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Bridging the Gap: Moving Large Healthcare Systems into the Home


Moving healthcare home is just part of the growing personalization of healthcare that has been made possible by advancements in technologies that seamlessly connect a patient to their care team.

David Hunt

David Hunt

Over the last several years we have seen a gradual shift towards home healthcare and a renewed effort by physicians across the spectrum to support aging comfortably in place. While the COVID-19 pandemic and its dramatic impact on hospitals and senior care facilities have certainly accelerated the adoption of this model, many hospitals and health systems were making gradual investment in the home care delivery model long before overcapacity, fears of COVID infection, and patient isolation came to the forefront.

One of the biggest non-COVID factors fueling this shift is the looming surge of older Americans. According toprojections by the U.S. Census Bureau, by 2030 all baby boomers will be older than 65 years old, which means that 1 in every 5 U.S. residents will be of retirement age. Additionally, by 2034 there will be more people over 65 years old than under the age of 18 for the first time in history—an important demographic milestone and one that our already burnt-out healthcare system may not be prepared to handle.

Recently, we have begun to see more action when it comes to federal support for this shift in care. Part of President Biden’s newly announced $2.3 trillioninfrastructure plan would devote $400 billion to providing seniors more medical care at home, with the aim of shifting treatment away from the hospitals and senior care facilities still struggling financially and operationally from the COVID pandemic, and looking for better ways to deliver care in a lower-cost setting.

Benefits of Moving More Healthcare Home

Over the last several years we have just begun to see the benefits of this evolution in post-acute care delivery. Not only do seniors largely prefer to be in their homes, but research shows they are more likely to experience better outcomes when they do. We also know that the less time patients spend in the hospital, the less likely they are to experience the cognitive decline, disorientation, and behavioral health challenges that often stem from the isolation of long-term inpatient care.

For hospitals and health systems, the growing momentum behind value-based care models coupled with programs like CMS’ Shared Savings Program—which enhances the fee-for-service model to deemphasize volume and prioritize value and experience—have created plenty of reasons to explore how to better plan, educate, and support a patient after discharge to reduce readmissions. Increasingly this has meant expanding the role of their primary care physician and providing in-home services to improve outcomes.

How Technology Is Enabling Better Collaboration

Leveraging new health technology has been—and will undoubtedly continue to be—critical to ensuring that seniors have access to the same care coordination support that they would in an acute or skilled nursing setting.

In one hospital study, approximately 20% of patients were discharged with one or more vital sign instability. These people had higher odds of readmission or death within 30 days of discharge. Leveraging digital health tools to improve patient education and discharge planning is one way that hospital systems can more easily help patients successfully transition back into their home environment, improve patient satisfaction, while reducing risk of readmission and also costs. Remote patient monitoring, artificial intelligence, and virtual care have all become critical parts of successfully bridging these gaps in care.

How Hospitals Are Benefitting from the Shift

The good news is that not only are these technologies increasingly accessible and customizable, but financially advantageous for health systems to implement. The Affordable Care Act, CMS’ Hospital Readmissions Reduction Program, and the recently instituted Merit-Based Incentive Payment System, or MIPS, have all made pursuing or expanding value-based-care driven home health programs more advantageous for hospitals and health systems than ever.

The impact of this shift is, rightfully, becoming a major topic in the national conversation around healthcare. Big-tech leaders like Amazon are now launching initiatives to encourage policymakers to include the home as a major site of healthcare delivery, shining a light on just how transformative they expect this demographic shift to be.

As an unprecedented number of older adults enter retirement age, the entire healthcare continuum, from older adults to pediatrics, will need to be prepared to handle and adapt to a higher demand on resources than ever before. Moving healthcare home is just part of the growing personalization of healthcare that has been made possible by advancements in technologies that seamlessly connect a patient to their care team. In the coming years, physicians must be poised to leverage these technologies to continue providing care that keeps patients safe, allowing them to recover, rest, and age in place.

About the Author

David Hunt is the founder and chief marketing and development officer at Cosán Group, an industry-leading healthcare organization creating new pathways to modern aging with technology-driven preventative care services.

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