Intensive Home Care Offers Comparable Treatment at Reduced Cost

Thanks to new technologies and a growing skilled-nursing workforce, home care has become a viable low-cost alternative to hospitalization for certain conditions. Yet, while these services are becoming more prevalent in the United Kingdom, France, Australia, and others, an absence of monetary incentives has prevented home care from gaining popularity in the United States, according to a recent editorial. 

“In this new world, the quaint house call will get an extreme makeover in the coming decade,” Luis Ticona, MD, MPP, of the Partners HealthCare System in Boston, and Kevin A Schulman, MD, of the Duke University School of Medicine and Harvard Business School, wrote in the New England Journal of Medicine.

Following diagnosis or acute care services from a standard setting, home health strategies employing telemedicine, pharmacy resources, home infusion technologies, and multidisciplinary home health care teams are capable of providing moderate-intensity services and frequent supervision, Dr Ticona and Dr Schulman explained. These alternative services are available for a number of clinical conditions including: exacerbations of heart failure or chronic obstructive pulmonary disease, stable pulmonary embolism or deep-vein thrombosis, pneumonia, and skin or soft-tissue infections. 

Along with reducing the burden on hospitals, the experts continued, data from meta-analyses and published program reports suggest reduced mortality and costs. However, implementation of home health care programs within the United States has been limited and faces substantial roadblocks, including concerns of appropriate substitution of care and induced utilization of services.

“An important challenge will be to develop robust eligibility criteria for triage into intensive home health care pathways,” they wrote. “Patient selection is an issue that needs to be addressed urgently if we are … to reduce avoidable and inappropriate hospital utilization.”

The other major concern noted by the experts was the dearth of financial motivation within the US health care system. If home care services were implemented, hospitals would miss out on inpatient revenue, outpatient providers would have no reason to work with home care providers, and payers would be unwilling to oversee these services. Although CMS has proposed alternative payment models and awarded a grant based on innovation in this space, these barriers continue to impede adoption of home care as a low-cost alternative.

“In health care systems that bear full risk for costs and full responsibility for outcomes, the ability to substitute such services for hospitalization makes sense, given the differences in cost between inpatient care and home care,” they wrote. “But in general, the lack of financial alignment in our system is an important concern.” —Dave Muoio