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Why care at home belongs in health equity strategies


Over the past few years, we’ve witnessed dramatic acceleration in the movement of more healthcare into the home. With healthcare leaders estimating 20-30% of all Medicare spending could shift to the home in the next few years, that momentum is continuing in spite of sluggish permanent payer incentives.

Moving care into the home provides value in terms of lower costs and better clinical and safety outcomes, but one topic that doesn’t get enough attention is the opportunity care at home provides to address health equity in our communities.

The care models that have arisen in this space, from Hospital at Home to chronic care management, offer better interactions between patients and providers, and allow us to more meaningfully address the numerous factors affecting health equity.

The home is a more accessible care experience 

When we move care into the home, that experience becomes inherently more accessible. This shift is especially advantageous to patients who may have to navigate transportation issues and other challenges to accessing care, such as mobility issues, and caregiver or childcare responsibilities.

Whether the patient has a provider visit in their home, or engages with their care team entirely virtually, the consumer-centric model of care at home lowers the burden for patients to receive that care, making it easier for them to engage in their health and less likely they miss a follow-up encounter.

Care teams get a more holistic view of patient health

When a patient visits a hospital or clinic, they leave behind most of the context that affects their health on a daily basis. Care-at-home models, however, allow providers to see and interact with patients in the context of their daily lives. With this more holistic understanding of a patient’s health, providers can more accurately assess mental health, activities of daily living, and SDoH such as access to nutritious foods.

Some in the healthcare and legislative community worry care-at-home programs only benefit patients with resources. But the teams who are actively caring for patients in Hospital at Home or other care-at-home models have a different perspective.

As Candra Szymanski, Interim AVP for Hospital at Home at UMass Memorial Health explained on a recent webinar, “This care model helps us discover SDOH factors that we wouldn’t otherwise be aware of. This discovery opens the door to addressing food insecurity, medication reconciliation, care coordination with a PCP, and services to shore up patients’ environments and keep them safe.”

Providers can’t treat what they can’t detect. But encountering patients in the context of their home and family puts issues of equity and access into sharp contrast, allowing case managers to connect patients to ongoing resources for SDoH or transportation.

The home softens the power dynamic of a healthcare encounter 

In a facility setting, many patients feel disempowered and therefore may be reluctant to ask questions, voice concerns, or even detail symptoms. Moving care into the home serves to undermine this dynamic, and allow for more shared decision-making. When sitting in their favorite chair, maybe with a family member or a pet nearby, patients often become more comfortable engaging with their provider.

This more comfortable experience also contributes to more human interactions. As Martha Diaz, RN, a care-at-home nurse at UMass Memorial said, “Hospital at Home has brought back the joy to the science and compassion of my nursing profession. There is no better satisfaction to being an RN than knowing I have made a difference in a person’s life.”

I often hear providers working within care-at-home models recall how they are more able to focus on each patient, caring for them more personally and holistically. Given the well documented exhaustion and burnout that providers are experiencing, care models that foster compassion and connection benefit everyone.

Making equity a reality 

Care-at-home models are already making a significant impact in the lives of many patients, but we’re just beginning to see the opportunity for these programs to have large-scale, long-term effects on health equity.

The greater accessibility of care at home allows for more inclusive representation of patients in healthcare research that fuels innovation. By including more diverse patients in clinical trials and chronic care programs for our most common diseases, we can start to pave the way for more inclusive therapeutics and standards of care.

While care-at-home models are well positioned to help us close gaps in health equity, significant barriers to access remain, including reimbursement from payers and connectivity infrastructure. According to the FCC, 19 million Americans still lack broadband internet in their homes. As more healthcare services require virtual interaction and engagement, the impact of this digital divide will likely continue growing as an SDoH.

We must recognize the real possibility of care at home exacerbating inequities if it doesn’t solve for the connectivity divide, which requires a combination of signal-boosting devices and over-the-threshold support. There is still much work to be done, but let’s dare to imagine a future where we enable care at home for everyone.

Photo: Kiwis, Getty Images



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