HomePatient experienceYour home healthcare questions answered! By Robin Farmanfarmian Your home healthcare questions answered! By Robin Farmanfarmian Robin Farmanfarmaian
29 November 2023 | 8min Quick takes
Major payers are helping drive primary healthcare into homes globally facilitating a significant shift in the healthcare landscape
At-home care is cost-effective and may be more affordable than clinic or hospital care, emphasizing the economic benefits of at-home healthcare as well as the improvements in patient experience
Engaging in at-home care requires evidence-based data for physician acceptance, personalized patient advocacy, and adaptation of the industry to streamlined processes, regulatory requirements, and user-friendly at-home care equipment
At the end of October, our latest webinar explored what it will take to successfully move healthcare from the hospital into the home. As new technologies, such as telemedicine and remote patient monitoring, are developed, more patients are being treated in their homes. Being able to deliver high-quality care at home is believed to help improve the patient experience while at the same time generating value for caregivers, physicians, tech companies, and investors.
We invited Robin Farmanfarmaian, Professional Speaker, Entrepreneur, and Angel Investor to share her first-hand experiences and insights into how shifting healthcare into the home improved her own patient experience. Robin also shared her perspective on the technologies and trends that are helping drive this initiative.
During the Q&A session, we were able to cover many great questions from the audience, but some questions remained outstanding due to time constraints. We therefore followed up with Robin after the event to make sure all questions were answered. Read on to find out more here.
Moving healthcare into the home
Q1: Your story was very much about the transfer of a regular regime of care into the home situation. Can we see a large piece of triage / first visit to primary healthcare going to a home situation?
Robin Farmanfarmaian: In addition to the major payers that have acquired companies that shift healthcare into the home, including United, CVS, and Humana, Medicare has been adding new codes for reimbursement on home health services that aren’t pandemic-related.
On a global scale, there are many devices and tools that shift primary care and chronic disease care into the home. For example, the TytoCare Telemedicine tool kit has a video camera and medical device applicators that fit onto the video camera so a physician or other healthcare professional can conduct or review remote diagnostics including an otoscope, stethoscope, temp monitor, and tongue depressor. This device can be used by the patient or someone with the patient in the home and has been distributed in places like schools, community centers, homeless shelters, concert halls, stadiums, and remote clinics that might not have any healthcare professionals on site but frequently need medical help.1
Other companies such as BioBeat, Apple, VitalConnect, BioIntellisense, Omron, Oxitone, and Google can track many vital signs, and companies like Propeller, Adherium, and NuvoAir can track inhaler usage.2-11 These tools provide remote healthcare professionals with the necessary medical data to make an informed medical determination about the patient, without the need to visit a healthcare professional.
The cost of at-home care
Q2: Is care at home going to cost more? What are the reimbursement guidelines for at-home care?
Robin Farmanfarmaian: In my experience, care at home won’t cost more. Several studies have suggested that at-home care can cost less than care received in a clinic or hospital. 12-14 Hospitals have to charge a lot for diagnostics, treatments, and follow-on care because hospitals are extremely expensive to run. Overhead costs for hospitals are giant, and include everything from employees to buildings to large machines like MRIs have to be incorporated into what they charge patients and payers.
I get an IV biologic medication called Remicade every 6 weeks. For the first 15 years, I had it administered in the hospital infusion center. My local hospital charges $USD 28,000 just for the medication, plus thousands more for the auxiliary supplies and time in the infusion clinic.
Seven years ago, my insurance company declared that Remicade would only be covered if done at home or in a freestanding infusion clinic. I now use an in-home infusion company called Option Care, and the cost of the medication went from over $USD 28,000 to less than $USD 2,500 per infusion.15 Over a 5-year period, that comes out to a difference in the billing of $USD 1 million, and Remicade is the type of medication patients can be on for life.
Q3: Could you share your perspective on creating the evidence asked by the payors for investing more in proactive screening and testing to reduce later-stage intervention costs?
Robin Farmanfarmaian: There are a number of ways, here are 3 suggestions:
Gather existing data: There are a lot of research studies that demonstrate the benefits of early detection and reduced intervention costs.
Conduct cost-effectiveness analysis: Assess the potential savings achieved by investing in proactive screening and testing.
Collect real-world evidence: Obtain data from healthcare providers that have implemented similar programs.
Ensuring patient safety and a high standard of care for at-home care
Q4: How do you ensure that at-home care is delivered to the same standards as care in a hospital?
Robin Farmanfarmaian: When considering at-home care, there are a lot of variables that can make it far superior to hospital care, depending on the patient’s environment. If someone is fortunate enough to have a home stocked with healthy food, quiet enough that they can sleep well without interruption, hygienic enough to reduce the spread of potentially infectious disease, clear air, and the patient can move freely around the home (i.e. absent of crutches or a wheelchair and stairs), then the home could be far superior to the hospital after being outfitted with the medical devices and treatments needed.
When patients reside far from a hospital, at-home care could be the only realistic option, especially when obstacles such as caring for young children, lack of transportation, or other constraints make reaching a hospital unfeasible. In such circumstances, any form of care is preferable to none, irrespective of the environment.
For patients who live in unsafe environments, are in intensive care, or are at risk for needing emergency surgery, or other life-threatening situations where time is a significant factor, a hospital might be a much safer option.
Fortunately, the hospital-at-home programs take a lot of these factors into consideration when deciding which patients qualify.
Q5: What measures need to be in place to ensure patient safety is protected?
Robin Farmanfarmaian: There should be protocols in place that:
Assess the home environment for risks
Train and educate potential caregivers in the home on safety
Supervise and monitor care through in-home visits, video calls, and remote monitoring devices
Provide necessary equipment, from some of the new portable dialysis machines, IV poles, and other medical equipment
Have an emergency plan in place
The role of the healthcare professional
Q6: How willing do you think healthcare professionals are to provide care at home? If not, how can we make them more comfortable or accepting of this?
Robin Farmanfarmaian: This depends on the healthcare professional; according to a US census in 2021, over 22 million people are healthcare professionals in the US, which includes physicians, pharmacists, technicians, aides, and nurses.16
Which means, millions of healthcare professionals already work in at-home healthcare.
Physicians practice evidence-based medicine so we would need to show them the data about the benefits of delivering care in the home environment.
Q7: How can healthcare professionals advocate moving care to the home for patients who are not confident enough to request it themselves?
Robin Farmanfarmaian: Like anything else, this needs to be personalized to the patient. The first step is to educate patients and their families, including providing resources and support.
If the patients are on board with shifting to the home, the next step is to advocate it with the payer. However as we’re experiencing with many of the IV medications, it’s actually the private payers who are the ones initiating the shifting of medical treatment to the home.
Process and equipment design implications of moving healthcare into the home
Q8: What is the impact that moving care to the home will have on the industry in terms of processes, regulatory requirements, etc.?
Robin Farmanfarmaian: There’s a huge impact on processes and regulatory requirements.
One example is data transfer and interoperability. Fortunately, the US government has enacted interoperability rules for the electronic transfer of medical data.
FHIR stands for Fast Healthcare Interoperability Resources and is a standard for exchanging healthcare information electronically.17 It is designed to improve interoperability and enable seamless data exchange between different healthcare systems and applications.
Now that there are standards in place, there needs to be platforms that can transfer remote monitoring and in-home data to healthcare professionals and electronic medical records.
Fortunately, there are also privacy and security standards for healthcare data, and these in-home devices and data platforms need to be HIPAA compliant, just like the hospitals need to be compliant.
Q9: Regarding the availability of care equipment for the home, how can we ensure that this equipment is user-friendly and doesn’t require that a trained professional is present at all times?
Robin Farmanfarmaian: That goes into the design of the device and will vary depending on the machine.
Some devices will require ongoing training. For example, at-home dialysis. It does take a few weeks to train the patient on how to use their dialysis machine. Fresenius is one of the giants in dialysis, and they put patients through a 4-8 week training course to learn to operate the at-home machines safely and effectively.18
Other devices are designed to operate in the same way as common household devices, like an Amazon Alexa that can listen for movement and remind patients to take their medication.
While we can’t ensure all products are accessible, these are the types of innovations already being used for healthcare at home.
References Author Robin Farmanfarmaian
Professional Speaker, Entrepreneur and Angel Investor
Robin Farmanfarmaian is a Silicon Valley-based professional speaker and entrepreneur working in cutting-edge tech poised to impact 100 million people or more. Robin has been involved with over 20 early-stage biotech and healthcare startups from curing cancer to medical d...
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