Home-based care: How removing barriers can improve access, experience, outcomes and health equity

Moving care outside the hospital and into patients' homes can have a powerful impact on reducing health disparities. But first, providers must overcome regulatory barriers.

During a featured session at Becker's Hospital Review's Shift to Digital Virtual Event sponsored by Moving Health Home, an alliance advocating for regulatory policies that recognizes the home as a site of care, healthcare leaders discussed barriers to and reasons for implementing home-based care models. Panelists were:

  • Krista Drobac, founder, Moving Health Home, and executive director, Alliance for Connected Care (Moderator)
  • Deidre Rolli, RN, clinical care coordinator, UMass Memorial Hospital at Home in Massachusetts
  • Ashok Roy, MD, chief medical officer, Caravan Health (part of Signify Health)
  • Nathan Starr, DO, medical director, home services, Castell and Intermountain's Telehospitalist Program (Salt Lake City)
  • Josh Tamayo-Sarver, MD, PhD, Vice President of Innovation, Vituity & Inflect Health

Three key takeaways were:

1. The COVID-19 pandemic evidenced the value of alternative models of care. Prior to the pandemic, telehealth and home-based care were considered second- and third-tier issues by federal institutions and by executive leadership at many organizations. But this crisis forced regulators to adopt more flexible requirements and reimbursement policies related to virtual care. Along with changes in requirements and reimbursement, access to care and the patient experience improved, causing the mindsets of regulators and executives to change. There is now a sustained push from providers to maintain these regulatory flexibilities indefinitely.

2. Home-based care models still need greater alignment among stakeholders. Operationalizing these models requires alignment and agreements at the payer-provider and facility levels about how services will be delivered without negatively impacting payment or penalizing clinicians for providing care from their

Intermountain negotiated an early discharge model with its insurer and a split diagnosis-related group payment model with its hospitals, so that providers could get compensated without having to bundle services with clinically unnecessary hospitalizations to get paid a full amount.

"We worked hard on pulling patients out of the ED so we could avoid hospitalizations. Between all the entities helping take care of these patients — our telehospitalists, home care team, pharmacy and nurses going into the home with a local paramedic company — everyone stepped up to the plate," Dr. Starr said.

3. Awareness of the interplay between health equity and home-based care is essential. Lack of broadband connectivity in rural areas and low-income communities, in addition to data package expenses, is another type of barrier to operationalizing home-based care models. To address them, Congress is working on greenlighting audio-only telehealth consultations.

On the other hand, enabling home-based care for patients of lower socioeconomic status, who may feel intimidated navigating the health system in person, can be empowering. "The power dynamic changes when someone is in their own home," Ms. Drobac said.

Dr. Roy added that home visits allow providers to get crucial insights into people's living conditions, which have an impact on access and health outcomes. Before Covid, he said, physicians "would do one home visit a week in the rural areas, but the insight they got was enormous. [With virtual visits], they could do it with more people." For example, visiting nurses can detect when a patient's household is dealing with food insecurity or lacks heating, connect them with services and relay the information to physicians. "These are patients that will show up at a physician's office completely put together; you would never know what was going on," Ms. Rolli said.

Healthcare leaders interested in seeing a permanent removal of barriers to telehealth and home-based care can advocate for such changes by reflecting on and evidencing their own experiences as patients.

"When I have a problem, I don't go to the hospital — I call a friend who's a physician in a specialty that I need advice on. That's been an access that's available to us," Dr. Tamayo-Sarver said. "From an equity perspective, maybe we should open that up to the rest of our patients to be able to get care in the convenience of their home and not have to take a day off of work."



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