Supporting the Last Mile of Patient Focused Care

Some chronically ill patients may not have the ability or resources to trek to an urgent care center or a medical clinic to receive more advanced care that can be provided via telehealth. The US also has a reimbursement issue relative to in-home care reimbursement,[1] but this could be eliminated as the COVID-19 service/outcomes analysis identifies benefits of the approach. Being able to treat people in their homes is a key foundation for patient-focused healthcare. The ability of care providers to visit patients in their homes provides a level of care beyond telehealth that may be necessary to truly determine the health of a patient. As the industry moves to higher levels of care reimbursement based on value, it will be important to have in-home care services to support higher levels of outcomes for chronic diseases, fragile health, and end-of-life services.

The coordination of services that includes dietary support, diagnostic testing, medication management, physical therapy, respiratory therapy, and dialysis is challenging for many providers who do not coordinate in-home care as part of their network services. If providers are not providing in-home services, they may be losing revenue to emerging in-home care services that offer physician and advanced practice provider visits on demand. If in-home care services become an extension of retail health providers (e.g., Walgreens, Walmart, and CVS), provider networks will have a significant new threat to their current business models.

Moving More Patient Care to Home Delivery

Providing in-home care using physicians and advanced practice providers delivers another level of patient-focused care that is driving new players into the market funded by established venture capital companies.[2] Mayo Clinic represents a provider network that understands the need to extend care to patients’ homes via telehealth.[3] Mayo Clinic is using a partnership with Medically Home as a foundation of this service. Mayo Clinic is also using AI-based solutions to drive these services to new levels of capabilities.

In-home care can deliver five key benefits: (1) a choice for patients relative to care delivery that can be provided in the home environment, (2) proximity to family and friends to improve care support, (3) cost efficiencies for patients and their support network, (4) a likely decrease in hospital readmissions, and (5) the ability to maintain a quality of life.[4]

The emergence of digital technologies that can accurately and efficiently monitor clinical data relative to a patient’s health will continue to evolve to better enable effective in-home care. As the patient data is captured, emerging AI applications can evaluate the data to determine what interventions may be needed to ensure the best possible patient outcomes. Over time, smart watches may be the only patient-monitoring device needed for most patients receiving in-home care.[5]

Less Costly Patient Care Services

The cost effectiveness of in-home care has been shown in several studies.[6] In-home oxygen therapy, blood glucose monitoring, heart failure treatments, and intravenous antibiotic therapy have all been shown to drive cost reductions for healthcare delivery services. The ability to reduce care delivery costs and improve outcomes will be a requirement for the viability of healthcare providers as the market moves to higher levels of value-based care reimbursements. Healthcare providers who first demonstrate market-moving advantages in their markets for efficient and high-quality in-home care services will be the best positioned for long-term viability.

Innovative Providers and Emerging Vendor Solutions

Innovative healthcare provider organizations have realized the advantages and need for extending care delivery to the patient’s home. In some cases, emerging vendors are establishing services outside of provider networks because this service need is not being provided by providers in the patient’s network or service area. Representative solution providers are the following:

Success Factors

  1. Third-party in-home care solutions should demonstrate interoperability with a provider’s EHR or population health systems.
  2. The ability to monitor patients’ clinical data remotely in a timely manner for the services being supplied needs to be proven.
  3. Self-developed solutions created by extending EHR or telehealth solutions need to deliver proven remote patient monitoring and care plans that are interoperable with EHRs or population heath applications.


In-home care is emerging as both an asynchronous (set up visit as needed) and a synchronous solution (an extension of EHR and population health interventions). Healthcare organizations should begin to establish strategies for extending telehealth services to in-home care services to reduce care costs and improve patient outcomes. The ability to collect in-home care information for sharing with primary care and specialty care physicians, whether from an asynchronous or a synchronous care episode, is a critical success factor with these services. In-home solutions will require intuitive and integrated patient-monitoring devices as well as AI environments that are used to continually improve patient care plans and diagnostic decision support.

If emerging retail health services (e.g., Walmart, CVS, or Walgreens) extend their services with in-home healthcare, a significant market disruption is likely to occur. The processes and technology involved in extending services to in-home care are relatively straightforward in most cases and require no use of provider care facilities. Pity the CFO of the poor provider organization with all the sunk-cost patient care facilities. As one author once said, “Pity for the guilty is treason to the innocent.”







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