When people hear “home care,” many still think this care modality is only for elderly, multimorbid patients who require a visiting nurse to come into their home and check in on them after their discharge from a hospital.
But home care is much more than that. Health systems and home care companies are working hard to decentralize high acuity, longitudinal care away from facilities and bring it into the home, Pippa Shulman, Medically Home’s chief medical officer, said during an interview last week at HLTH in Las Vegas. She thinks that accelerating the decentralization of hospital-level care will help improve healthcare’s access and health equity issues.
Medically Home provides hospitals with a technology and services platform that allows clinicians to treat a range of conditions in patients’ homes, including high acuity conditions that are traditionally treated in hospital settings, such as heart failure, pneumonia and cancer. Its competitors include Homeward and Optimize Health.
The Boston-based company has partnered with several health systems to advance this mission. Two of these collaborators include Kaiser Permanente and Mayo Clinic, both of which also invested a combined $100 million into the company last year.
Working with health systems is a vital part of decentralizing hospital care, according to Shulman.
“There’s a lot of consolidation happening in healthcare right now, particularly around payers and retail clinics, which is hugely exciting when you think about access. However, people still prefer to seek their care from a doctor or nurse practitioner or health system. And they would like that to be an easier, better and faster experience. They would like help when they have a problem. We can help health systems get there,” she said.
In order for Medically Home’s health system partnerships to be successful, health systems must understand that centralizing all care around brick-and-mortar facilities is a dying model, Shulman declared. She thinks that eventually, these facilities will only be used for complex care and “the sickest of the sick patients.”
The health systems that Medically Home partners with must be passionate about “the idea that health is not taking place in a building, but health is taking place in your everyday world where you live,” according to Shulman. In her view, home care does a great job of humanizing patients and gives providers a window into how they live and maintain their health.
When providers take care of patients in a hospital, they walk into a room that looks like every other room in the hospital and see a patient who is lying in the same gown that every other patient is wearing. It’s difficult to create a personalized care plan that way.
“As a doctor, I can ask a lot of questions, but time is quite limited,” Shulman said. “When I have my primary in-home clinician at the bedside of the patient and the tablet camera opens up, I can now see pictures on the wall. I see plants, I see mess, I see tidiness, I see dogs and cats roaming by. Think of all of the information that can go into medical planning — people are not diseases, people are the accumulation of all of their life experiences and the people they’re around.”
Home-based care also has the potential to address health equity concerns by minimizing distrust in populations that have been traditionally poorly served by the medical system. For vulnerable populations that have been structurally discriminated against due to their race or socioeconomic class, there is immediately a power dynamic when they walk into a hospital, Shulman pointed out. When a clinician enters a patient’s home, that power balance is reset so they’re more on the same level, she said.
In order for health systems to set up hospital-at-home programs the right way, Shulman said they must make equity a priority. This means ensuring that the barrier to entry is as low as possible. At Medically Home, she said they have created a home-care model that can be executed anywhere.
The technology has to be simple, not relying on the patient to bring anything to the table. Having to set up antennas or have a strong connectivity is not a burden that patients should face, according to Shulman.
“The only requirements to be in our program are electricity, running water and access to a bathroom,” she said. “We’ve done this in trailers, apartments, houses, rooming houses — all over the place.”
Photo: kate_sept2004, Getty Images