Don’t overlook these factors as you explore health-at-home model

Tanya Albert Henry , Contributing News Writer

Before physician offices, hospitals and urgent-care centers took over as the dominant places for patients to seek the health care they needed, physicians brought their skills to patients’ homes, often carrying their iconic black bags by their side.

Making technology work for physicians

The AMA is working to make sure technology is an asset to physicians—not a burden.

Technological advances now are enabling physicians to offer a level of care in the home unlike ever before. In addition to improving the patient experience, offering health care in the home when appropriate can reduce strain on hospitals and clinics that are at capacity.

In a recent AMA webinar (available for free on demand, registration required), expert panelists discussed:

  • The types of care being provided in the home today.
  • How their health care organizations have used health-at-home models to provide better access.
  • Clinical outcomes and experiences.
  • How other organizations can get started on providing more in-home care.

“Let’s challenge [the] status quo,” said Vimal Mishra, MD, the AMA’s director of digital health and a co-author of a recently issued AMA report on health-at-home models.

“Let’s think about: How do we get humanity back in patient care? Create a care paradigm around patients and think about the patient journey from well care to sick care,” said Dr. Mishra. “And think about this whole continuum of care from at home care to ambulatory care to on demand care to transitional care to acute care to end of life care. ... Let’s think about what the perfect, optimal journey that the patient should experience when they are sick. Every one of our patients—and us—deserve it.”

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Technology is already allowing health at home to be provided across these care settings:

  • Ambulatory care.
  • On-demand or urgent care.
  • Transitional or post-acute care.
  • Acute care or inpatient care.
  • End-of-life care.

Dr. Mishra said that with the help of technology, as much as 30% of patients in a hospital could easily be taken care of in the home.

Virginia Commonwealth University (VCU) Health has offered primary care in the home since the mid-1980s, but technology advances have allowed them to expand their services, said Ryan Raisig, MHA, the system’s associate vice president for coordinated care and continuum integration.

“How technology has enhanced our care paradigm is twofold—it’s driving up the acuity. It’s allowing us to go from primary care and now to urgent care, to post-hospital, transitional care and now even acute care in the home,” he said.

The advances—such as having nearly real-time access to a nurse or other health professional—are also making families feel more comfortable with the care provided in the home. Studies show that two-thirds of patients who have not heard of acute home hospital care would accept that form of care. More than 95% of those surveyed nationally who had experienced that form of health at home said that, if they had to be hospitalized again, they would prefer to get the care at home.

“It’s more patient-centric,” Raisig said. “It’s organizing care around the patient versus the care-delivery organization.”

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The first question to ask when deciding how to provide health at home, panelists said, is what problem your organization is trying to solve.

“You can easily get lost in what is the new shiny technology versus trying to get to the root of the problem,” Raisig said. “The technology can be added on as you understand what it is you are trying to accomplish in the home.”

There are two ways to approach health in the home: Building it into the existing system or partnering with a company that solely provides care in the home.

Dr. Mishra, who also heads digital care at University of California, Davis, Health (UC Davis), said that the health system recently partnered with DispatchHealth, which specializes in providing health in the home, to bring more care into patients’ homes.

The AMA health-at-home report helps physicians and health systems think through questions to guide organizations on what the best option for them may be. For example, UC Davis created a connected care center to triage patients into the best place to get care in their system.

Kevin Riddleberger, PA-C, co-founder of DispatchHealth, said “we need to do a good job moving forward to make sure that we have the right clinician practicing at the top of their license to deliver the right care. That holds true to facility-based care, but it is also going to be very, very important moving forward for the growth of in-home care.”