Home Care Could be Heart of the U.S. Health System by 2024, Leaders Say

Within 10 years, people’s homes could replace hospitals and other settings as the primary location for health care in the United States, according to leaders from technology company Intel and a prominent provider organization. They presented at a recent workshop convened by the Institute of Medicine (IOM) and National Research Council (NRC).

“The home setting and health services and supports will become so synonymous that they may not be called home care; rather, they will just be modern health care,” stated Steven Landers, MD, MPH, president and CEO of the Visiting Nurse Association Health Group, in a keynote address.

Landers gave his speech during the event that took place on Sept. 30 and Oct. 1, 2014. A summary of the workshop was released Wednesday. The event involved stakeholders from the government, academia, industry, philanthropic groups and consumer groups, and was in part prompted by a 2011 NRC report that found home health care is expanding due to lower costs and patient preferences.

The 139-page workshop report does an excellent job of capturing what took place there, participant Teresa Lee, executive director of the Alliance for Home Health Quality and Innovation, told HHCN.

In particular, Lee highlighted the ideas put forward by the keynote speakers, including Landers.

Affordable Care Act changes to better coordinate care, as well as people’s preferences to age in place, are among the factors that could lead in-home services to become the predominant type of health care by 2024, Landers said, according to the workshop summary report. Other advantages of home care include better safety for an increasingly aged population in danger of infections during hospitalizations, and an “enhanced view” of patients that can improve care by affording insights into how they eat and manage medications.

Yet, to achieve this vision for the future of home care, several “ingredients” must be put into the mix, Landers said. These include greater capability to care for higher acuity patients in the home, and expanded use of technology to maintain a person’s condition between caregiver visits.

Medicare changes, such as reimbursing more for value rather than volume of services, should help improve quality and consistency among certified home health providers, he said.

While his vision might seem difficult to achieve, current policies already are paving the way for this future, which is “clearly and tangibly before us,” he concluded.

Several of Landers’ points were echoed by another speaker, Eric Dishman, general manager of Intel’s Health Strategy & Solutions Group.

Misdiagnosed with a rare kidney cancer at 19 years old, Dishman spent more than two decades in treatment. He developed first-hand insights into the U.S. health care system, which now inform his work at Intel, where he strives to create technologies to improve people’s quality of life while shifting the point of care from the hospital to the home.

“[Dishman] noted that this approach flies in the face of some 230 years of hospital history, which says that, if you have a medical problem, you ‘make a pilgrimage to a place where the experts can be with their experts’ technology, and you time-share that system, just like we used to time-share the early computers,” the workshop report states. “Continuing the analogy, he said, ‘We couldn’t conceptualize back then that the power of personal computing was going to be that it would become truly personal. . . . It’s yours and you can do with it what you want.’”

Technological innovation and health care policy changes can make home- and community-based care the “default” and hospital-based care “the exception,” he argued.

“I think that really what he was trying to do is dare us to think strategically and think big,” Lee said of Dishman’s address. “How are we going to make this shift in the healthcare system? That’s a long-term and big picture exercise. But we should embrace value-creation. We cannot be wedded to the current system.”

The Alliance for Home Health Quality and Innovation was a sponsor for the workshop as part of its own Future of Home Health Project, which will include a Capitol Hill briefing in the spring as well as a white paper.

Written by Tim Mullaney