The home is replacing the hospital as the center of the healthcare system, according to Andy Slavitt, founder and partner of Town Health Ventures and former head of the Centers for Medicare & Medicaid Services. Slavitt spoke in a question-and-answer session Wednesday, the last day of the Home Care Innovation + Investment Conference.
He used the symbolic “H” hospital sign to make his point.
“We can say with good confidence ‘H’ is going to stand for home,” he told the audience at the Swissotel in Chicago. “It’s not going to stand for hospital any longer.”
He noted that those services traditionally created as hospital wraparound services — everything from primary care to dialysis — are now shifting to the home.
“You go to that big building for some high-acuity event, but everything else you can possibly do is going to be in the home,” said Slavitt, who served as acting administrator of CMS under President Obama.
‘Bullish’ on PACE
Slavitt, whose company invests in healthcare firms to improve care for low-income populations, believes the Program of All-inclusive Care for the Elderly (PACE), a joint Medicare- and Medicaid-funded program that offers comprehensive services to older adults at home, is “the ultimate model.”
The program, which is geared to seniors’ clinical, social and behavioral needs, has greater than 95% satisfaction and is cheaper than traditional skilled nursing care, he noted.
It is “one of the few things in healthcare that does just about everything right,” he said.
While he said he is “very bullish” on PACE, he also is interested in hospital-at-home as an area of opportunity. He pointed out that the clients of hospital-at-home provider Medically Home include major health systems such as Mayo and Kaiser. Those companies would agree they don’t know when hospital-at-home, which is only in place among around 200 healthcare systems, will take hold.
“All they know is it should and they want to be there when it does,” Slavitt said.
The government naturally lags behind in terms of innovation, commented Slavitt, who answered a variety of questions from Laura Veroneau, managing partner of Optum Ventures. That is why the Center for Medicare and Medicaid Innovation, which tests out new payment models, is so important, he said.
“One of the reasons CMMI is so different is it allows you to sort of go and see and experiment,” he said, adding that it is important to keep CMMI apolitical. “That’s under threat.”
A fresh look at labor
Slavitt also talked about the labor shortage, which will see a massive loss of nurses in the next decade, as an opportunity for innovation. The challenge demands that healthcare community think differently about its workers. It is important to examine what degrees and licenses workers need and why doctors receive a lot more compensation than nurses who can do many of the same tasks.
There are also taboo topics around the labor force we need to confront, such as the antagonism between nurses and doctors, he said.
