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1/ what's a big shift in healthcare this coming decade that you’re betting on?
mine is that we'll see much *much* more care delivered in the home as opposed to traditional post-acute care sites (e.g. SNF, hospice).
mine is that we'll see much *much* more care delivered in the home as opposed to traditional post-acute care sites (e.g. SNF, hospice).
2/ more specifically, i think this will cause a shift in spending to the tune of >$100 billion dollars/year towards the home setting, and cause a reordering of the healthcare ecosystem.
3/ why?
covid has been a huge catalyst, as the home is now obviously a more preferable place to receive care than a nursing home for most.
but covid only accelerated a pre-existing trend: more than 90% of americans now want to spend their last days at home vs. in-facility.
covid has been a huge catalyst, as the home is now obviously a more preferable place to receive care than a nursing home for most.
but covid only accelerated a pre-existing trend: more than 90% of americans now want to spend their last days at home vs. in-facility.
4/ but there are a number of other factors as well.
one is expense.
nursing homes are estimated to cost ~$6000 more per discharge episode compared to home health based on AHRQ-funded research of 17+ million discharges: https://pubmed.ncbi.nlm.nih.gov/30855652/
one is expense.
nursing homes are estimated to cost ~$6000 more per discharge episode compared to home health based on AHRQ-funded research of 17+ million discharges: https://pubmed.ncbi.nlm.nih.gov/30855652/
5/ yet the same study showed that "there were no significant differences in 30-day mortality rates...or...functional status" between the two settings: https://pubmed.ncbi.nlm.nih.gov/30855652/
6/ another factor is patient and family experience.
many older adults have issues with transportation and scheduling to get the medical attention they need in current facilities.
and then there's comfort: would you honestly rather be in your own bed, or one of these all day?
many older adults have issues with transportation and scheduling to get the medical attention they need in current facilities.
and then there's comfort: would you honestly rather be in your own bed, or one of these all day?
7/ technology also plays a huge role as well.
the rise of connected wearables and sensors allows for an unprecedented level of monitoring at home, which is a lot less expensive than in-facility (no room and board fees, for one)
the rise of connected wearables and sensors allows for an unprecedented level of monitoring at home, which is a lot less expensive than in-facility (no room and board fees, for one)
8/ remote monitoring can then lead to "step up" home visits by clinicians when emerging issues are detected. this is an opportunity that companies like http://heal.com , and many others, are pursuing.
9/ finally, many doctors also find value in #bringingbackthehousecall, as it allows for better identification of social determinants of health and rapport.
"It's a better observation of their real life, compared with a typical office visit" - Dr. M, ref: https://www.health.harvard.edu/staying-healthy/the-doctor-will-see-you-now-in-your-home
"It's a better observation of their real life, compared with a typical office visit" - Dr. M, ref: https://www.health.harvard.edu/staying-healthy/the-doctor-will-see-you-now-in-your-home
10/ what are the headwinds?
i think current reimbursement structures will have to change to accommodate this shift.
i also think there's still an untapped opportunity to really support and incentivize caregivers, who will inevitably pick up more of the burden in this model.
i think current reimbursement structures will have to change to accommodate this shift.
i also think there's still an untapped opportunity to really support and incentivize caregivers, who will inevitably pick up more of the burden in this model.
11/ ultimately though, i think this is the right direction from a Quadruple Aim perspective, and i'm excited to continue to play a role in the development of this space.
thanks for reading!
thanks for reading!
