Why Patients Should Recuperate at Home, Not in Hospitals
By Kevin Pereau
A Talk with Steve McDonald
Patients want to be sure that going home, or staying home, is a safe thing to do. Hospitals do not want to expose themselves to legal risks that can result from releasing patients early.
Insurers, from their side of the situation, realize that releasing patients too soon can result in hospital readmissions, health complications, and opening up Pandora’s box of problems that they hoped to avoid by releasing patients early in the first place. So, what to do?
The solution lies in creating safe ways to release patients earlier, and in ways for patients who are aging in place to heal and get care safely in their homes. That means collecting and analyzing data with a keen eye on taking action when appropriate. Sound familiar? This is next-level connected health. The result is a win-win for all the parties involved in the care experience.
How do all the pieces fit together and work? I sat down with Steve McDonald of ThriveWell to find out.
Steve has a 30-year track record in the healthcare industry, including hospital, ambulatory care, and information technology sectors. He has worked in executive leadership roles at Meditech and Cerner, as well as at Beacon Partners (now KPMG) and Impact Advisors. Steve knows healthcare has a broad perspective, so we asked him a basic question: “Where is home care going?”
“Hospitals now are looking at home care as a viable venue to serve up their own services,” Steve says. “One trend is aging in place which more and more seniors are choosing to do. Many are taking advantage of the proliferation of home care devices. It’s now very viable to have someone get discharged from the hospital earlier, which is a more cost-effective way to manage their chronic diseases in the comfort of their home.”
But how can hospitals let people go home sooner, without hurting health outcomes or incurring legal and financial risk? How can hospitals, for example, be satisfied that patients are recovering at home in a way that equals the care they could have experienced if they had remained inpatients for longer periods of time?
“You need to have information,” Steve says. “First, you need the discharge planning notes, and all of the care plans you will need to engage patients when they are discharged from the hospital. That’s just one element. You then need to keep your patients engaged from there.
“Wi-Fi capabilities are the foundational technology. At the baseline, you must be connected.
“From a technology perspective, lots of things are built on that connectivity, including video chats, Telehealth and remote patient monitoring. Plus, there are many devices that are purposely designed for each chronic care condition. Whether a patient has COPD or CHF or diabetes, there is a digital solution for each of them and they all hit your clinician or care provider’s radar in a way that recognizes who needs help right now and who is doing fine. But I’m seeing that it’s not enough to just throw a device at someone.”
Who Will Pay for Advanced at-Home Care?
Steve points out that when it comes to being reimbursed for at-home care, things are changing quickly, and new business models are evolving that allow companies to offer at-home care in ways that make economic sense. Some of the trends Steve cites are:
- The Centers for Medicare and Medicaid Services (CMS) have introduced a more liberal reimbursement policy for remote patient monitoring. The net is you now get to go home earlier after hospital stays.
- Medicaid has recently adopted parity laws to mandate that Telehealth visits be paid at the same price as inpatient visits. Although this varies by state, going home early is the new norm and a growing expectation.
- New home-care business models are evolving, some charging a subscription fee for monitoring and connecting you to your clinician and all the specialists servicing your episode of care.
Steve also points out that technology is evolving in ways that provide better remote care.
“Someone has an alert that fires because their blood pressure spikes,” Steve cites as an example. “And their phone will ring and there will be a person on the other end who will say, `Are you OK? Let’s find out what caused this. Can we intervene on your behalf to make sure that there’s no episode of care that’s going to result in an emergency room visit?’
“There are so many devices now that can capture that information at home. And it stands to reason that anyone would prefer to be at home rather than driving to a hospital, trying to find a parking spot, then following the yellow line or the blue line to their doctor’s office. It’s just a much more affordable approach and a more convenient, more efficient way to be able to manage your chronic diseases.”
That reduces the friction which often prevents us from getting the care we need.
I asked Steve to define the greatest beneficiary of more connected, advanced at-home care. Is it the patient, the provider? Where is this trend evolving?
“The quick answer” Steve told me, “is that both patients and payers benefit quite a bit. With better outcomes, the provider gets reimbursed at a higher rate and makes more money. The patient receives better care, likes the familiarity of being at home, and doesn’t have to deal with driving, dealing with traffic, or looking for parking.”
Who among the old-school healthcare incumbents could imagine healthcare applying Yelp scoring concepts where our ratings matter? Are there challenges that could hinder the wider adoption of at-home monitoring and healthcare? I asked Steve.
“I would say there are challenges, depending on the demographic,” Steve says. “One is that some seniors don’t want to mess with devices. Yet there are ways around that, like passive devices. Maybe it’s a sensor under your pillow that can track heart rate or respiration or even a simple ring that your wear like Oura’s Sleep Ring and activity trackers.
“The solution can be more of a care-centric model that treats chronic diseases with a combination of devices. And patients, payers, and providers (hospitals) all benefit. Hospitals in risk-based contracts or value based contracts benefit financially, due to with lower costs associated with better health outcomes.”
Episodes of Care
An “episode of care” can be defined as a span of time in which a patient receives healthcare to help with a finite health issue.
- If you break your arm, have a cast put on it, then have the cast removed and undergo a period of physical therapy until you are able to use your arm again normally, that is an episode of care.
- If you have a rash and go to a dermatologist who gives you a salve to apply and then the rash goes completely away, that is another example of an episode of care.
Yet other episodes of care can last longer, or maybe even never go away. If you know someone who is dealing with diabetes, for example, their episode of care is lifelong.
I mention this concept because considering episodes of care sheds light on the patient experience, including issues like health insurance.
“Aging in place was the beachhead for home care and is a critical piece in managing episodes of care,” Steve says, “with a finite time frame to address outcomes of that episode. Additionally, chronic care like COPD, CHF and Hypertension are all more effectively maintained with an age-in-place technology solution.
“Yet we have to be realistic and think that there will always be reasons for people to go to hospitals. There are obvious ones, like emergency room visits. There are also triage oncology visits, which involve some really sophisticated diagnostic machinery, like linear accelerators to look at how cancer is growing. Dialysis isn’t typically done at home. People are not going to get a hip replacement done there either.
“But regarding that hip replacement, the hospital might say, okay, this person is 58 years old. He’s not too fat. He can actually go home and be managed remotely. Or maybe we can send a physical therapist to his house. And that would be incredibly cost-effective.
“A hip replacement typically costs $30,000. That is the average cost, based on actuarial data. Some surgeries will always take place in hospitals. Yet if the patient starts recuperating at home sooner, the cost could be reduced to $21,000. And that care can still hit all the metrics from a quality perspective.”
To provide that care, we need to be asking, what kind of care can we provide remotely? Steve foresees a world where smart technologies will appear more and more in home settings.
“We’re already seeing smart homes that shut off lights and monitor what is in your fridge and know when it is time to order milk,” Steve notes. “From a wellness perspective, a lot of digital health investment is going into wellness.”
The result will be lower-cost, better healthcare in a growing number of situations, and conditions. “That’s why we’re called ThriveWell,” Steve adds.
No question about it, things are improving across the board in healthcare, thanks to a combination of technology, compassion, and smart thinking – in whatever combination and alchemy. Thanks to some very smart individuals and their companies, we are surely entering a brave new world of healthcare – one where receiving hospital level care at home is the new normal.
If homecare is indeed the next big thing, then let your mind wander to how Anthem’s Sydney platform fits into the equation. I know Sydney was designed from the ground up to be a member benefit for Anthem health plan members, but you can’t help but think about how versatile a tool this has become and how that might have a broader impact for us as consumers.