It’s no secret that the healthcare system in America is complicated, rife with inefficiency, and undermined by competing interests. Stakeholders from the government, healthcare providers, and insurance providers are faced with rising costs and inefficiencies that interfere with quality healthcare. For individuals, the consequences of a struggling healthcare system can be even more severe. One study found that in one sample of malpractice lawsuits “communication failures resulted in $1.7 billion in malpractice costs and almost 2,000 preventable deaths”. Leaders in the healthcare industry have their work cut out for them to improve outcomes for patients.
On a recent episode of the Health Care by the Numbers Podcast, SVP of Product at Signify Health, Marcus Lanznar discussed some key areas he sees as needing to improve in the healthcare system that can begin to address these issues and improve patient care. Specifically, he shared his experience at Signify Health and some strides the company has made to shift the focus in the healthcare system away from being a facility-centric system to focusing on the entire continuum of care.
Care networks that allow for in-home visits result in greater intimacy and understanding
One area of immediate improvement that is needed in the healthcare system is the lack of human connection and familiarity in many healthcare interactions that occur in clinical settings. It is estimated that 33% percent of patients do not feel comfortable seeking medical care and going to the doctor due to negative expectations of the experience with their doctor’s office. These negative associations with healthcare providers have a significant impact on their ability to give people the care they need. One solution to this issue is for more healthcare interactions to take place in the home of the individual. While in-home care is less frequently available than it was in the past, new options like Clinically Integrated Networks (CINs) and Accountable Care Organizations (ACOs) are often designed to include personal touches like home visits and follow up support.
In his recent interview, Marcus Lanznar said it best: “The fundamental value that you get from walking into someone’s home is just a differentiated experience and a level of trust, honesty and a widening of the aperture of understanding what’s going on with that patient’s life.” While there will always be interactions and procedures that must take place in a clinical setting, wellness checks and other routine procedures conducted in the patient’s home offer significant improvements to common healthcare offerings. This results in improved comfort for the patient and builds trust that the clinician will be able to rely upon as they build a relationship with the patient.
Urgent needs are readily addressed when care plans include in-home visits
As a consequence of the tendency for adults in America to avoid going to the doctor beyond their yearly checkup, it is unfortunately common for individuals to miss early signs of urgent health issues. This can result in excessive healthcare costs or – in the most severe cases – preventable deaths. For example, Marcus Lanznar says that a striking 1-2% of Signify Health clients find upon their in-home care visit that they are in need of emergent healthcare. This is possible because when the provider visits the home, they are able to get a better picture of all the elements of the patient’s health.
Further, an estimated 20% of individuals face social or security needs that have an impact on their health that may not be identified with an in-office visit. These needs could include issues of accessibility around the house, nutrition, or social isolation. While not necessarily indicating life threatening issues, this awareness contributes to better care. By bringing care providers into the home, the entire “patient story” can be understood and brought to the attention of the care team.
At-home healthcare results in greater healthcare follow through
Taking care of your health can be complicated. Especially as one ages, there is usually an increase in medications needed, more complex care instructions, and greater need for careful monitoring. In addition to increasingly complicated healthcare needs, aging patients experience difficult to decipher healthcare plans and face bureaucratic confusion when they have even simple questions. Especially for aging and high-risk patients, it is quite common for individuals to misunderstand the instructions for their medication or lack clarity on their care plan and what resources they have access to. Additionally, it is not uncommon for patients who are uncomfortable in clinical settings to ask fewer questions than they actually have about their medication and healthcare plan and therefore not understand what they are meant to be doing when they arrive home.
These issues can be addressed with in-home care provided by a skilled clinician who is not constrained by an efficiency-obsessed clinical setting to hurry through as many patients as they can in a day. By shifting the care setting to the patient’s home, clinicians are able to dedicate the time needed to ensure that patients deeply understand how, why, and when to take their medication. Additionally, when patients receive follow up visits at home, they can share with their clinician how they accomplish their medical routine, giving the clinician an opportunity to help the individual remedy mistakes and improve their routine for better health outcomes.
Care networks with in-home visits offer greater accessibility to patients
Healthcare access is not available to an equal extent for individuals across the United States. Depending on where you are, the community you are a part of, and how rural your living situation is, it is not uncommon for individuals to experience drastically different levels of healthcare access. This can take the shape of not having a healthcare provider in close proximity to your place of residence or it could take the form of your nearest healthcare provider having long waitlists for appointments due to too many individuals relying upon them for healthcare support to be able to reasonably reach each person.
While this is a symptom of a much larger shortage of healthcare providers, in-home healthcare provided by flexible providers can be a fantastic solution for this issue. Providers like Signify Health are able to dedicate significant resources to bring clinicians into the homes of people who would otherwise be lucky to get into a doctor’s office at least once per year. Marcus Lanznar reports that they are able to “make sure the clinicians get to the patients … We’ll put them on airplanes. We’ll put them in hotel rooms. Our goal is to meet patients where they are, and that means if that’s in a rural county somewhere, we’re going to go there.” By supporting individuals with in-home care, in-home providers are able to bridge the gap between the yearly “whole health” assessment and the changes in wellness that occur over the course of a year.
At-home care represents a shift to a patient-centric healthcare system
Clearly, there is a consistent and difficult systemic issue in the American healthcare system. Far too often, individuals are expected to figure out complicated systems or navigate lack of resources without help. To rephrase this issue in another way, it would be fair to say that the healthcare system in the United States has traditionally been built around the clinical setting or the doctor’s office rather than the individuals in need of help. An impactful solution to many of the issues previously mentioned that also has the benefit of connecting a wide variety of systemic issues is to shift the focus from the clinic to the patient.
Through the use of care networks and rethinking the value of in-home visits, the patient can be brought to the center of the conversation. Marcus Lanznar explains that at their best, care networks represent “a true care team acting as a care team and ensuring that we deliver the best results for that patient.” Whether that is accomplished with in-home healthcare or with other systems that center the patient’s experience, it will be vital going forward to rethink the way that healthcare in America takes place. Rather than requiring an aging populace to build their lives around visiting clinics and structuring their decisions around when they’ll be able to next visit their doctor, it will benefit everyone if the system is able to center around the patient.
There are many challenges and complications facing the American healthcare system, and there is no cingle answer or solution that will fix all these issues. Rather, it will take an approach that centers the patients and is built on teamwork between healthcare providers, insurance issuers, and community members to help achieve the best possible outcomes for individuals. While it may have worked in the past for doctors to build local practices and wait for the sick and needy to find them, in 2022 and beyond it will be necessary for us all to rethink our approach and build new systems.