay or management of a chronic condition.”
It’s an approach that is in high demand today. According to the U.S. Census Bureau, 56 million Americans were 65 years or older in 2020, and 84 million will be so by 2040. Surveys indicate that 90 percent of those in the demographic want to stay in their homes as they age.
This desire, coupled with advancing telehealth capabilities and an increasing acceptance of alternative care models, has begun to drive a significant uptick in demand for home healthcare services. Currently, the U.S. home care market is expected to top $225 billion by 2024 — more than double its $100 billion height in 2016.
The quality and cost arguments for home care
The case for expanding home-based healthcare isn’t just a matter of convenience or demand. Recent studies have demonstrated that patients who experience such services following hospital discharge or in place of residential care tend to experience equal-to-better outcomes, higher satisfaction rates, fewer instances of readmission, fewer emergency room visits and lower costs than their facility-based counterparts.
The cost-saving element cannot be understated here. As researchers for one 2019 study on home-based services concluded, “Not only is home healthcare more effective at improving patient outcomes, it is also a cost-effective alternative to hospitalization, saving both Medicare and taxpayers money. In computing total 90-day costs, the researchers found the average costs for the home healthcare group were significantly lower than the inpatient cohort ($13,012 vs $20,325).”
That said, it is worth noting that home-based services tend to be more effective when incorporated early in a patient’s care journey. Consider research around the Zaitaku care model in Japan, for example. In Zaitaku care, patients receive physician-led, end-of-life services in their homes. Researchers found that Zaitaku care costs 16.7% less than hospital-based care, provided it was incorporated as a long-term solution. When applied as a short-term approach, costs could exceed hospital levels.
In an ideal world, seniors with chronic conditions would have the option to receive home-based services to remain at home and out of the hospital for as long as possible. Doing so would allow them to avoid institutionalized care, potentially improve care outcomes and quality of life, and reduce costs for patients and payers alike.
The challenges of implementing home-based care as a Medicare Advantage norm
Home-based services are not a common, or even widely accepted, part of most Medicare Advantage plans. However, there have been some signs that the Centers for Medicare & Medicaid Services (CMS) have begun considering flexibilities that could allow such care in the future.
In January of this year, the CMS announced that it would be expanding its Home Health Value-Based Purchasing (HHVBP) Model starting in 2022. The model, which underwent three years of testing in nine states, has been proven to improve quality of care, bolster patient outcomes, and reduce unplanned hospitalizations and skilled nursing facility (SNF) stays.
“The Coronavirus pandemic has tragically illustrated how important it is for elderly Americans to have a robust set of options outside of nursing homes,” CMS administrator Seema Verma commented in a press release. “Nursing homes will always be an important part of the care continuum — especially for those who need an intensive level of care — but home health services are often preferred by seniors. Expansion of this model would improve the overall value and quality of that home health care — and seniors stand to benefit.”
But the road to expansion may be a rocky one.
At present, the industry does not have the staff needed to facilitate a major shift to home services. According to research from Mercer, the U.S. is on track to experience a shortage of roughly 500,000 home health aides, 100,000 nursing assistants, and 29,000 nurse practitioners by 2025. Informal caregivers (adult children, siblings, spouses, etc.) can help, of course — and have been proven to be invaluable contributors to a patient’s care — but are limited regarding their capacity for medical treatment and support.
As one writer for Business Insider recently put the matter, “An intensifying shortage of U.S. home health aides and physicians, a booming senior population, and the prevalence of chronic illnesses all point to a need for transformative solutions when it comes to senior care services.”
Thankfully, I believe that we’re in a perfect position to develop such solutions.
The potential for home-based care in a post-COVID-19 world
During the pandemic, acceptance of and interest in telemedicine has gone through the roof. Patients are more amenable to remote care than they have ever been — a shift that undoubtedly works in the home care sector’s favor.
As one reporter for mHealthIntelligence writes, “[Telehealth] is shining a spotlight on the home health care industry, which has long balanced connected and in-person care but — faced with a shortage of providers and a growing surplus of patients — could use more of the former and less of the latter.”
It’s also worth noting that there is a ton of elder-specific technology on the market. Today’s seniors can connect with their entire care team from the comfort of their home and have access to wearable devices that flag irregularities in their vital signs and predict falls. They can even use AI-powered voice assistants to help plan their daily medicine, exercise, and diet.
The U.S. healthcare sector evolved away from home healthcare because it no longer suited the needs of the many. We now have the technology, logistical capacity, and funding flexibility as a core part of our senior healthcare playbook. Medicare Advantage plan providers should strongly consider incorporating home-based services into their offerings to benefit their patients and bottom lines alike.
Jeff Fox is CEO and chief expansion officer of ATRIO Health Plans Inc. In his position, he leverages his experience to further ATRIO’s efforts to deliver high-quality, community-focused health insurance. Jeff Fox has a proven ability to conceptualize and execute large-scale health plan strategies and is also adept at developing market-growth initiatives that deliver returns in local and national markets alike. His major capabilities include but are not limited to market strategy development, sales, product innovation, provider strategy, marketing and health plan growth.