in a MedCity Influencer Articles Dr. Michael Lalor, published in early April, made a strong case for continuing to move cases of appropriate patient care from inpatients to homes. This goal is correct; however, it leaves another area of unexplored opportunity to improve care at a more manageable cost – the transfer of appropriate patient care cases from residential post-acute care settings to the home. Many people living in nursing homes do not require high-level clinical interventions for high-risk patients, but a more intermediate combination of continuous monitoring, appropriate home visits, and outpatient clinic visits will positively impact their lives. Life, health and overall care costs.
The post-acute care industry, including nursing homes and assisted living facilities, is under increasing pressure, especially after the Covid-19 tsunami impacted patients and staff at these facilities. Nursing homes, in particular, are losing staff and struggling to cope with residential loads.According to the Kaiser Family Foundation article, more than 70% of Americans have a negative view of the performance of nursing homes. This pressure exacerbates a trend that is growing as the proportion of our country’s aging population increases. There is a need to increase nursing home staffing, but more importantly, provide people with alternative ways to stay home and avoid early entry to these facilities.As the AARP recorded before the pandemic polls As they age, more than 75 percent of Americans over the age of 50 want to stay at home or in the community. The cost of high-quality nursing home care is certainly a factor. Many families will be able to support home care with proper monitoring; group facilities are already looking to digital technology support to reduce costs and staff overload.
Technology for remote monitoring and remote therapy delivery is in place and improving every day. Communities not yet hospitalized can benefit from the myriad of vital signs and health sensors and devices on the market, including proven features such as pulse oximeters, blood pressure cuffs, and scales. New sophisticated devices, including continuous glucose monitoring capabilities, are now also accepted by the medical community as accurate and valuable. Full-fledged devices like sophisticated heart monitors (beyond the ubiquitous sports watch capabilities) will soon become mainstream and I believe will be widely accepted by the heart care community. On top of these technologies and other emerging sensors, cloud-based capabilities tie together personal data, including care plans created by clinicians, and help monitor organizations and households to keep abreast of an individual’s health, allowing more people to stay in at home or in a community setting of their choice.
Remote monitoring can also capture signs of clinical events that, if undetected, could lead to emergency room (ER) visits and subsequent possible inpatient admissions, which could have been avoided by remote patient monitoring beforehand. For example, dialysis patients are at increased risk of adverse cardiac events due to factors such as changes in body weight and blood pressure. Remote daily monitoring (rather than waiting for multiple visits to a dialysis facility) can trigger outpatient/home visit interventions, reducing the risk of exacerbations and emergency room visits.
The investment community is increasing its investment in digital health startups, both at the VC level and at the corporate VC level, such as Medical City News and Healthcare diving. Led by public payers such as the Centers for Medicare and Medicaid Services (CMS), followed by the private healthcare industry, rates and coverage of teleservice insurance payments have increased during the pandemic. Investments are on the rise, in part because more money is available for digital services than in previous years. While there have been some recent drawdowns in payments and coverage as the impact of the pandemic has eased, many of the changes remain, and the trend going forward is clear. Healthcare systems are shifting toward paying for more home functions, lowering overall costs compared to in-facility services, and delivering better health and life outcomes for patients. Challenges like Medicaid, which only pays for services that can reach the entire state population (excluding those on the wrong side of the digital divide), must be overcome.
Let me echo Dr. Lalor’s closing remarks in the April 3 article: “We just need to fund it.” Let’s also openly extend this focus to the post-acute care community.
Photo: FG Trade, Getty Images
