The evolution of at-home testing and what that means for healthcare and the patient experience

The evolution of at-home testing and what that means for healthcare and the patient experience Kate Dion

Quick Takes

• Innovation in home healthcare and the pandemic have opened the doors for at-home testing, enhancing the patient experience

• Managing care for patients with chronic disease is more cohesive and easier with at-home testing

• Accuracy and compliance continue to be the main priority with at-home testing

The pandemic brought home testing kits into all of our homes. Once deemed too complicated for people to do by themselves, the need to test regularly for Covid-19 has shown that at-home testing is a viable, convenient, and efficient way for people to monitor and manage their conditions.

Innovation in home healthcare and at-home testing is not only empowering patients to take control of their health, but it is also reducing the burden on healthcare systems and enhancing accessibility and convenience.

Today, we hear from Anh Hoang, Chief Executive Officer of Jana Care, to explore the evolution of at-home testing, its impact on healthcare delivery, and its potential for a more patient-centric and efficient healthcare system.

Innovation in home healthcare and the evolution of at-home testing

HT: What unmet need does at-home testing address for patients with chronic disease?

Anh Hoang: There are a number of needs that we are working to address. First of all, the needs of the patient, in particular patients with chronic diseases, such as diabetes, chronic kidney disease, and heart failure. These are patient populations where testing compliance is sitting at around 10–20%.^1,2 This is often down to issues related to access and social economic factors. Often people with these chronic diseases have jobs that require them to be physically present at the workplace, and this can make it difficult for them to go out to clinics for their tests. People living in more rural areas can also find it difficult to get to testing centers. So we are trying to work out how these tests can come to patients rather than the other way around.

The other area we are trying to address is making sure that the tests that are most relevant to specific patient populations are also available to our patient populations. At the moment, they are not readily available. We are also trying to help patients analyze analytes that are more complex to collect.

Enhancing patient outcomes through at-home testing

HT: What can be done to make diagnostic testing the way you’ve described it more accessible and more affordable for people? How does this increase the compliance of patients?

Anh Hoang: There are a lot of studies that show if you make testing easier for the patients, compliance goes up. Compliance can be more of a challenge if you require patients to schedule a time for an appointment and then figure out how to coordinate the logistics to get there. Some of these patients have impaired physical mobility, while others need to coordinate their care across reference labs, blood tests, and doctor’s visits.

What we want is for a patient to be able to do a home test at a time that is convenient for them and for this data to then be integrated into their medical record. It would be a much more efficient way of doing things.

We’re also trying to reach populations that have limited access to a device because of affordability or reimbursement issues.

Reimbursement is also very important because the way we are accessing care is changing. Since the pandemic, we are used to engaging with colleagues remotely, and we’re seeing this spillover to the way we are engaging with healthcare providers.

The last visit I had with my clinician was through Zoom. To make those remote consults more comprehensive for both the patients and the doctor, they need to be paired with lab tests. Making sure these tests are adequately covered by health insurance plans will play a key role in increasing the adoption of important tests.

Payment for at-home testing

HT: Who is paying for these tests now? Is it out of pocket or are they getting reimbursed as things stand now?

Anh Hoang: Congress is devoting time post-pandemic to make reimbursement more available for telehealth consultations. The majority of at-home tests today are paid for out of pocket, except for COVID testing, which was heavily subsidized by the government.

Glucose testing or glucose monitoring are also reimbursed in the US, but if you’re looking at an at-home creatinine test, there isn’t one available that’s FDA cleared for blood.

We’re working with various organizations to get the right reimbursement policies in place. This is particularly important for patients with chronic diseases.

During the pandemic, we saw a lot of legislative changes that helped to increase access to telehealth. I’m hoping it will be the same for testing. There is language already in place for reimbursements for point-of-care testing, but it’s still a gray area. We don’t know whether point-of-care extends to the home because there weren’t many available testing options in the home space a decade ago. Once this is clarified, there will be clear policies in place that outline what reimbursement would look like for an at-home test.

Elevating the delivery of care

HT: How does at-home testing help alleviate stress on healthcare systems and those responsible for delivering care within our systems?

Anh Hoang: At-home testing helps alleviate stress and healthcare systems in the following ways:

1. Ongoing patient monitoring: At-home testing provides a tool that can be used to help manage and monitor a patient after they’ve been diagnosed.  When it comes to monitoring a patient at home, they don’t need to be in the clinic for all these visits. Some of these visits can be as simple as getting a blood draw or assessing key target levels in the blood, which can be done at home.
2. Maximizing time, resources, and convenience: At-home testing alleviates the burden that you would see in the clinic, saving clinicians time. For the patient, it saves them from having to coordinate their visit(s) to the clinic. It can also reduce the reliance on an ambulance to get them to a clinic for simple tests.
3. Reducing hospital readmission: If a patient were hospitalized for CKD or heart failure, they can get sent home with a device that can measure their NT-proBNP levels, which is one of the biomarkers that is most associated with hospitalizations.
4. Patient empowerment: Patients can monitor their conditions by themselves at home and can avoid extra trips to the Emergency Room (ER) if they feel unwell post-discharge.
5. Greater flexibility and accountability: Providing patients with alternative testing and monitoring enhances the patient and healthcare experience.
6. Greater compliance: If you have heart failure, unlike most of these patients in their sixties, or seventies, it’s unlikely that they’re managing their care alone. Their kids or somebody will most likely need to take time off from work to take their parents to these appointments. If it were possible to get these tests done in five minutes at home, we would likely see increased rates of compliance.

The pandemic opened the doors for at-home testing. COVID testing at home is not that easy. You have to swab yourself, both nostrils, then put the swap into a vial, mix it, then drop the solution onto the tester. Prior to the pandemic, the Food and Drug Association (FDA) would have said that’s just too hard for an at-home patient. Now you’re seeing six-year-old children doing the COVID testing on their own.

The importance of accuracy in testing

HT: Can the accuracy of home testing replicate the accuracy in the lab?

Anh Hoang: Our at-home tests are designed for use at home, they are prescription based, and they will be FDA cleared. It’s more about the intended use, which is for monitoring and triaging, not diagnosing. That means if a patient is outside a certain range of levels, the doctor needs to be able to see that on a screen and be able to say, “I need you to come back into the clinic. We’re going to do another analysis.”

The importance of partnerships in innovation

HT: How important are partnerships for startups or partnerships with larger companies for startups?

Anh Hoang: Partnerships are extremely important as it allows startups to expand their resources and scope. In a small company, resources both in talent and in funds are limited, but a partnership with a company that has better scope makes things easier. In collaboration, there are regulatory and legal experts who know what to look out for, who understand what the FDA expects, and who have experience in clinical studies.

Startups, generally can’t afford to hire a regulatory expert because the scope isn’t there to hire the resource. In these partnerships, suddenly the scope and resources expand for the startup. It makes it much easier to go up against the gold standard when your gold standard is your partner.

Jana Care successfully participated in Startup Creasphere, a leading digital health accelerator that strives to transform healthcare together with startups.

1. Schmidt M, Mansfield K.E, Bhaskaran K, et al. BMJ Open. (2017). Article available from https://bmjopen.bmj.com/content/7/1/e012818. [Accessed June 2023]
2. Alfego D, Ennis J, Gillespie B, Lewis M J, Montgomery E, Ferrè S, Vassalotti J. A, and Letovsky S. Diabetes Care 44, no. 9 (2021). Article available from https://pubmed.ncbi.nlm.nih.gov/34353883/. [Accessed June 2023]