Editor’s Note: The home is now becoming a primary care haven. And what defines “home” is changing. To learn more, Patrick Barlow, Partner in Oliver Wyman’s Health and Life Sciences and Organizational Effectiveness practice, spoke with Monique Reese, nurse practitioner and Senior Vice President at Highmark Health, a national blended health organization. Here’s what they had to say.
Oliver Wyman: The idea of “home” as a house with a white picket fence has evolved. How do you think about “home” and its care delivery context?
Monique: In the last 10 years, there has been significant change in how consumers, payers, and providers look at home health. When the Accountable Care Act became law in 2010, advanced payment and reimbursement models influenced how payers and providers looked at how home care was shifting to create value and create a better experience – improved quality at a lower cost. And how advanced payment models could support greater affordability and lower healthcare costs as the population ages and the Baby Boomer population grows. New payment models like these created an opportunity for innovation.
Since 2010, there's been enormous transformation around what home care means and what care in the home looks like. Payment changes, models, technology, and consumerism have driven that. So do individuals’ and their families’ preference to be healthy and heal in their home environment.
Oliver Wyman: What might the future of change look like?
Monique: Traditionally, after someone's been in the hospital or after an event, you leverage the team of home care nurses to provide skilled care. But I’m seeing significant change driven by consumers, payers, and providers for care in the home to be much more proactive and interventional – utilizing physicians and advanced practice providers so individuals can stay in their home environment and avoid hospitalizations or unnecessary emergency department visits.
We're also seeing teams in the home environment continuing to become inter-professional or interdisciplinary so we can approach an individual’s care based on their individual preferences, but also on their needs – whether medical, social, or financial.
Oliver Wyman: When you think about this evolution, is there a different or expanded mix of services you expect to see being delivered?
Monique: Yes, we're looking at populations in the home environment over a much longer set of time and across the continuum. It should be before hospitalizations (not just after) and/or before emergency room visits and how we're partnering upstream to keep those individuals healthy and in their home environments.
The home environment is the most authentic place someone can receive care. It's where people live, raise families, have dinner, and where they make difficult decisions. A highly skilled team working in that environment must recognize different clinical, social, home, and environmental facets.
The home environment is the most authentic place someone can receive care. It's where people live, raise families, have dinner, and where they make difficult decisions.
Oliver Wyman: Hospitals are not always a place where consumers say, “That's where I want to go to get better.” Do you envision a broadening of different sets of services where certain procedures historically done on an outpatient basis migrate into the home?
Monique: Absolutely. From a consumerism standpoint, we’re evolving from traditional home care to modernizing care in the home. Offering choice to consumers is critically important to their health, and we're already seeing innovation in the home environment aligning with consumer preferences. A model that matures to care delivered virtually or through technology is critical for us to meet the expectations of individuals and their families. The Hospital at Home Model is a great example of care migrating to the homes of individuals — here, we’re meeting inpatient criteria, yet patients have the choice to receive that acute level of care in their home, or they can still elect inpatient care.
Oliver Wyman: What key capabilities helped you transition to delivering differentiated services in the home?
Monique: A few key capabilities are needed to be successful. First, having a highly skilled interdisciplinary team in the home environment that's interventional and highly skilled in assessment, and who can intervene appropriately and proactively.
Second, are virtual health capabilities and the ability to complete virtual visits in home environments with a hospitalist or advanced practice provider-type role that can in real-time, complete a visit, assess, diagnose, and implement interventions with individuals in their home environment.
Oliver Wyman: What kinds of technology are pivoting home care’s evolution?
Three types of tech are driving home care’s evolution. First, virtual visits in which patients visit with their physicians and other care team members via telephone or video. Virtual visits are convenient and highly accessible for patients everywhere and had been gaining traction pre-COVID-19. During the pandemic, they’ve been readily adopted as a safer means of receiving care, supported by positive changes to policy by the Centers for Medicare & Medicaid Services (CMS) and to medical coverage by insurers. Virtual visits have immense potential as a real-time solution for delivering certain types of care efficiently across large populations — important as the Baby Boomer generation ages. And today’s most progressive care delivery models, such as home recovery care that provides hospital services to patients at home, leverage virtual visits in combination with traditional in-person visits with great success.
The second type of tech that’s been pivotal is remote monitoring, which includes both wearables and medical equipment enabled by microprocessors, the Internet, Bluetooth, and other technologies. These devices make it possible to collect and transmit actionable, real-time data related to blood pressure, heart rate, weight, blood glucose levels, pulse oximetry, and more. While these devices have been in the marketplace for some time, combined with today’s more sophisticated predictive analytics and artificial intelligence, they enable clinicians to detect when a patient’s health is declining and to proactively intervene earlier, an exciting development in protecting the health of patients upstream.
Finally, the third type of tech is the analytics piece — both business and care analytics that enable the health care industry to be more strategic about their home-care operations and to be better informed about their patients’ health, including risk factors, optimal care models, and interventions that can improve health and longevity.
Oliver Wyman: Regarding broader consumer applications for home health in light of COVID-19, what may happen in the future?
Monique: From a consumerism standpoint, individuals are wanting to stay in their home environment. They want to avoid emergency departments and hospitals if possible. Those individuals likely still need care from home health organizations and or community-based organizations to meet their needs. COVID-19 allowed home care organizations to step up and care for people and keep them safe in their home environments and free of infection.
As we’re caring for COVID-19 patients, we’re actively working with patients to continue to educate and provide in-home care. We’re also preventing individuals and families from being exposed to an infection or becoming infected – something critical on a regional and national basis. We're seeing home care organizations nationwide responding and caring for all individuals who are COVID-19 positive and providing high-quality care.
Oliver Wyman: What's your perspective on engaging the family, the care team, and individuals in that close orbit around the patient as they think about their care journey at home? Sometimes, the consumer can either be the patient or caregiver team, and you must support both.
Monique: I completely agree that the consumer can be either the patient, caregiver team, or both. At the front-end, it’s being able to identify and ensure the entire care team is informed about who that decision-maker is or whom they can go to – maybe a family member or friend – to communicate that across the care team. The individual and/or caregiver being part of the care team and the development of an individualized care plan is very important in the care journey at home.
Oliver Wyman: Being in a home environment requires knowledge of the local neighborhood, cultural expectations, transportation issues getting to your doctor, or how to communicate with empathy. How do you contemplate this as part of a care pathway?
Monique: The team working in the home environment must be highly skilled and able to recognize a wide range of clinical, home, social, and environmental factors. You see, feel, and experience what an authentic environment looks like for an individual and family. The home is the most autonomous place for care teams to practice. The clinical skill level must keep developing as care shifts into the home and so must the competency of how clinical teams partner with individuals to reach optimal self-management. Pathways that ensure social determinants of health are identified and solutions are implemented to ensure there is a connection to the needed resources or education is crucial.
As care in the home continues to transform there are several competencies teams should display to be successful, and knowing how to communicate with empathy is an extremely important piece. A person-centered approach is required that builds on trust and shared decision making, individualized assessment of needs, values, and preferences, collaborative goal setting and planning, continual skill-building, problem-solving, and expertise in the coordination of care.
Oliver Wyman: Do you see more vertical integration or horizontal integration? How do you expect to see that shaping up in terms of market structure?
Monique: I foresee the continual merger and acquisition – both vertical and horizontal – in this space. We're seeing both financial and care models now looking at how you manage populations. We’re seeing advanced payment models being developed outside of traditional home care, especially in models like primary care-first. Innovations are also coming from commercial payers and Medicare Advantage plans about paying differently for care in the home.
From governmental and commercial payers, we’ll continue seeing new models of payment developed and implemented in the home – an opportunity for home care organizations to continue delivering in a traditional home care model, but also outside of that traditional Medicare model. As healthcare continues to transform, we will also continue to see provider organizations partnering with organizations that provide care in the home. It is an exciting time and opportunity for organizations delivering care in the home.
Oliver Wyman: If you think five or seven years in the future from an innovation and consumer standpoint, what do you expect to see where you say, “Wow, that was a breakout innovation that changed health?”
Monique: I expect to see that virtual care's going to become even more important for us. Our ability to care for the population that's going to continue to move in the home and stay there will become an expectation. Our capabilities and use of predictive analytics, artificial intelligence, and how we can proactively identify at-risk individuals will continue to evolve and be central to our success.
I am excited about why we're here, why we do what we do, and how being predictive and proactive creates a remarkable experience, freeing people to be their best. I’m super excited about that.
Monique Reese, DNP Senior Vice President, Highmark Health
Patrick Barlow Partner, Health and Life Sciences, Oliver Wyman