We are in the middle of an evolution in healthcare. It’s not coming fast, but it is happening everywhere. The redesign of our facility-based delivery model is upon us.
Not a destruction, but rather a deconstruction—this evolution allows for specific care-delivery models to work outside the hospital.
If other verticals are any indication—and I believe they are—this change will be clunky, but necessary. Take for example industries and companies like Blockbuster (thanks Netflix), Sears (thanks Amazon), taxi services (thanks Uber) that, despite achieving massive national scale of networks or brick-and-mortar facilities, were disrupted and decimated by new entrants that leveraged technology to deliver similar capabilities in a more convenient way to consumers.
In healthcare, our facilities, and our business models, were built around provider needs, productivity, and their required efficiencies. Hospitals grew bigger as they began to convene clinical specialists, provide support and equipment in order to keep up with the advances in medicine, and generally received compensation for admitting patients for inpatient observation, diagnostic testing, medical treatment, and surgical procedures. As our national healthcare system evolved, our facilities got bigger and bigger, and as a result, the hospital became the center for care in our communities.
As a result, millions of lives have been saved by delivering care in the systematic way a centralized facility can enforce with good management: sterile techniques, medical peer review, evidenced-based protocols, trauma systems, stroke centers, and cardiac protocols—the list goes on. These are critical learnings for advancing quality in care delivery.
"Caring for patients at home is shown to dramatically increase patient satisfaction, improve outcomes, prevent hospital readmissions, 911 transports and ER visits"
And for the sickest patients with a need for significant, complex care, the hospital will always be the best location. An emergency room can take care of virtually any level of illness, save a life that requires immediate intervention, and route care to the right spot for definitive treatment and admission.
But as we well know and are starting to see—healthcare delivery will face the same forces that impacted companies like Blockbuster and Sears—a desire for care to be delivered in a more convenient way for consumers, with similar systematic controls through digital enhanced logistics, mobility, and care models. And, unlike the historical precedence when medical care required large facilities as a convener of specialty capabilities and medical equipment, these same capabilities have become mobile through miniaturization and digitization. Adding to the efficacy, specialists are available through telemedicine, which does not require any bricks and mortar to deliver care.
So why does this matter? What does this look like for patients? Providers? Payers?
A huge wave of Americans are aging into their eighth decade where functional limitation and chronic illness create complex health problems and make it difficult to treat those patients effectively at the right cost. And facility-based medical care is simply more expensive. For this reason, patient’s homes are emerging as a critical access point for healthcare.
Roughly 5 million aging adults now have difficulty leaving home without help and nearly half of those seniors are considered frail, fragile or functionally limited, according to a 2015 study published in Journal of the American Medical Association Internal Medicine. The high cost of caring for these patients effectively is crippling and exacerbated by the fact that aging patients tend to rely on the emergency room for treatment that could take place in a lower-cost setting.
Caring for patients at home is shown to dramatically increase patient satisfaction, improve outcomes, prevent hospital readmissions, 911 transports and ER visits. It has also enabled end-of-life care to take place at home. Importantly, caring for patients at home has the added benefit of providing a much less disorienting experience for the many patients who also suffer from cognitive dysfunction, often enabling an easier recovery with lower stress and fatigue when a patient can stay put where they are most comfortable.
In addition to aging patients, busy parents with young children, adults with physical and behavior disabilities, and professionals used to on-demand services like Amazon, Uber, and Netflix, also show high interest in alternative care that provides a more effortless, convenient experience. For many, it’s a relief to know they can conveniently recover from issues like migraines, lacerations, urinary tract infections and the flu without ever leaving their homes.
As interest in identifying new ways to extend quality healthcare to the most demanding populations intensifies, innovative young companies such as Denver-based DispatchHealth are working ahead of the demand curve. These pioneers are solving the training, staffing, technological and logistical challenges inherent in delivering sophisticated, effective medical care to people in their homes. They have adopted the learnings from the best facility-based care models, and are using technology and evidenced-based models to deliver care in the home. This type of care is already seeing market adoption—DispatchHealth treated thousands of patients over the last few years, saving millions of dollars in unnecessary ER and 911 transport costs for the government, payers, and the patients themselves. They have lower bounce back rates to the ER than averages seen across hospital-based emergency medical care—largely because of rigorous coordination with a patient’s primary care provider and an ability to address other social issues obvious in the home. Additionally, patients rate this care highly: DispatchHealth has an average Net Promoter Score (NPS) of 95 across all settings and demographics, essentially unheard of in healthcare delivery where scores are traditionally very low. Companies who can address emerging or unmet needs such as this will continue to evolve, and prove the value of home-delivered care to payers, risk-based medical groups, hospital systems, patients and caregivers.
While healthcare evolution is big, clunky and not necessarily fast, I believe you’ll start to see impact accelerate and scale in the near term. And we should all do our part to support the game-changers who can foster a healthier population, a more efficient workflow, and a sustainable ecosystem.