When patients enter a healthcare facility, their primary aims are to become well again and to go home. While increasing disease burden and rising healthcare costs in the United States have already contributed to a boost in home health services, the COVID-19 pandemic has created a catalyst to truly reimagine their future.
Based on a survey of physicians who serve predominantly Medicare fee-for-service (FFS) and Medicare Advantage (MA) patients, McKinsey & Company estimates that up to $265 billion worth of care services (representing up to 25 % of the total cost of care) for Medicare FFS and MA beneficiaries could shift from traditional facilities to the home by 2025 without a reduction in quality or access. That number represents a three-to fourfold increase in the cost of care being delivered at home today for this population. What’s more, Care-at-Home could create value for payers, healthcare facilities and physician groups, Care-at-Home providers, technology companies, and investors. It also could improve patients’ quality of care and experience.
A variety of pandemic-related factors have created an opportunity to rethink Advantage care and Care-at-Home. These include the following:
Growth in virtual care: In February 2021, the use of telehealth was 38 times higher than pre-pandemic levels. About 40% of consumers surveyed said that they expect to continue using telehealth going forward. 85% of physicians already use some type of telehealth to care for patients. Whereas 80% of patients polled state they have better access to healthcare using telehealth. Both sides, healthcare providers and patients want more telehealth solutions, not less.
More patients with post-acute and long-term care needs may be evaluating their options: As baby boomers age and families contend with the ongoing impact of the COVID-19 crisis, a growing number of patients and families are considering their options for post-acute and long-term care. Ideally, eligible individuals would receive care in the most appropriate setting, whether that is at home or in a facility for rehabilitation, assisted living, skilled nursing, or long-term care. A combination of remote monitoring, telehealth, social support, and home modification may enable more patients to receive some level of Care-at-Home. The share of Medicare visits conducted through telehealth, for example, rose to 52.7 million in 2020, from approximately 840,000 in 2019, according to a December 2021 report from the US Department of Health & Human Services.
Emergence of new technologies and capabilities: New technologies like those at Gal3n Health are making Care-at-Home possible for more people. Remote patient-monitoring devices, for example, allow providers to monitor patient progress remotely and receive alerts if there is an issue. In an April 2021 poll, more than one in five healthcare leaders said that their practice offers remote patient monitoring.
Gal3n has developed a simple system to incorporate physical examination into medical consultation. This is significant for several reasons:
1 - This is the proper way. Medical examination of a patient remains a basic tenet of any medical consultation. This has not, nor is expected to change anytime soon. Whatever the telemedicine or telehealth option you consider, it must include a physical examination. Physical examination in the elderly population specifically is not just needed but required and without it, quality and clinical outcomes would suffer. Those caring for this elderly population need a telehealth option that allows for physical examination to feel that they are providing care properly, safely and accurately. Without it, they would not feel inclined to use telehealth as intended or as expected.
2 - By having a physical exam in the telehealth encounter documentation, payers, including Medicare/Medicaid and others, will pay the healthcare providers more for a full encounter, not just what is paid for audio/video communication which is less. This incentivizes healthcare providers to use the technology. Using Gal3n, providers can bill for such services with 100% parity as an in-office consultation by using a specific G-code. They will receive an additional $27.91 in addition to the full telehealth encounter code. CMS is doing this to incentivize providers to use more telehealth.
3 - By adding a physical exam to the telehealth encounter, a myriad of healthcare providers would be able and willing to properly perform and bill for services that just using audio/video simply they would not be able to. Think of specialty disease management programs like COPD, CHF, Cardiac Rehabilitation, etc.
Stakeholders at the moment are aggressively exploring ways to provide higher-quality care, especially for an aging population, and at the same time cost savings. The answer may lie with Care-at-Home, with examples that include primary-care visits via telehealth, self-administered dialysis at home, and skilled nursing-facility services at home with remote patient monitoring and support for activities of daily living, disease management programs for specialty populations like COPD, CHF, or hospice services. These interventions can be delivered to different kinds of patient archetypes (for example, high-risk patients with chronic conditions or those who are healthy and at low risk) throughout the patient journey (for example, diagnosis, treatment and discharge, or self-care) as either point solutions or as a comprehensive offering all using the right telehealth option.
Care-at-Home could improve the quality of care and the patient's experience by providing patients with care in the comfort of their homes and by potentially reducing preventable adverse health events. Additionally, stakeholders—including payers, healthcare facilities and physician groups, technology companies, and investors—could see substantial value, although the types of benefits and costs would vary by stakeholder. For example, a payer could benefit from lower medical costs resulting from the reduction of preventable adverse health events and the use of a lower-cost site of care. Value could also result from enhanced quality performance and more clinically appropriate and accurate risk coding. This value may be partially offset by the reimbursement for Care-at-Home services and the potential for induced demand through more convenient care. Ultimately, the value of Care-at-Home will likely depend on which specific opportunities are pursued and adopted.
Advantage patients in the clinical settings. A unique opportunity and notable example of how Gal3n systems can revolutionize how Advantage member clinic systems deliver care is the sub-specialty consultation of their members. Conventionally these Advantage clinic systems provide sub-specialty consultation for their members either by one of two business models: One is having the required subspecialty provider, i.e., cardiology, lung specialist, nephrologist, etc. be hired by the clinic owner providing the service in-house. The second is they send their members that require a subspecialty consult out to the specialists at the subspecialist office locations. Sending the members out comes with the inherent costs of transport, time delays on care and transportation risks, as well as the inconvenience for the members having to go to a different location. Polling tells us members do not like doing this and is the main reason an Advantage member might change from one clinic to another. The members would rather have all the health requirements delivered at the clinic location only. Having a subspecialist in-house business model works very well, and member satisfaction is high with this model. However, it saddles the clinic owners with the cost of hiring the subspecialist which can be significant since subspecialists' fair market values are higher than their own primary specialists' salaries. Also, by using the in-house model, the choice options for subspecialists available to consult in-house is shorter for the members. The second option, sending the member out, is what most Advantage clinic systems are doing more and more of late. Exporting the subspecialty consultation addresses the cost savings for the clinic owner, but saddles the members with something they don’t want or like, threatening retention and affecting customer satisfaction significantly.
The question becomes how to offer what members want at a lower cost to the clinic owner. The Gal3n system creates another option that can turn this on its head. Consider for example Ms. Rodriguez has an appointment with her cardiologist today at 10:30am. She can be referred to any number of specialists by using our telehealth option, but she physically remains at the clinic using the G-cart. This saves the inconvenience to the member of having to be sent out to a different location. It also saves the clinic owners money associated with transport, liability, risk of falls and most of all the cost of hiring subspecialists. The subspecialist on the other hand sees no significant difference in patient flow since they can stay in their offices, and use their existing computer system, but now are able to do remote physical examinations. The documentation of the visit is exactly the same as an in-person consultation that is sent immediately to the members EMR, or even printed at the POS, plus the encounter is saved for future reference. The subspecialist keeps the document and likewise bills with it and uploads it to their EMR and member's chart. It's an efficient solution to the problem that will increase member satisfaction and retention for the clinic system while addressing the cost of the consultations for subspecialty services.
