Payers and providers are investing in home healthcare, in a shift that promises to change the paradigm of care delivery, writes Clarivate market access expert Parvathy Menon
Home healthcare is hardly a new concept in the United States – in the 1930s, physicians toting doctor’s bags to home visits made up 40% of patient encounters. However, after the Second World War, the growing sophistication of medical technology and the advent of modern hospitals and health systems concentrated care provision in clinical settings. Now, however, faced with a graying population, enabled by digital technologies and driven by a renewed focus on the patient experience, providers and payers are investing in building out capabilities to deliver care at home.
This shift could complicate patterns of care provision, accelerating a shift away from doctor’s offices and hospitals as the primary sites of care. Life science companies seeking to educate patients and physicians about their products at key decision points are rethinking these “moments that matter” and how they can inform them.
Commercial payers and providers partner for home care to realize cost savings
Following the lead of the Centers for Medicare and Medicaid Services, which expanded coverage of home care, commercial insurers offering Medicare Advantage plans have been building out their home health offerings through partnerships and acquisitions, including:
- UnitedHealth’s partnerships with Encompass Health and Landmark Health
- Aetna’s collaboration with CareLinx, myNexus and Landmark Health
- Cigna’s tie-up with Monogram Health
- Anthem’s acquisition of myNexus and partnerships with Heal and Papa
- Humana’s partnerships with Heal and Dispatch Health, along with its April acquisition of Kindred at Home (Humana is now rebranding its home health offering under the name CenterWell)
Large hospitals and health systems are working to expand their home health capacity, too. For example, Kaiser and Mayo Clinic recently announced a joint venture to bring acute and restorative-level care to homes, and Amedisys is acquiring Contessa Health, a small hospital-at-home service.
Home health offerings are expanding beyond caring for chronic diseases
Home health services are broadening beyond an initial focus on routine home care for chronically ill patients. A number of providers now offer at-home infusions, including Optum, Carecentrix, eviCore and BriovaRx, and infusions are increasingly being offered through outpatient and ambulatory care settings, as well as retail clinics. Insurers are looking to improve the patient experience and realize cost savings by redirecting specialty drugs through these services, and by limiting procurement to preferred specialty pharmacies, as Cigna did earlier this year when it switched infusion providers from Carecentrix to eviCore and restricted procurement of specialty infusions by providers to Accredo.
Home care and remote care are evolving in tandem – and the resulting disruptions will affect all stakeholders, including pharmas and medtechs
While home healthcare may not replace long-term care facilities, residential care is likely to become a key part of the care continuum as Baby Boomers head into their 60s, 70s and 80s. The rapid expansion of telehealth services and the increasing sophistication of remote monitoring technologies and virtual care platforms is helping to nudge payers and providers into delivering more care at home and online.
For healthcare providers and professionals, this will bring about substantial changes in the range of services offered and modes of care delivery.
Decentering the hospital or doctor’s office as the primary site of care also poses challenges to life science companies, which must understand the new and more varied pathways through which their ultimate end users – patients – are accessing care and making treatment decisions. To ensure that patients are informed about their condition and treatment options, pharmas and medtechs will need to know where they’re receiving care, from what mix of primary care physicians, specialists and other healthcare professionals, and what sorts of educational materials and other resources can best support them at these therapeutic inflection points.
As patient care continues to shift from fully functional, high end provider facilities to smaller facilities, home and remote care, we expect to see home care providers grow organically and through collaborations with specialty care providers. IDNs, hospitals, insurers and physician groups will adapt to close healthcare gaps through greater use of remote monitoring and in-home care.
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