The Future of Healthcare, Part I
The expanding population of seniors and their chronic diseases are a major challenge to the U.S. healthcare system. Much of the Medicare budget is now spent on hospital-based care for patients with multiple chronic diseases, and such costs will only grow in coming decades. As a result, major changes are coming to the way healthcare is delivered and the way it is paid for. One aspect of those changes is the growing importance of in-home care, which will include:
- Healthcare services increasingly delivered in a patient’s home, rather than in a medical facility. Patients much prefer treatment at home rather than in an institution, and home care is much less expensive and doesn’t expose patients to risks of infection from other patients.
- Medicare and Medicaid reimbursement to healthcare providers based on value (e.g., the health of a patient population) rather than volume of services. For example, if a Medicare patient is re-admitted to a hospital within 30 days of his or her discharge, Medicare won’t pay for the additional charges. And starting in 2020, similar reimbursement changes are coming to in-home care, along with an emphasis on coordinated care that addresses the full range of a patient’s needs.
- Growing use of advanced technology, including mobile IT systems to support in-home caregivers and in-home diagnostic devices, tablet-based video consultations or voice-based care access, as well as the use of data analytics and artificial intelligence to help manage patient healthcare.
- New emphasis on behavioral health and the social determinants of health, especially for in-home care, including interventions that seek to prevent falls, to improve diets or adopt healthy habits, to ensure access to medicines, and to address isolation or provide mental health support. There is growing evidence that regular in-home contact with a trained healthcare provider is far more effective in changing patient behaviors and improving compliance than most institution-based programs.
The goal of this new emphasis on integrated in-home care is not only to lower costs and prevent hospitalizations, but also to improve patients’ quality of life. It will also trigger increasing consolidation among hospital chains, healthcare provider organizations, and pharmacy chains. Moreover, growing in-home care will mean that nurses—or nurse-led teams that include trained health workers for non-clinical services—will provide a larger share of direct patient contact, opening up new opportunities for both full- and part-time health occupations.
Common Sense for the Eastern Shore




