The Evolution of Home-Based Care Over the Last 25 Years—And How the Pandemic Accelerated Its Adoption

Home is where the heart is. More and more, it’s also where better health is.

As someone who has worked in and around the home-based healthcare industry for the last 25 years, starting out as a physical therapist and then transitioning to management positions, I have witnessed immense changes in the types of patient care that can be provided in the home setting and the approaches used for delivering that care.

This evolution in at-home care encompasses a shift in payment models toward value-based care, technological advances that support care delivery and a significant broadening of healthcare services now available to patients in their home.

The speed of change has rapidly accelerated in recent years, a development that greatly benefits patients, who overwhelmingly prefer to be cared for in their home, while at the same time reducing healthcare costs.

The Shift Toward Value-Based Care

When I started in the industry, the fee-for-service (FFS) payment model was the only game in town. We are now seeing broader adoption of value-based care approaches that take a whole-person, longitudinal view of the patient and place greater responsibility on providers for keeping patients out of the hospital while allowing them to share in the financial benefits when they do. Although still in a transitional phase, with episode-based payment models currently predominant, value-based models are gaining traction. Humana has been a leading force in embracing the value-based approach and in doing so is accelerating the uptake of healthcare services in the home as an effective way to reduce hospitalizations and the overall cost of patient care. 

An important advantage of treating patients in their own environment is that it provides a window into their daily lives and the factors impacting their health. Care delivery in the home provides direct visibility into the patient having enough healthy food in the fridge, whether the temperature of their home poses a danger, furniture and rugs that could pose a safety risk, and we can better assess a patient’s mental health. Not only can we identify these social determinants of health, a value-based approach also enables us to help alleviate these issues by connecting people to the services they need.  The recognition that addressing social determinants is as important, if not more important, than medical treatments has been a recent shift in thinking that is essential to preventive care.

Technological Advancements in Home-Based Care

Advances in technology have had a huge impact on how we deliver care in the home and the range of care made possible with the use of these tools.

From new medical monitoring and diagnostic devices to telehealth services, technology is making it safer for patients to remain in their homes while having their vital signs and symptoms closely monitored. At Humana, we are starting to use asynchronous communications software so patients can report their symptoms at a time of their choosing and have software provide insights that enhance the conversation with their nurse or therapist. Patients can also use video conferencing and synchronous communications to compliment and improve the care they receive in the home.

Increased Breadth of Home-Based Care

Applying both technology and a value-based payment model has the potential to vastly expand the types of health services that can be provided in the home setting. Humana is on the leading edge of this transformation, offering at-home services including primary care, advanced urgent care and even hospital care for patients within a certain acuity range. By treating health emergencies in the home, we not only eliminate the need for an ER visit but we also reduce the potential for a hospital stay given the high probability that an elderly person with complex medical issues will be admitted for observation even when it may not be medically necessary.

How the Pandemic Accelerated the Adoption of Home-Based Care

Given the benefits of at-home care, it was already becoming more widely accepted prior to the pandemic. But COVID-19 quickly expanded its adoption as congregant homes and visits to medical facilities increased the risk for exposure. Not only do at-home health services provide a safer care environment as the pandemic continues to rage with the spread of the delta variant, they ensure patients get the timely care they need. According to one survey, 54% of Americans delayed or skipped medical care during the pandemic out of fear of contracting the disease. In addition, as Covid-19 cases continue to strain hospitals, there is a greater need now for in-home hospital-level care.

The Future of Home-Based Care

Home-based care has a bright future because of the many factors in its favor: services delivered more safely and affordably; a fuller view of the patient’s health from being treated where they live; advancements in tools and technology that allow for an increasingly wide spectrum of care in the home. And most important, the opportunity for an improved patient experience—and thus, better health outcomes.  

Home is where patients want to be. The healthcare system will continue to evolve to meet that need.  

Kirk Allen is senior vice president of home care at the Louisville-based Humana.