Opinion

Health Care in the Home: An Idea Whose Time Has Come

From work-from-home policies and virtual classes to online banking and e-commerce, the COVID-19 pandemic has fast-tracked large-scale transformations of the worlds of work, education, personal finance and shopping. After years of doggedly resisting change, health care is finally next in line.

This is due to the efforts of health care leaders, policymakers and regulators who are considering the options involved with moving away from the brick-and-mortar model of health care as the only means of providing patient care. The goal is to ultimately eliminate the overcrowded waiting rooms, provide increased access to those with barriers to care, reduce overhead costs and facilitate a more expedient means of assisting those who require medical attention. Those who have been critical of the way health care has been traditionally run have indicated, “It’s about time!”

COVID-19 has accelerated adoption of remote decentralized care with a mix of virtual and in-home care services. E-consultations, remote video or image-based evaluations, telemedicine diagnoses, phone-based follow-ups, remote patient monitoring and at-home testing has forced a reckoning among health care professionals. After years of reticence, physicians found telemedicine enhanced the care they delivered, while patients have indicated they want to continue accessing care virtually for many types of visits. In short, it has demonstrated that digitally aided, home-based care is doable, wanted and needed.

This paradigm shift toward greater acceptance of decentralized care, due in part to the pandemic, is taking place in the broader context of value-based health care. When considering the virtues of patient-centered care, what is more patient-centered or outcomes-focused than bringing health services into the home of an elderly, fragile patient who has trouble getting to a doctor’s appointment? Here too, the COVID-19 crisis hastened a change that consumers of health care have been waiting for – that our health system would eventually accept and adopt – but that was needlessly being weighed down by legacy models, contrary incentives and organizational inertia.

So, how do these two trends – the move towards digitally enabled, home-based health services on the one hand and patient-centered, value-based care on the other – converge, from two physicians’ perspectives? As an ER doctor and a former heart and lung transplant surgeon, respectively, we have had front-row seats to observe how patients’ attitudes are evolving in the direction of moving care to the home. It’s a dramatic cultural shift.

A few months ago, while working in the emergency room, I (Amal) had a patient encounter with a 90-year-old gentleman presenting with cough and a low-grade fever. The resulting lab work and diagnostic imaging concluded the patient had community-acquired pneumonia, and his findings met the criteria for hospitalization. Yet, the patient and his family expressed their interest to be sent home for three reasons: concern of being infected with COVID-19 (he had tested negative), discomfort in the hospital and out-of-pocket cost. After giving detailed instructions to his family on how to care for him and what signs of deterioration to watch for, I discharged him.

This encounter is a reminder of how we should modify care access points, expand modalities of care delivery and get comfortable with digitally integrated health services. Seamlessly integrating virtual home-based care into our traditional brick-and-mortar approach to care will make home monitoring and care a routine reality, and not the exception.

Regulators are already on the ball. Last year, the Center for Medicare and Medicaid Services expanded coverage for over 135 telehealth services, as a temporary measure, to reimburse providers for care provided remotely. It was a decision the agency took in the throes of the pandemic, when getting to an in-person doctor’s appointment was especially risky for seniors. However, this has paved the way for maintaining coverage for those services sine die.

Bringing care into the home is an idea whose time has come. Victor Hugo’s famous phrase — “Nothing else in the world … not all the armies … is so powerful as an idea whose time has come” — adopted by the public policy scholar John Kingdon to describe ideas whose becoming reality can be postponed no longer, captures the significance of the current moment in health care. The COVID-19 pandemic has acted as a catalyst for us all to get serious about adapting the care model to respond to an evolving context, and do it in a way that permeates the entire system to the benefit of all patients.

 

Amal Agarwal, D.O., MBA, is a board-certified emergency room physician and vice president, home solutions business development and strategy at Humana Inc.

Sen. Bill Frist, M.D., is a heart transplant surgeon, former U.S. Senate Majority Leader, and co-founder of Aspire Health, the nation’s largest non-hospice community-based palliative care company.

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