Improving Care and Monitoring at Home Through Technology
By Matt Phillion
One of the prevailing themes as we continue to work through the COVID-19 pandemic is the need for—and the benefits of—at-home patient monitoring, telehealth, and engagement. As technologies continue to emerge and improve, what does the future look like for remote options, and how have they impacted care over the past months and years?
Boston-based Current Health recently merged with Best Buy to increase access to home health options. Chief Medical Officer Adam Wolfberg, MD, was part of discussions about expanding work in this area prior to the pandemic. But when COVID-19 hit, “Current Health quickly realized we had an opportunity to serve an important role,” he says. “Healthcare had a capacity problem, and we were expanding capacity to let relatively less acute patients be cared for at home.”
At the same time, Wolfberg says, patients across the world were getting sick but wanted desperately to stay out of healthcare facilities. “It was a really busy, scary, meaningful time. We’re not out of it yet, but we know so much more,” he says. “The core mission of the healthcare community has essentially remained the same, which is to serve patients in need of care. As policymakers and healthcare leaders are thinking about the next pandemic—I’d say we didn’t do a great job planning for this pandemic, and I think everyone is committed to doing a better job next time.”
The expansion of home monitoring and care
Wolfberg identifies three core reasons why home-based care, in its various formats, rose so quickly to prominence during the pandemic, and why home-based care will be important in the future.
“First, no one wants to be in the hospital, during a pandemic or not, if they can avoid it,” he says. Moreover, throughout the pandemic, the industry has demonstrated that it’s possible to receive relatively acute care in the home rather than requiring a hospital stay. “I don’t think providers or patients are going to forget about this just because the pandemic passes,” he says.
The second issue is capacity flexibility. Healthcare needs to be able to react to extreme circumstances without relying on standing structures or outdated models. “It doesn’t make sense to build brick-and-mortar beds and facilities that remain relatively empty while anticipating the next medical crisis that demands them,” says Wolfberg. “[A] hospital at home program is a great way of creating capacity without building beds and walls.”
The third component: Throughout the pandemic, we’ve seen that delivering care in the home is not merely possible, but also cost-effective and safe. “From a clinical perspective, we’re not going to forget that either—patients will continue to demand it, providers know it’s safe, and the economics of hospital bed capacity is here to stay,” says Wolfberg.
Hospital at home programs are not designed to treat the sickest COVID-19 patients or other ICU patients, but they can take pressure off those precious ICU spots by helping patients stay out of the facility.
“A good number of hospital at home beds have been filled with COVID patients, but it was never designed to be an ICU valve,” he says. “It never took patients from the ICU. If ICUs filled up—the patients spilled into inpatient facilities, for example—the stable inpatient patients could go home or were never admitted in the first place.”
This form of home care has always been on the lower end of the acuity spectrum, Wolfberg says. “As we move through the pandemic, we mostly see patients with, for example, heart failure who need tuning up, COPD, patients with malignancy, chemotherapy patients who require a higher level of monitoring,” he says. “They’re able to receive that care outside the four walls and really often do better outside the hospital.”
Obstacles and questions
The transition to this level of home care for certain acute patients has been relatively smooth, Wolfberg notes.
“The visionary clinical administrative leaders are driving hospital at home, and we’re facilitating it,” he says. “We’ve learned a lot, but we serve our clients. Without the desire, leadership, and demand to make it happen from innovative health system leaders, hospital at home would not be moving forward.”
Two questions still remain, however.
“First, will CMS maintain the waiver?” asks Wolfberg. One of the obstacles pre-pandemic was the question of who would pay for this sort of care and how, but with CMS willing to reimburse for care at home, new innovations and care options became possible. “Organizations don’t want to invest too deeply if it might go away, or remain but at a lower reimbursement rate. The key feature of the waiver is you get the same DRGC payment if they are at home as you do if they are within the four walls of the hospital.”
The second question: When will commercial payers follow? “I think commercial payers will be very concerned about paying the same for at-home care, and so innovative health systems and payers will need to come together to create a reimbursement structure that rewards the triple aim: quality, cost reduction, and patient satisfaction,” says Wolfberg. “I would imagine there will be a five- to 10-year negotiation process as commercial payers get on board.”
While the payment question looms, the patient and provider experience with this level of at-home care has been overwhelmingly positive.
“The response has been fantastic,” says Wolfberg. “We’ve had really touching anecdotes from patients—such as a patient who, because of the program, was able to spend much of their last few weeks at home with their family instead of confined to a hospital bed.”
The experience offers a meaningful improvement for both patients and their families, he says. “The stories we hear about quality time patients are able to spend with their family that would not otherwise be possible are really gratifying,” he says.
Anecdotal patient experiences are one thing, but Wolfberg notes that the hard data is showing results as well. “UMass is moving seven to nine patients a day into their hospital at home program, at an average of five days per patient, so that’s seven to nine patients a day that would otherwise be taking up a bed,” he says.
Hospital at home programs are seeing positive results in patient safety and outcomes too. “The safety profile with these patients is very positive—they have a 1.1% fall rate, including zero with major injury, [and] a 4.7% 30-day readmission rate, which is generally below the readmission rate for the overall population” related to the conditions being treated, he says.
Looking back at the question of who pays for this care, Wolfberg says there is an opportunity to advance a value-based model. “I don’t see any signs that this type of care is going away or will be scaled back,” he says.
Wolfberg sees the future of home monitoring and care built differently: based on the needs of the patient population and community.
“I see it as being flexible, community focused, built for each community, and serving the social, family, and economic needs of each community that each system serves,” he says. “I don’t think it’s one size fits all. There are patients who are living with chronic illnesses in need of different levels of care, and we can serve those patients” through the various services and technologies available.
Care at home can be used to follow chronic patients as their needs evolve as well, Wolfberg notes. As they become healthier and treatment plans change, home monitoring can be used to monitor medication adherence, vitals, and more. “All of this enables patients to be compliant with care without barriers like transportation, or in areas where PCPs are overburdened and in high demand,” he says. “It’s a spectrum of enabling care.”
It may have taken the COVID-19 pandemic to get here, but the future looks bright for care at home models for patients of varying acuity levels. “It’s gratifying to serve a lot of patients who don’t have to go to the hospital, and we’re enthusiastic about being able to enable care at home in whatever form it comes,” says Wolfberg.
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.