Homebound Americans have more complex and costly medical conditions on average than the general population. They also are more likely to have been hospitalized in the past 12 months, research shows. A recent analysis of National Health and Aging Trends and Medicare fee-for-service claims data concluded that homebound people aged 70 and older accounted for 11% of Medicare spending in 2015, despite comprising only 5.7% of the Medicare fee-for-service demographic.

In addition, homebound Americans too often deal with health equity issues related to social determinants of health (SDoH). These include physical disabilities and a lack of reliable transportation, which makes it difficult or even impossible for these patients to go to a clinic, hospital or doctor’s office for evaluation and treatment. Eventually their failure to get treatment causes their conditions to worsen, resulting in poorer health outcomes and higher healthcare costs.

Among healthcare organizations, patient advocacy groups and policymakers, there is an emerging consensus that patients tend to be happiest and healthiest when they’re in the home. Monique Reese, DNP and senior vice president of Highmark Health, characterizes the home environment as “the most authentic place someone can receive care. It’s where people live, raise families, have dinner, and where they make difficult decisions.”

Shifting healthcare to the home

The increasing number of homebound Americans and growing realization that patients do better in their homes are combining with technological advances to drive a shift toward primary care in the home. Up to $265 billion worth of care services (representing up to 25% of the total cost of care) for Medicare fee-for-service and Medicare Advantage beneficiaries could shift from traditional facilities to the home by 2025, according to a McKinsey estimate.

Delivering basic healthcare services and providing help with daily activities for homebound Americans require a team-based approach to primary care that includes non-traditional providers such as community-based organizations (CBOs) and social service agencies. Under a coordinated team model, a primary care provider may visit some patients in their homes a handful of times a year; allied and affiliated care providers would deliver other services as needed to homebound patients, including assistance with daily activities, wellness visits, nutritious meals and groceries. 

Deploying skilled nurses, social workers, lab technicians and other service providers to where patients are at enables homebound Americans to be monitored more closely for things such as changes in a chronic condition. A coordinated, personalized approach also helps patients develop trusted relationships with primary care providers and care team members. Critically, this reduces a patient’s social isolation, a condition that can cause mental and physical health problems among homebound populations.

Benefits of direct primary care for homebound

For homebound patients to effectively manage their own care, it is imperative that they have a trusted relationship with a primary care provider. This need has led to the rise of a care delivery model called Direct Primary Care (DPC), an alternative payment system that eliminates fee-for-service payments and third-party billing. DPC is an attractive option to many patients concerned about rising healthcare costs and providers eager to reduce administrative burdens. DPCs are built upon and enhance those clinically important patient/primary care provider relationships.

One recent study analyzing the impact of DPC on health outcomes and costs concluded that DPC members had 25.5% lower hospital admissions, while the cost of ER claims was reduced by 53.6%. By improving outcomes and the patient experience while reducing paperwork and costs, DPC payment models can help smaller practices remain independent.

Strong working relationships with CBOs also can allow smaller practices to thrive while ensuring patient needs are met where they are. To successfully integrate CBOs into a care network, providers must deploy technologies that offer support for onboarding, data capture, digitization, and exchange. These technologies must support SDoH, quality reporting, reimbursement, and other use cases. 

Many smaller providers have digital infrastructures in place. However, these are unlikely to support the many-to-many complex relationships between different entities necessary for coordinated care of patients in their homes. Integrating CBOs into a care network requires:

  1. A cloud-based data infrastructure that powers real-time clinical decision-making, information sharing and analytics.  Such an infrastructure can digitize data (including unstructured data), integrate with legacy systems and provide a unified view of the data sets for better decision making.
  2. Realignment of downstream reimbursement to include both medical and non-medical providers (behavioral health services, nutritionists, etc.)
  3. Integration of SDoH resources and CBOs

Increased demand for primary care

As the number of elderly Americans and others homebound continues to climb, demand for primary care in the home through DPC and more traditional care models will rise. The most successful home care initiatives will feature a collaborative, team-based approach involving multiple disciplines and services that improve health equity for our most vulnerable populations. Independent providers and CBOs can coordinate care, services, and reimbursements by implementing a scalable, cloud-based digital infrastructure.

Lynn Carroll is the chief operations officer of HSBlox, which assists healthcare stakeholders at the intersection of value-based care and precision health with a secure, information-rich approach to event-based, patient-centric digital healthcare processes — empowering whole health in traditional care settings, the home and in the community.