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In North Texas, Care Is Moving From the Hospital to the Home

Technology, the pandemic, and patient preference are moving healthcare into residences, and cutting costs by as much as 30 percent.
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Improved patient monitoring, developments in portable technology, and accelerated implementation of telehealth have all pushed healthcare from the hospital to the home during the past year. Home healthcare has proven to be less expensive and more comfortable for the patient and just as effective as care delivered in a hospital or clinic. But the trend means that more home healthcare workers, who are often women, are leaving clinics and hospital environments.

During the pandemic, the shift to at-home care meant more risk for women, a population already disproportionately impacted by COVID-19. A study from the British Medical Journal found that 70 percent of coronavirus infections for healthcare workers were women, and 40 percent of those were nurses early in the pandemic. It has also complicated the treatment pipeline for home health organizations.

“We have patients who might have otherwise, in a non-pandemic environment, gone into a nursing home for a couple of weeks before they came home,” says Encompass Home Health and Hospice CEO April Anthony. “Now, those patients are going directly home because they don’t want to go to institutional care.”

“We have patients who might have otherwise, in a non-pandemic environment, gone into a nursing home for a couple of weeks before they came home.”

April Anthony, Encompass

Moving care to the home has also enabled many women to stay in the workforce, where they may have previously had to become full-time caregivers to family members or loved ones.

“Care at home gives the opportunity for primary caregivers to continue working and taking care of their loved one the way that they’d like to, in a way that previously they weren’t able to do,” says Winjie Tang Miao, senior executive vice president and chief experience officer for Texas Health Resources.

As work returns to normal and the pandemic subsides, risks will decrease for all healthcare workers. Increased flexibility during the workday is probably here to stay, and technology plays a role in making that happen.

Quality and Cost

The hospital-to-home movement works like this: A hospital physician or emergency department identifies a patient who is sick enough to be hospitalized but stable enough to be treated at home. Providers determine the suitability of the home, and care is assigned to a supervising physician, who may be an internist or specialist. The patient is then visited at home by various caregivers, such as physical therapists or nurses. The physician sees the patient daily via a virtual or in-person visit, as if they were in the hospital. When the patient has recovered, care is passed back to the primary care physician for future follow-up.

Big data has been essential in moving care to home. “Advances in technology that incorporate predictive analytics help us understand patients’ inherent risk profile,” says Bud Langham, chief strategy officer at Encompass. 

This allows providers to predict which patients are better suited for home care, resulting in better outcomes and lower costs. The pandemic forced everyone to avoid in-person visits if possible, but there was a silver lining. Widespread adoption of telehealth meant patients were more comfortable with a video visit, and providers could access and interpret data received from devices in patients’ homes with improved monitoring technology and better broadband.

Encompass is in talks with several health systems to implement the hospital-at-home platform. Texas Health Resources plans to move more acute care into the home and add to its mobile urgent care services established before the pandemic. The health system may also add chemotherapy and radiation follow-up appointments and chronic disease management to at-home care options.

“We will always need to have a place where you can have complex care and surgery,” Miao says. “But this is one of those times where [home care] is the right thing to do for myriad reasons.”

Centers for Medicaid and Medicare Services is continuing to force providers toward value-based care over fee-for-service, and the hospital-at-home model rewards providers who can care for their patients efficiently. The movement has been implemented around the world in countries with government-run health systems. At Johns Hopkins University, a similar pilot being launched by the VA, home health, and various hospital systems has been shown to reduce costs by 19 to 30 percent without losing quality. 

Those improvements in cost, quality of care, and patient experience could soon accelerate in North Texas, says Langham.

“We want to push boldly into hospital-at-home, which should lead to a significant change in how health systems do business,” he says.

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