No doctor is an island

Giving physicians the tools they need to succeed on the road.

The house call is back.Being old enough to have home visits as part of my medical school training, it has been fascinating to watch it come full circle as part of the modern healthcare system.

The surge in adoption of virtual care during the pandemic is receding to a steady state, as both patients and practitioners seek a return to face-to-face visits when appropriate. But for certain populations of patients – most notably the more than 40 million seniors in the U.S. – at-home care is proving to be the best option.

Primarily, because it’s good for the patient. Providing care in the home not only increases the chances that a patient will receive care, but it also gives clinicians a 360-degree view of the medical and social barriers to that care. Housing security, food security, transportation, also known as social determinants of health, profoundly impact quality of life and health outcomes.

This home-care model works best in a team format. The attending physician receives support from office-based staff, perhaps nurse practitioners and administrative assistants. That care team will also gain valuable information in many cases from insights provided by a social worker. And integrating a pharmacist within the model of care produces further positive clinical impact on patients.

But what about the physician? Burnout is already a serious issue, only exacerbated by the pandemic, as is the ongoing struggle with administrative burdens. How can we support them in at-home care, which can add travel time and a different system of administration, to their workload?

This care model isn’t possible in the fee-for-service world. Home-based care only works in the value-based care model, where risk is shared between providers and payers. Instead of billing by the episode, physicians track care and outcomes. In the value-based care “subscription model,” physicians or advance practice providers engage with patients in ways that are best suited for the consumer. For those who are elderly, have multiple medical conditions, or are transportation-challenged, that means at-home care.

Practices still face the challenge of performing their services outside the office, taking them away from some of the usual resources. Using technology-enabled solutions can help make home-based care a stronger reality for more seniors in the years to come. Obviously, it’s now likely that clinicians will use laptops, tablets, or smartphones in the home during a visit. Patients may be using wearable monitoring devices.

But there are two areas where clinicians can benefit most from support in at-home care:

Predictive Analytics: The pandemic, producing an extreme level of stress on clinicians, has exacerbated the already-serious clinician shortage. It is more important than ever that a clinician’s time is spent where it is needed most. Predictive analytics technology can help assess which patients are at the highest risk for adverse outcomes. By segmenting the most at-risk patients, care teams can decide which member of the team is best fit to serve that patients’ needs – freeing up clinicians to work at the top of their license.

Patient Insights at the Point of Care: Electronic health records gather continuous patient information, which can be a good thing, provided that providers have the ability to search through and process these droves of data. Managing this problem is a good use of AI and assistive technologies in healthcare. Providing curated information to providers at the point of care enhances their clinical decision making, reduces the time spent sorting through volumes of data, and lessens the possibility of potential errors.

Identifying the most relevant clinical insights aligns with our theory of “data minimalism.” Data minimalism, in healthcare, means providing the minimum data set a provider needs at the right moment to act, to elevate the care of the patient. When successfully applied, the patient gets better outcomes and the risk bearing entity receives appropriate financial reimbursement.

At-home care should not make a physician feel like they are working on an island, any more than they would in a hospital or their office. Re-thinking the tools they use and need in that setting can make home-based care work as well for physicians as it does for the patients they serve.

Dr. Matt Lambert is chief medical officer of Curation Health. He has more than 20 years of experience as a clinician, and CMIO in value-based care. He is the author off two healthcare books: Unrest Insured and Close to Change: Perspectives on Change and Healthcare for a Doctor, a Town, and a Country.