Healthcare is Moving to the Home. Are Health Plans Ready?

Healthcare is Moving to the Home. Are Health Plans Ready? Paul Mango and Vijay Kedar

The home is re-emerging as the preferred place for patient care. Accelerated by the pandemic, a growing number of patients view the home as a more comfortable, safe, and convenient environment in which to receive post-acute and long-term care.

But patients aren’t the only ones who recognize this value. Confronted by continually rising healthcare costs, health plans are embracing opportunities to introduce new models for managing cost and improving quality. Home-based care offers a high-quality, cost-effective alternative, improving patient outcomes at a lower-cost site of care while reducing hospital readmissions.

Nearly all major health plans are encouraging patients and providers alike to consider more use of care in the home. They are making major investments themselves to achieve this and watching with great interest as national pharmacy chains and other large retailers seek to compete more aggressively in the market for care at home. To cite just two examples, CVS Health’s  purchase of Signify Health to help expand care at home. And UnitedHealth Group, in the process of acquiring home health provider LHC Group, cited the growth of its at-home platform at a “very significant scale” in its third-quarter 2022 earnings call.

As health plans continue to encourage the migration of care to the home, they face hurdles requiring careful consideration and adequate resources to overcome. Here are three often-overlooked areas insurers will need to reconcile to make the most of the home-based care opportunity – and ultimately to help members achieve optimal health.

Shift focus to chronic and pre-acute care

Today, only about 6% of medical spending is on home-based care, including home health, durable medical equipment (DME) and non-durable medical products, according to the Centers for Medicare and Medicaid Services. Most claims for home medical equipment and supplies are associated with post-acute care, such as rehabilitation, palliative care, and skilled nursing. But more pre-acute care should be happening at home, both as a way to help patients improve their health away from a facility and to save on the costs of facility-based care.

Patients experiencing chronic illness or multiple illnesses leading to frequent emergency department admissions and doctor visits are increasingly becoming appropriate candidates for improved care at home. When patients with diabetes or cancer, for example, have access to more frequent monitoring and preventive care at home, they are more likely to avoid hospitalizations and expensive procedures.

Successfully moving more care to the home, however, will require health plans to identify interventions that support chronic needs and pre-acute care. Instead of treating deliveries of equipment and supplies to the home as one-time events, health plans will need to manage these on an ongoing basis.

One example of this ongoing review and management is for internet-enabled devices that go beyond traditional remote patient monitoring. Ventilators, bipap machines and other equipment offer more clinically intensive data that health plans need to consider in enabling chronic care in the home. Another example is the use of CPAP equipment for at-home COPD patients.

Capture insights in the home

Shifting more chronic and pre-acute care to the home is an opportunity for health plans to directly impact the care their members receive. But how will they know they’ve succeeded?

One way is by capturing more insights from care providers who encounter patients in the home. Clinicians and technicians typically make home visits for equipment setup and instructions and to check on patients. In fact, about 40% of durable medical equipment requires in-person setup and support.

Health plans often fail to capture this information. By setting up simple reporting procedures for home visits, insurers can take advantage of these encounters and respond more quickly with support. When patients interact with their equipment supplier or respiratory therapist much more than their pulmonologist, any effort to support members with appropriate interventions and information can result in better, more coordinated care and fewer emergency department visits and hospital readmissions.

Improve quality measures

Healthcare providers measure quality and patient outcomes all the time – especially as more value-based care contracts require it. But when a patient is recovering or receiving care in the home, it’s a black box.

There are few recognized quality standards for the more than 32,000 unique home-based care suppliers. These suppliers perform a vital function in healthcare, yet problems persist, such as hospital discharge delays resulting from slow delivery of DME. Referrals to suppliers are largely driven by relationships, not by data on the most appropriate and highest-quality suppliers.

Rather than treating these suppliers as a relatively unknown commodity, health plans should now acknowledge the impact suppliers have on patient outcomes and measure quality and performance accordingly.

Metrics related to equipment delivery, such as turnaround time and number of equipment failures, are easy to track – and revealing. Patient recovery measures such as time to becoming fully ambulatory, reduced readmission rates, and reduced emergency department use can reveal valuable information about a supplier’s performance. By introducing quality measures, health plans will be able to hold suppliers accountable to a higher level of performance and care.

The future of healthcare means more home-based care. By taking steps now to embrace this shift, health plans will set the pace for supporting patients in the place where they most want to receive care.

Photo: Maria Symchych-Navrotska, Getty Images