Home care providers play a pivotal role in bringing health equity to a fragmented care ecosystem. Insurers and providers must support this overlooked and under-resourced healthcare service. Transformative partnerships can enable safe transitions of care, complex care coordination, assistive technology solutions and quality home care for under-resourced populations.
Physicians are under pressure to decrease hospital length of stay, which means patients go home with more complex needs than before. In-home support from licensed healthcare providers bridges the gaps between inpatient and outpatient services, reducing hospital readmissions and adverse events in the home.
Home health providers coordinate care across the continuum
Home health providers often serve as care coordinators; they identify the needs of patients who are unable to make routine physician or outpatient visits. Home health providers see patients in their element, gaining insights into their daily health habits. For instance, a patient with diabetes and elevated blood sugars can tell their doctor they are eating all the right things, but when a home health nurse is sitting in their kitchen, they see firsthand what foods the patient is eating.
Patients frequently require changes to their prescription medications during a hospital stay. A licensed nurse can keep an active medication list, reconcile medications at home and verify the patient is taking their medications as directed. EMR advances would make this review more seamless. In under-resourced populations, pharmacy care coordinators can connect home health providers with drug assistance programs or suggest lower-cost alternatives to boost medication adherence.
Telehealth advancements expand the services home healthcare providers can offer patients. Digital scales, blood glucose monitors and blood pressure cuffs will transmit data to the provider, allowing more frequent patient monitoring without additional in-person visits. Patients or caregivers can request a telehealth video conference with their nurse or another care team member if they have concerns about wound healing, medications or managing durable medical equipment.
Medicare Special Needs Plans (C-SNPs) are a proactive, flexible, collaborative and value-based approach to treating chronic diseases such as diabetes, heart disease and kidney disease, which impact underserved communities disproportionally. A home health clinician can suggest a dietician consult to help the patient control their blood glucose; physical therapists to prevent falls and injury; occupational therapists to help the patient eat, dress or bathe independently; or social services such as rides to medical appointments, meals or prescription payment assistance.
Many patients need services beyond what their payer source allows. In most cases, patients must be homebound, able to travel only with taxing effort, to qualify for home health services. Determining coverage may be complicated for dual-eligible individuals who qualify for Medicare and their state’s Medicaid services. Medicare Advantage plans vary widely in their reimbursement rates for home health services. To assure health equity, insurers must align on care practices for home health providers and set rates that support quality care.
How policymakers can utilize home health to reduce health disparities
Policymakers can join insurers in providing the right incentives to reduce health disparities. Rewarding value-based care strictly on outcomes disadvantages underserved populations, whose members often struggle to manage chronic conditions. While clinicians may provide patients with excellent education and instruction, following a treatment plan is more challenging for those lacking access to healthy, fresh foods, a safe place to exercise or the resources to pay for their prescriptions and medical supplies.
To reduce health disparities in underserved populations, policymakers should consider expanding Medicare coverage to include nonskilled services, such as assistance with personal care, errands, meal delivery and housework for those without adequate caregiver support. Policymakers also must ensure that dual-eligible (D-SNP) plan recipients have the same access to care as other Medicare beneficiaries.
Care coordination across the continuum of care promotes patient well-being, saves resources and reduces health disparities. Primary care providers are crucial to the continuity of care. But for patients who may be unable to visit their PCP regularly, home health clinicians also play a vital role in meeting patients’ needs in their home environment. Insurers and other participants in the health ecosystem must do their part to support collaborative relationships with home health providers.
Eric E. Whitaker, MD, is executive chairman and founder of Zing Health, a physician-founded insurance company offering Medicare Advantage plans that return the physician and the member to the center of the healthcare equation to address social determinants of health. To learn more, visit myzinghealth.com.
