The promise and challenge of community-based care
by Stephen Wogen
June 6, 2018

The future of care is in the home. Lower costs, improved outcomes and better engagement are the results. The journey home is not possible without the confluence of two other trends currently changing how we deliver care to patients.

The first is the accelerated development and easy accessibility of technology-based platforms. These will become the backbone that will enable the evolution of home- and community-based care. Powered by artificial intelligence and machine learning analytics, technology has opened the door for greater efficiency, improved care connectivity, and alternative patient and caregiver models including telehealth, telemedicine and fail-proof remote patient monitoring that, among others, are critically important tools for the expansion of homecare.

The second is the growing interest in and widespread adoption of community-based, multidisciplinary networks that are replacing the traditional episode and acute-centered model of delivering care. The community-based model has come to the forefront and is a promising alternative to our antiquated way
of providing health care.

Out with the Old

That old acute-centered model is no longer financially sustainable.

In fact, a recent report published in the Journal of the American Medical Association (JAMA) found that in 2016 medical care spend in the U.S. was nearly twice as much as in 10 other high-income countries. That number, which represented nearly 18 percent of the U.S. gross domestic product, compared to 10 to 12 percent in the other 10 nations studied. The stark disparity is even more alarming considering the JAMA paper reported those other 10 countries outperformed the U.S. on many population health outcomes. Combine this with an aging demographic, clinical resource supply shortages, and caregiver and patient attitudinal shifts toward health care, and the case for change is clear.

Industry leaders, legislators and the nation have struggled for years to agree on solutions that deliver improved health outcomes at reduced costs. Proponents of the community-based model are stepping up to the plate with data to support its successful implementation as a patient-centric, cost-cutting, outcome-improving solution. The Centers for Medicare & Medicaid Services (CMS), in their 2019 Call Letter, has recognized the value of personal care assistants for the first time, allowing home health as a supplemental Medicare Advantage benefit. We are moving, albeit slowly, in the right direction.

Like the Olden Days, But Online

Community-based health networks engage patients where they have always wanted to be engaged—locally and at home. Health care must go back to its roots to redefine itself and emerge as a patient-centric system that addresses the needs of each person individually, not the other way around.

To do so, we need to move away from the traditional American approach to health care. In this transactional-based, episodic-driven model, patients see doctors only when sick or injured. That may work for patients with conjunctivitis or the flu. However, for patients suffering from chronic diseases and conditions, that model just doesn’t make sense.

The U.S. Centers for Disease Control and Prevention (CDC) estimates chronic diseases and conditions and the health-risk behaviors that cause them account for most health care costs. According to the CDC, an alarming 86 percent of the nation’s $2.7 trillion annual health care expenditures are related to the care provided to people with chronic and mental health conditions. Treating the symptoms of these patients is not enough because, although they are the spark that triggers a medical intervention episode, the symptoms are not the root of the problem.

The chronic condition will remain, so if the patient is not treated in a holistic way, he or she will continue to return for additional treatment. This episode not only adds costs that could have been avoided, but also does not help the patient manage the condition in a way that will meaningfully change the course of the chronic disease. The way to stop this cycle is to address the cause of the symptoms—the chronic condition.

This is particularly true for those patients who are not navigating the system because of lack of access, knowledge or other social or financial barriers. These patients end up using more costly services—such as the emergency room—to address problems that have already reached a critical point. For these people, community-based and homecare services can have a significant impact providing solutions for providers and the patients they serve.

The patient-centric, holistic approach addresses the social determinants that are identified and solved through local resources. This approach includes addressing a patient’s appropriate and timely access to prescription medications, food, transportation services, housing and safety, for example, to make sure best health outcomes can be achieved.

Figuring out the right intervention for each patient is key to the success of the community-based model. Analytics is needed to make sure the right resources are activated, mobilized and provided based on the personal needs of each patient.


3 Challenges for Community-Based Networks and Homecare

For the community-based care approach to take root and thrive, a few obstacles need to be addressed.

1. Reimbursement reform. CMS needs to accelerate the adoption of codes that cover services that don't occur in face-to-face patient interactions. And because 2016 administrative costs in the health care industry were one of the main drivers of spending in the U.S., CMS also needs to decrease the burden on providers billing for these services and, over time, design benefits that incentivize care in the home.

As outlined above, there are baby steps in process, but speeding up the pace is needed. The private sector also needs to become more innovative.

2. Logistical barriers. Providers need to determine the best way to identify patients who will benefit from their services. They also need to engage them and then build a relationship to keep those patients in the system on a long-term basis. Additionally, other operational barriers need to be addressed, including how to identify the patient’s needs, the appropriate level of service and the health care professional who is best suited for the patient. Communications and health plans need to be connected and synchronous.

3. Workforce quality. Local and quality networks of care providers need to be identified and built. This includes researching local market needs to determine the services that are in demand in that community. The system also requires more consistency with how it trains and evaluates individuals on the tools and services that are used and provided to patients across the U.S. We can easily evaluate a hotel or restaurant online—why not an in-home caregiver? Providers looking to deliver immediate results partner with vendors who have already built the local resources network and are ready to hit the ground running.

Regardless of the challenges, there are proven programs that, when combined with new initiatives currently being tested, are setting the stage to deliver a more patient-focused, lower-cost, less administratively burdensome health care system that actually treats patients as patients as opposed to a series of transactions. We need to accelerate and make the home the focus of care now.