The Affordable Care Act has been the catalyst for seismic shifts in the healthcare landscape.
The associated regulations pertaining to Medicare and Medicaid, value-based outcomes, discharge planning, and home health agencies have created both challenges and opportunities. One of the trends arising from these changes is an increase in home-based health care, which is being promoted as a more efficient and effective way to treat the growing elderly population as well as patients with disabilities and chronic conditions. A recent U.S. Census report on the 65-and-older demographic claims this age group will two times larger in 2050 than it was in 2012. This cohort is currently pegged at 13 percent of the total population; by 2030, this group will represent 20% of all Americans. As the baby boomer generation ages into Medicare eligibility, the government and health care providers are striving to address their particular needs more efficiently and at a larger scale. One of the major initiatives in this area is increasing the availability of home health care.
According to the American Academy of Family Physicians, the existing long-term care and assisted living infrastructure is not sufficient to address the needs of the growing elderly population, many of whom are homebound due to disability, chronic illness, poverty, and lack of familial support. Medicare billings show an increase in house calls from 1.4 million visits in 1999 to 2.3 million visits in 2009. Thanks to the ACA, Medicare patients are better able to afford home health care, and as the population ages, more patients qualify as homebound. Medicare guidelines now encourage house call-based models as more cost-efficient than traditional facility-based options, which often require patients to endure lengthy waiting periods for an appointment or placement.
In November, President Obama signed the PACE Innovation Act (Programs of All-Inclusive Care for the Elderly), which included provisions for opening these services to anyone over age 21 who meets the criteria for nursing home care. The aim of these programs is to keep patients out of nursing home settings as much as possible, due to the higher costs of these settings. Patients generally prefer to stay home when possible, and have better health outcomes, more independence, and more support from loved ones and local community services. Opening these programs to a wider demographic creates opportunities for home health agencies, hospitals, and other providers to expand on this model. The risks and costs for providers and insurers (both Medicaid and commercial) decrease as the pool of eligible patients expands. Moreover, new regulations for discharge planning and value-based care encourage better communication between providers as well as more active engagement of patients and caregivers.
The convergence of these government initiatives, the growing elderly population, and the pent-up demand for home-based care points to significant growth opportunities for providers and healthcare technology companies. In November alone, three home health M&A transactions had a cumulative value of $108.7 million, following a year of heightened M&A activity in the space, with more expected in 2016.
Less than a hundred years ago, house calls were common practice. In 1930, approximately 40 percent of patient exams took place in the patient's home. By 1980, only one percent of patient visits were house calls. As healthcare technology developed (ECGs, etc.), it became more practical for patients to visit the doctor's well-equipped office. Now the technological tides are turning again—many basic medical devices are available in portable formats, electronic health records can be accessed from any location, and mobile devices provide logistics support (GPS driving directions, patient communications, and so on). We're likely to see an increase in mobile health services even for relatively healthy patients; a Boston-based experiment called UberHEALTH is using the on-demand service model to deliver basic healthcare services (e.g., flu shots) to patients in their homes and workplaces.
House calls may seem like a simple and obvious solution at first glance. However, few medical practices are currently set up to accommodate the time and logistics required. Fortunately, much of the supporting technology is available and more solutions are in development. EHRs and integrated database-driven back-office solutions enhance collaboration among providers and make it possible to provide treatment outside of the office setting. Card scanning and identity verification solutions and mobile tablets, for example, will make it possible for home-based healthcare providers to check Medicare eligibility, process insurance, review prescription medication records, and log visit details while caring for homebound patients. Many of these patients have cognitive or physical impairments that prevent them from filling out forms, remembering insurance and prescription details, or following through on treatment recommendations. Home health technology systems will increase treatment accuracy, enhance communication with family caregivers, and prevent medication issues—resulting in fewer hospital admissions and improved health outcomes.
There is a tremendous demand for advancements in the availability and efficiency of home-based healthcare. Millions of homebound Americans are in dire need of better healthcare, and their caregivers are equally in need of support and respite. These patients generally have more than one health problem, and many have been underserved for years. Bridging the gap between traditional healthcare settings and home care will have significant benefits for patients, caregivers, and the healthcare system in general. Technology solutions will be essential to building the connections necessary to rapidly scale systems for a growing population of homebound patients.
Yossi Zekri is president and CEO of Acuant, the leading provider of identity solutions. Acuant's award-winning and patented credential management solutions automate the intake, processing and verification of unstructured data from ID documents. Leveraging virtually any device, the company's solutions transform this data into useful and insightful information used in critical business applications, whether local or in the cloud.
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