As care delivery moves from hospital to home, health systems see new opportunities, risks

For many patients, care has been restricted to the four walls of a hospital. With COVID-19, however, those boundaries have blurred, and health systems are finding innovative ways to serve individuals where they are.

During a session from the Becker's CEO + CFO Virtual Forum, Teladoc Health hosted a webinar to explore the growing trend of home-based care delivery. Five experts shared their insights:

  • Jordi Altes, MD, adjunct medical director at Hospital Clinic de Barcelona (Spain)
  • David Fletcher, associate vice president of telehealth at Danville, Pa.-based Geisinger Health System
  • Dustin Hufford, senior vice president and CIO at Camden, N.J.-based Cooper University Health Care
  • Hiten Patel, PhD, chief product officer at Rush University Medical Center in Chicago
  • Bruce Brandes, senior vice president of consumer-centered virtual care at Teladoc Health

Four key takeaways:

1. Even before the pandemic, healthcare systems were adopting home-based care. For five years, the Geisinger at Home program has targeted patients at high risk of readmission, emergency department usage and multiple comorbidities. In its first year, a pilot demonstrated a cost savings of $2 million. "When we decided to scale the program up, we added telemedicine," Mr. Fletcher said. "Nurses and community health assistants use tablets to connect with providers in a central location."

Similarly, Rush University Medical Center started its telestroke program nearly a decade ago. Its next step was reducing readmissions by getting patients home with the right monitors. Now, the organization is stepping back and taking a more comprehensive approach to home-based care.

2. Home care increases patient satisfaction and lowers costs. The Hospital Clinic de Barcelona began providing home care to patients with infectious diseases in 1996. Today, the unit offers all types of medical, surgical and mental health services. This model has proven to be safer, less expensive and more satisfactory than conventional hospital-based care. "In a survey conducted last year of patients admitted to home hospitalization, 95 percent were satisfied with the experience," Dr. Altes said. "The cost of this program is almost 55 percent less than typical hospital care." Experience shows that the closer care is to patients' homes, the cheaper and more convenient it is.

"COVID-19 presented the opportunity to unleash new virtual care models out of necessity, and now the underlying financial model is changing, so organizations can benefit from that," Mr. Brandes said.

3. Healthcare organizations are shifting to a command-center approach to home care. To provide outstanding home care, organizations must create a command center that takes the entire patient experience into account. "You have to treat the home like it's a hospital room," Mr. Hufford said. "You must wrap services around that including laboratory, radiology, food and nutrition, frequent nurse visits, and the ability to reach a clinician." A command center demands a comprehensive, standard approach to technology and often requires assistance from outside organizations.

"We are adding partners to the full care journey, including innovators in the area of urgent care in the home, such as Teladoc and their Livongo suite of services," Dr. Patel said.

4. Consumer technology is the new standard in healthcare. In the months and years ahead, the relationships that healthcare organizations have with patients will be more like the relationships people have with consumer products. This raises the bar for healthcare software. "When a new entrant says they will provide 60-second care, that changes the playing field. We need to jump farther and faster in this space," Dr. Patel said.

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