Home-Based Care: What Does the Future Hold?

care at home
5 min read
Vince Porter
June 8th, 2022

One hundred years ago, it was common for doctors to visit patients at home. Over time, house calls and other forms of home-based care became less popular as patients increasingly received care in hospitals and other institutional settings. While most care now takes place in medical facilities, in recent years there has been a resurgence in home-based care as a convenient and cost-effective way to provide treatment for patients. Today’s home-based care models vary based on type of condition, level of acuity, and regional adoption of non-brick and mortar services. The coming years will see further refinement and additional opportunities for experimentation giving patients options for the right care, at the right time, in the right setting.

Developments in medical technology, including the expansion of telehealth, advances in remote patient monitoring, digital record sharing, and portable imaging and diagnostic equipment have expanded providers’ abilities to deliver care outside the confines of a medical facility. Patients can receive a broad range of health services in their home, including acute care, post-acute care, primary care, behavioral health care, palliative care, dialysis and infusion therapies, and behavioral health services. There is also significant potential for future medical innovation and business creation in this space to provide additional treatment options to meet growing patient demand for home-based care.

Demonstrated outcomes

Home-based care has demonstrated that care can be delivered in an effective, high-quality manner, with appreciable benefits for stakeholders across the health care system. It allows patients to receive treatment in a comfortable and familiar setting, often with the additional support of family members and other loved ones. Delivering care in the home also allows providers to view a patient’s home environment and address additional factors that could be negatively impacting the patient’s health, such as food instability or an unsafe environment.

Other important facets of home-based care include the potential to reduce hospital acquired infections. During the COVID-19 pandemic, patients receiving treatment at home avoided crowded institutional facilities reducing their risk of exposure. Home-based care also has the potential to improve health equity among vulnerable populations by increasing treatment options for those unable to access care in more traditional settings.

There is evidence that home-based care is effective in reducing clinical complications, increasing patient satisfaction, lowering hospital readmission rates, and lowering costs compared to traditional inpatient care. Home-based care can also reduce pressure on institutional care facilities, freeing up space for patients most in need of receiving inpatient care. With the greater shift to value-based payment arrangements in the U.S., with incentives for demonstrated quality of care and patient outcomes, home-based care has the potential to provide tremendous utility for patients, providers, payers, and facilities.

Rapid adoption

While home-based care has increased in recent years, the COVID-19 pandemic rapidly accelerated its adoption. COVID-19’s high transmissibility necessitated shifting more care from facilities into the home setting, and during the declared public health emergency (PHE), state and federal waivers and flexibilities have helped facilitate this transition. An example would be the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home waiver which enabled patients to receive a wide range of acute care outside of the hospital setting. Since November 2020, CMS has approved 237 hospitals in thirty-six states for the Acute Hospital Care at Home waiver. In Regence’s four state footprint of Idaho, Oregon, Utah, and Washington, we have seen gradual acceptance of the model, with nine hospitals receiving a waiver, but there is room for more adoption in the northwest and intermountain regions.

Home-based care’s incredible value makes it likely that its popularity will continue to grow even once the PHE has concluded but there are potential obstacles that could stunt further adoption. There is considerable uncertainty concerning the end of the PHE, which is limiting additional adoption of new care models. For example, the Acute Hospital Care at Home program is set to expire with the conclusion of the PHE. Without an extension of this program and implementation of other regulatory flexibilities allowing for greater adoption of the care at home models that have proven to work during the PHE, we will see a reversion to old facility-based care models.

Home-based care options are not restricted to those offered by hospital systems. In recent years, several innovative models have come to the forefront. As regulators consider extensions of waivers and regulations created during the PHE, it will be important to embrace proven models operating today that are providing cost effective high value care while also creating an environment that promotes further innovation. These new models can add value to our overall public health system and offer relief when the more traditional systems of care are challenged.

A general lack of awareness of the availability of home-based care may also be limiting greater uptake among patients, and provider concerns around safety, payment and legal risks may be preventing providers from referring additional patients to home-based care, even when it is appropriate. Overly broad state certificate of need regulations, which typically require health care facilities to obtain state approval before expanding services in a designated area, are also impeding greater adoption. Vulnerable populations and those living in rural communities may not have access to requisite technology, such as high-speed broadband, necessary to facilitate certain types of home-based care visits, and patients suffering from housing instability may not have reliable access to a dwelling in which they can receive home-based care.

Despite these challenges, there is an immense opportunity within the current political environment to increase access to home-based care for patients and to promote its adoption among key stakeholders. In the upcoming months, the Regence Health Policy Center will be highlighting organizations that facilitate home-based care and we will be examining the most effective policy options to promote further access to this valuable care model.

Vince joined Regence in 2017 as Director of Oregon Government Affairs. In that role he worked on several key pieces of legislation including the creation of Oregon’s Drug Price Transparency Program and the Sustainable Health Care Cost Containment Program. Previous to his tenure at Regence, Vince was the Jobs and Economy Policy Advisor to Governor John Kitzhaber and Governor Kate Brown.