‘Home is the future’: Bruce Greenstein talks about healthcare in the home

As more care is shifted to the home, payers must support better reimbursements for providers, Greenstein said.

More people have been choosing to get healthcare in their own homes, and Bruce Greenstein said that trend is only going to continue.

Greenstein is chief strategy and innovation officer of LHC Group, a Louisiana-based company that provides in-home healthcare services. For years, hospitals and healthcare organizations, often at the behest of insurers, have increasingly discharged patients to their own homes. Many patients would rather continue their recovery at home, and payers have increasingly encouraged sending patients home, as opposed to long-term care facilities or rehabilitation centers.

“Home is a very effective setting of care, even in high acuity patients,” Greenstein said in a recent phone interview with Chief Healthcare Executive.

“Home is the future. Period. Full stop,” he said. “The question is: Will savvy, forward thinking payers figure out how to harness the power of it? That to me is unclear.”

“If they miss that opportunity, that’s a shame for American patients, the American health system and the American taxpayer,” he said.

Payers need to improve reimbursement rates for home-based care, Greenstein said. He recognizes payers have been challenged due to the COVID-19 pandemic.

But at some point, Greenstein said the reimbursement issue needs to be addressed.

“Only a handful of payers have recognized and increased payments,” Greenstein said.

While more patients have recovered at home after hospital visits, Greenstein said home healthcare providers such as the LHC Group are treating more patients who are seriously ill.

“When COVID starts to wane, we can’t keep doing this without having some payment mechanism that addresses the acuity of the patients that we serve,” he said.

If the situation isn’t addressed, Greenstein said it could lead to access problems in some parts of the country. He also criticized what he called the lack of regulatory oversight.

“We take referrals. We have a moral obligation when we take these patients,” Greenstein said. “We are really frustrated it’s no longer a partnership with the payers.”

The demand for in-home healthcare services is only going to grow, he said. Americans are getting older, and will be facing greater health challenges. More Americans would rather age or recover in the comforts of their own homes than in nursing homes or other long-term care facilities.

“Payers are delighted to have patients go to home health instead of skilled nursing facilities,” he said.

Greenstein discussed other trends and challenges for home healthcare and the healthcare industry as a new year begins.

Workforce challenges

Hospitals and healthcare organizations have been hampered by a shortage of workers. Nearly 1 in 5 healthcare workers have quit their jobs during the COVID-19 pandemic, according to a report from Morning Consult.

“Early in COVID, we saw a significant spike in early retirements and burnout displacement,” Greenstein said.

The amount of turnover has dropped in the past year, but there’s still a high demand for labor.

The cost of recruiting new talent is rising, he said. The LHC Group has 30,000 employees in 37 states.

“We’re seeing so much demand for services,” Greenstein said. “Now we have a very high number of open positions. We’re continuing to look to hire. It’s become an incredibly competitive game.”

In one encouraging development, the use of more expensive contract labor is dropping, he said. But the healthcare industry has to work to encourage more people, including younger people, to pursue careers in healthcare.

Interoperability

Healthcare systems are moving toward interoperability, the ability to seamlessly share records across health systems.

The federal government is prodding the healthcare industry to move toward interoperability, but organizations still have a long way to go. Experts say many health systems use different electronic record systems within their own organizations, and of course, different providers also use their own systems.

Greenstein, the former chief technology officer for the U.S. Department of Health and Human Services, said he sees a culture shift starting to occur in the healthcare industry. Organizations are “moving from the norm of keeping up all the information yourself for fear of leakage,” he said. “That’s no longer acceptable,” he said.

Another factor driving the change is there are fewer “old school” chief information officers who resist sharing information. “Those people are retiring,” Greenstein said.

The next set of leaders is interested in transparency and better outcomes, Greenstein said. Healthcare leaders must be focused on increasing patient satisfaction and improving efficiency.

“If you plan to do it without sharing data, you’ll never be successful,” Greenstein said.

Telehealth

Healthcare providers greatly expanded the use of telehealth during the pandemic. That trend will continue, Greenstein said.

Greenstein said telehealth will continue to have a significant part of primary care. Others, such as the Business Group on Health, have projected telehealth will be one of the top healthcare trends in 2022.

Telehealth can be tremendously useful in expanding the reach of mental health services and making it easier for people to get help, Greenstein said.

“One of the best collateral advantages of this process is people seeking behavioral health needs can get access to it,” he said. “It lowers the barrier for people seeking mental health services.”