When people hear the word “home care”, many still think that this method of care is only for elderly patients with multiple diseases who need a visiting nurse to come to their homes and check them after they are discharged from the hospital.
But home care is much more than that. Health care systems and home care companies are striving to decentralize longitudinal and high-risk care away from facilities and bring it home, Pippa Schulman, Medical HomeThe chief medical officer, during an interview last week in the HLTH in Las Vegas. She believes that accelerating the decentralization of care at the hospital level will help improve access to health care and health equity issues.
Medically Home provides hospitals with a technology platform and services that allow physicians to treat a range of conditions in patients’ homes, including critical conditions traditionally treated in hospitals, such as heart failure, pneumonia, and cancer. Its competitors include Homeward and Optimize Health.
The Boston-based company has partnered with several health systems to advance this mission. Two of those collaborators are Kaiser Permanente and the Mayo Clinic, both of which are also collaborators Combined $100 million invested in the company last year.
Working with health systems is a vital part of decentralizing hospital care, according to Schulman.
“There’s a lot of consolidation happening in healthcare right now, particularly in terms of payers and retail clinics, which is very exciting when you think about access. However, people still prefer to seek their care from a doctor, nurse practitioner or system “Healthy. They want it to be an easier, better, faster experience. They want to help when they have a problem. We can help health systems get there,” she said.
For Medically Home health system partnerships to succeed, Schulman declared, health systems must understand that focusing all care around brick-and-mortar facilities is a dying paradigm. Ultimately, she believes, these facilities will only be used for complex care and “the sickest patients.”
The health systems that Medically Home partners with must be excited about “the idea that health doesn’t happen in a building, but that health happens in your everyday world where you live,” according to Schulman. In her view, home care does a great job of humanizing patients and giving providers a window into how they live and stay healthy.
When providers take care of patients in the hospital, they walk into a room that looks like every other room in the hospital and see a patient lying in the same gown that every other patient is wearing. It is difficult to create a personal care plan this way.
“As a physician, I can ask a lot of questions, but time is very limited,” said Schulman. “When my primary doctor is at home at the patient’s bedside and the tablet camera opens, I can now see the pictures on the wall. I see the plants, I see the mess, I see the cleanliness, I see the dogs and cats walking around. 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 around them.
Home care also has the potential to address health equity concerns by reducing mistrust in a population that has traditionally been underserved by the medical system. Schulman noted that for vulnerable populations that are structurally discriminated against because of race or socioeconomic class, there is immediately a power dynamic when they enter the hospital. When a doctor enters a patient’s home, she said, the energy balance is reset so that they are on the same level.
In order for health systems to position home hospital programs the right way, Schulman said they must make equity a priority. This means making sure the barrier to entry is as low as possible. At Medically Home, she said they’ve created a home care model that can be just that executed Anywhere.
The technique should be simple, and not dependent on the patient to bring anything to the table. According to Schulman, having to mount antennas or have a solid connection is not a burden that patients have to face.
“The only requirements that should be in our program are electricity, running water, and access to a bathroom,” she said. “We’ve done it in trailers, apartments, townhouses, homes — everywhere.”
Photo: kate_sept2004, Getty Images