Rethinking health care delivery through home-health technology advancements

The post-Covid healthcare crisis is upon us, with gaps in preventive care in 2020 morphing into full-blown chronic diseases in 2022, putting the 60% of Americans who live with at least one chronic health condition at higher risk for adverse events.

Meanwhile, physician shortages — driven largely by clinical burnout — have left community hospitals without the staff to attend to patients who need critical, often lifesaving, care. As a physician working in a small critical access hospital in North Dakota, I never imagined we’d be so understaffed to the point we’d need to fly our patients out of state to other facilities that can handle a higher level of acuity.

Given these converging trends, we need to rethink healthcare in a big way. Our healthcare system needs to be redesigned to work smarter to address chronic disease, mitigate risk factors, and get ahead of future health emergencies. As we acclimate to pandemic life, with an eye toward the horizon, it’s clear that the only way forward involves a massive shift toward prevention and preventive care.

The technology we choose, as providers, and the technology we recommend to our patients, is a major element of this movement.

Reimagining technology

Telehealth and other home-based health tools and applications proved critical in 2020, when non-emergency health facilities temporarily shut their doors. But over the last year or so, as health facilities began seeing a resurgence of patients who had put off preventive care, telehealth use has declined again in most areas outside of behavioral health because of a lack of payment parity (while coverage is pretty universal, only a few states have payment parity laws for telehealth).

Yet many of the benefits of virtual care and other technologies used by patients outside of healthcare settings are underestimated. We don’t need physical locations for pre-operative consultations for routine procedures such as colonoscopies, and many pediatric visits can be done remotely.

Given the ongoing physician shortage crisis, policymakers need to think about reimbursement discrepancies, and whether they’re truly supporting future healthcare-delivery needs. Healthcare providers must also ask themselves how to invest technology that engages patients in a convenient way, while also driving better outcomes and cost savings.

For example, if a technology application or tools can help a 27-year-old patient who rarely visits their doctor identify a major health risk (e.g., prediabetes), that’s huge. About one in four young adults have diabetes, but many don’t know it until they end up in the hospital in an emergency. In this new world where hospitals are chronically short-staffed, every prevented emergent care visit counts.

Also, as part of our overhaul of healthcare, we need to reimagine preventive care through the lens of convenience. We need to ask ourselves what we can do at home, and how we can make home-based health technologies compelling and even fun to use.

Following through, engaging

As we rethink healthcare delivery, health leaders, physicians and other stakeholders need to focus more on prevention — so patients have the tools and resources they need to stay out of the hospital.

We can’t shift toward a prevention-mindset, however, without supplementing or enhancing in-person care – at our PCPs, OBGYNs, etc. – between scheduled visits. We need to engage our 28-year-old, 48-year-old and 68-year-old patients in a way that drives behavioral change and prevents adverse events and chronic disease. Here’s how health leaders, clinical workers and other can do this in the movement toward a new model of convenient, prevention-focused, value-based healthcare:

1. Think big picture. What can be done remotely and what should be done remotely? These questions are the starting point for any investment in patient-facing technology or solution that patients should engage with between in-person visits. If a physician, for example, wants a patient to track their food intake and exercise to manage their diabetes, they should recommend the use of an app or program that offers health coaching and/or dietary counseling, and can potentially share data with the physician to hold the individual patient accountable.
2. Incorporate more virtual tools into brick-and-mortar operations. As technologies advance, so do our abilities to use them to enhance and speed up care. Telestroke applications, for example, have enabled hospital emergency departments to speed up care by connecting patients experiencing symptoms of a stroke to neurologists throughout the country. As one study noted, telestroke hospitals had relative rates of reperfusion treatment that were 13% higher and relative rates of 30-day mortality that were 4% lower, compared with non-telestroke hospitals. Exploring virtual care use cases that can enhance primary or specialty care is going to become more essential as resources dwindle. The sooner physician practices can find out how and where to leverage telehealth, the better off they’ll be.
3. Empower and encourage patients with the right home-based tools, coupled with the right guidance. Putting the right screening tools in front of the right patients at the right time — and in the right place — can make a measurable difference in outcomes and outlook. Home-based screening kits that can measure multiple biometric values, such as weight, BMI, cholesterol, blood-glucose and more, in a convenient home setting and communicates and processes data through a mobile app to a central hub are game changers: They can enhance patients’ awareness of their overall health and generate metrics that can be shared with physicians and other healthcare providers, who can recommend next steps. At-home cholesterol or diabetes screening kits have the potential to help health plans, providers and patients broaden and deepen their population health risk assessments: If 10% of seemingly healthy individuals had diabetes but hadn’t been diagnosed yet, a home testing kit could gauge any abnormalities in blood-glucose levels.

Shifting to a prevention-centered mentality is more critical than ever, given physician shortages and the rise of chronic disease. Encouraging patients to engage with their health while at home will foster a new kind of relationship with the health system, one that emphasizes disease prevention and accountability. And by connecting patients to preventive-care tools that are convenient and engaging, we’re lessening the burden of our emergency medicine providers, while also helping patients live their best lives.

Dr. Alex Marsh is the Chief Medical Officer of Reperio, and a practicing emergency physician in North Dakota.