When people hear “home care,” many still think that this type of care is only for elderly, multimorbid patients who require a home care nurse to come into their home and see them after they are discharged from hospital.
But home care is much more than that. Health systems and home care companies are working hard to decentralize high-acuity longitudinal care and bring it into the home, Pippa Shulman, Medical homethe chief medical officer of the said during an interview last week in HLTH in Las Vegas. She believes that accelerating the decentralization of care at the hospital level will help improve health care access and health equity issues.
Medically Home provides hospitals with a technology and services platform that enables clinicians to treat a range of conditions in patients’ homes, including high-acuity conditions traditionally treated in hospital settings, such as heart failure, pneumonia and cancer. Its competitors include To home and Optimizing health.
The Boston-based company has partnered with several health systems to advance this mission. Two of those collaborators include Kaiser Permanente and Mayo Clinic, both of which also invested a total of $100 million in the company last year.
Working with health systems is a vital part of decentralizing hospital care, according to Shulman.
“There’s a lot of consolidation in healthcare right now, especially around payers and retail clinics, which is extremely exciting when you think about access. However, people still prefer to seek care from a doctor or nurse or health system. And they’d like it to be an easier, better, faster experience. They would like help when they have a problem. We can help health systems get there,” she said.
For Medically Home’s health system partnerships to be successful, health systems must understand that centralizing all care around physical facilities is a dying model, Shulman said. She believes these facilities will eventually be used only for complex care and “the sickest of the sick patients.”
The health systems that Medically Home partners with must be passionate about “the idea that health doesn’t happen in a building, but health happens in your everyday world where you live,” according to Shulman. In her view, home care does a great job of humanizing patients and giving providers a window into how they live and maintain their health.
When providers care for patients in a hospital, they walk into a room that looks like any other room in the hospital and see a patient lying in the same gown that all the other patients are wearing. It is difficult to create a personalized care plan in this way.
“As a doctor, I can ask a lot of questions, but time is pretty limited,” Shulman said. “When I have my primary home doctor at the patient’s bedside and the tablet camera opens, I can now see pictures on the wall. I see plants, I see clutter, I see order, I see dogs and cats walking. Think of all the information that can go into medical planning – people are not diseases, people are the accumulation of all their life experiences and the people who are around them.
Home care also has the potential to address health equity issues by minimizing mistrust in populations that have traditionally been underserved by the medical system. For vulnerable populations who have been structurally discriminated against because of their race or socioeconomic class, there is an immediate power dynamic when they enter a hospital, Shulman pointed out. When a clinician walks into a patient’s home, that power balance is reset so they’re more on the same level, she said.
For health systems to get hospital-at-home programs right, Shulman said, they need to make equity a priority. This means ensuring that the barrier to entry is as low as possible. At Medically Home, she said they’ve created a home care model that can be fulfilled everywhere.
The technology should be simple without relying on the patient to bring anything to the table. The need to set up antennas or a strong connection is not a burden patients should face, according to Shulman.
“The only requirements to participate in our program are electricity, running water and access to a bathroom,” she said. “We’ve done this in trailers, apartments, houses, quarters — everywhere.”
Photo: kate_sept2004, Getty Images