Key Barriers Could Limit Adoption of Home-Based Care Models

Over the past few years, the U.S. health care system has learned that home-based care companies are well-positioned to respond to unique challenges, with at-home care approaches often boosting patient satisfaction, lowering costs and improving quality of care.

Despite that positive movement in the home-based care market, a few key barriers could limit broader adoption and growth in the sector, experts caution.

Some of those barriers include an uncertain regulatory environment in a post-COVID-19 world, overly restrictive requirements for hospital-at-home programs and significant variability in requirements for providers across state lines. That’s according to a recent report from Moving Health Home, a coalition of home-focused health care organizations.

“To fully realize the benefits of home-based care, state and federal policymakers will need to implement permanent flexibilities and programs that build on the lessons learned from the temporary [public health emergency] PHE waivers,” the report read. “The pandemic has gifted the opportunity to transform how health care is delivered and this report is an important step in ensuring home-based care is part of our health care future.”

It’s no secret the PHE changed the U.S. health care system.

Providers turned to remotely caring for patients through a combination of telehealth and in-home services at a rapid pace. Meanwhile, the surge in virtual care was driven by quick decisions by Congress and the U.S. Centers for Medicare & Medicaid Services (CMS) to remove limitations on the use of telehealth in Medicare.

Regulators also allowed for greater coverage of health services in the home during the pandemic, including hospital-level care.

The CMS Acute Hospital Care at Home waiver program has been among the success stories, for example. As of March 4, there were 92 health systems and 203 hospitals in 34 states participating in the program.

The future of the waiver is now in question, however.

DispatchHealth is an at-home care provider that operates in over 30 states, providing urgent care and other higher-acuity services. The company received a temporary waiver in November 2020, though it was already delivering hospital-level of care prior to the pandemic, according to Chief Strategy Officer and co-founder Kevin Riddleberger.

“We’ve seen results [by] delivering hospital-level of care inside the home, how do we look at pushing that even further?” Riddleberger said during the webinar. “We’ve had great clinical outcomes, operational outcomes, but how do we sustain that moving forward? That is under consideration right now as we start to move away from the PHE. We need to push for and consider an extension, or an additional two years, to be able to deliver that hospital-level of care in the home.”

Rachel Raymond echoed those sentiments. Raymond is the chief strategy officer for post-acute and at-home care at Ascension, a faith-based nonprofit health organization focused on continuation of care.

Even with the rise of hospital-at-home programs, Raymond said the main purpose for hospitals won’t change. But investing in at-home care programs will be a key to continued innovation, she added.

“Hospitals will continue to remain as the site of care for treating the sickest, most vulnerable patients,” Raymond said during the webinar. “But building on the momentum of the last couple years, ensuring that we’re investing in the home, the infrastructure, the processes, the care teams, the ability to be able to deliver this comprehensive care, I think, is what’s going to get us to a much more ideal state.”

According to the Moving Health Home report, in-home care innovators have struggled to make long-term investments to expand services because it’s hard to predict two or four years into the future when it comes to regulation.

In other instances, existing regulatory restrictions have limited providers’ ability to scale quickly.

Jackie Lichwell, the regional vice president of Landmark Health in the New England area, said that innovation and self-scouting are among the keys to spurring growth.

“We have an entire team dedicated to expansions, both for the clinical and the operations piece, and we’re very fortunate in that way,” Lichwell said. “We have to continue to be able to support an innovative mindset. We’re constantly looking at the data and the analytics.”