Founded by a visionary doctor, Benneth Husted, D.O., Housecall Providers would rise to national prominence for the effectiveness of his home care model. It eventually merged with CareOregon, a major Oregon insurer, where it serves as CareOregon's home medical care unit. Practicing medicine in patients' homes has come a long way since that house call in 2012. So far, in fact, that insurers, plan sponsors, brokers, and major health systems are all finding ways to integrate home medical care into their products and services.

The demand

Why? Two major reasons: It improves patient care and patient health; and it saves money, especially by reducing trips to the emergency room and readmissions to hospitals. But there's another factor: Consumers want it. Especially post-pandemic, consumers are resisting clinical visits that could expose them to infections and viruses–or are just plain inconvenient.

"Look, people like receiving medical care at home," says Mark Claster, managing partner, Carl Marks Advisors, a New York investment banking and restructuring firm. "Those models are becoming more and more common due to consumer preference. It's like anything else. Consumers have choices. Health systems have become very competitive. So home health is expanding."

Today, most major health care systems offer home medical services of at least some type. Insurers are increasingly paying for the service as they see its cost-effectiveness in improving patient health, and reducing emergency room trips and hospital readmissions.

And influential corporations like United Health Care, Kaiser Permanente, and the Mayo Clinic are creating their own home medical care models. These, they believe, are going to become ever more pervasive as Baby Boomers age and telehealth innovations push the envelope of what can, and cannot, be done remotely.

The barriers to home medical care are coming down as regulations are relaxed or disposed of and insurers authorize more at-home treatment. As Claster says, "The technology was there years ago, but incentive on both sides–patients and physicians– never made it something that each party was expected to do. COVID changed that in a big way."

The innovators

While "telehealth" receives much of the credit for bringing medical care to the patient, it is the emergence of mobile services that has really made home medical care more practical for more people. Monitoring devices to measure blood pressure and blood sugar can help a physician understand a remote patient's condition.

But mobile services allow a patient to remain in their home rather than be transported for any number of medical procedures. Mobile care teams comprise a key component of a growing number of health systems. More diagnostic work and early-stage treatment is being provided by specialists who combine medical and technical knowledge.

Taryn Tanzer is President of Patient Care Associates (PCA), a mobile medical services company providing cardiology, radiology and ultrasonography diagnostic testing services throughout New York, New Jersey, Pennsylvania, and Connecticut. Founded 40 years ago, PCA initially offered mobile diagnostic testing services to sub-acute and long-term nursing facilities, psychiatric facilities, clinics and correctional facilities. Then, about a decade ago, PCA began making house calls.

"Physicians were looking to enhance the quality of care patients could receive in their home and our imaging business started to grow amongst a homebound population. Then came COVID, which drove, and increased, need to provide health care to patients in homebound settings," Tanzer says. "Over the past five years we have watched the homebound division of our practice increase year over year by approximately 15-20%.

"In 2020, the country experienced the need to reduce hospital ER visits to compensate for capacity restrictions shifting treatment of patients from facilities to the patients home," she continues. "PCA has been working with hospital systems to provide diagnostic services to those being treated under 'Hospital-at-Home' programs. Diagnostic services, when medically necessary, are covered by insurance and enhance the level of care that a practitioner can provide to his/her patients. As we are seeing the benefits of expanding services to treat patients in a homebound setting and the cost savings of treating patients outside the notoriously costly hospital settings we believe home care is the newest trend in health care."

PCA provides one of many mobile medical services now available to bring medical care to the home. As they become more connected with telehealth products, a network to support patients at home is being created. But their numbers, and their financial value, were held in check until major insurers and health systems adopted home medical care as a core value.

Enter the behemoths

Major insurers and health systems have been cautiously monitoring the demand for, and opportunities in, home medical care for years. The Centers for Medicare and Medicaid Services provided the medical validation for in-home care with its years-long Independence at Home study in the past decade. The study proved that patients who received quality care at home enjoyed better health, made fewer trips to the ER, and had fewer post-hospitalization re-admissions than patients receiving clinic-based care.

That translated into huge cost savings for payers and reduced demand on overwhelmed hospital and clinic staff.

COVID proved the tipping point. With patients refusing clinical visits, even when warranted, the insurers and health systems got a closer look at home medical service performance. The steps taken by UnitedHealth Group, and by the Mayo Clinic and Kaiser Permanente, will forever change the way medical care is delivered, health care experts agree.

UnitedHealth Group is among the major players today lobbying for care that reduces ER visits and hospital readmissions. While its policies have been controversial, there's no question that billions are spent every year on unnecessary ER trips and hospital readmissions.

UnitedHealth has made a major foray into home health medical care through its unit, UnitedHealthcare Retiree Solutions. It offers a range of home medical services to retirees designed to improve the quality of the care while reducing the cost of providing it.

Joseph Agostini, MD, Chief medical officer, UnitedHealthcare Retiree Solutions, says the program was created "to improve a retiree's health, reduce unplanned hospital readmissions, and provide a better health care experience from the convenience of their home."

For plan sponsors that provide retiree health insurance, that's very good news, given the efficacy of emerging home health care.

Retiree Solutions calls the program "Healthy at Home." It was developed for Group Retiree Medicare Advantage plans.

"While in-office clinical care will remain a vital setting for many health care services, more people are looking for innovative ways to access the care they need outside of a clinical setting," Agostini says.

Services include:

• Post-discharge meal delivery: two meals per day for two weeks following all inpatient or skilled nursing facility discharge
• Post-discharge transportation: up to 12 one-way rides to and from medically related appointments and to the pharmacy following every inpatient or skilled nursing facility discharge, and
• In-home personal care: up to six hours of in-home personal care following all inpatient and skilled nursing facility discharges. Services will be available every time a retiree is discharged from a hospital or skilled nursing facility.

"Also, our UnitedHealthcare HouseCalls program offers people a yearly visit with a licensed clinician from the comfort of home, helping to coordinate needed care – including with an individual's primary care provider, conducting health screenings and providing education on the management of chronic conditions," Agostini says.

He says UnitedHealth envisions an evolution of care that covers the spectrum from clinic-based to home-based, with an emphasis on meeting patient needs in the best way available.

"As a Medicare Advantage plan, we have the opportunity to connect people to services that allow them to get the right level of care at the right time and in the right place. Having flexibility to support care at home when it is safe and effective is important. Effective homecare can address a person's needs and support the caregiver to help people remain independent in their preferred setting as long as possible," he says.

"As a geriatrician I would say it's important to get that balance right in terms of thinking about what are the types of services that a person needs to maintain their health and allow them to stay safely at home."

The Mayo Clinic-Kaiser partnership, unveiled in May, hinges on a mutual investment in Medically Home, a Boston-based technology-enabled services company.

The two partners intend to help build out Medically Home–already successfully offering home medical care on the East Coast–so that far more consumers will have access to its care model. Both parties already offer Medically Home to their patients. Impressed by the results achieved, they created the joint venture.

"Patients expect and deserve high-quality care and excellent outcomes in a convenient and comfortable setting, even when faced with complex medical challenges," said Gianrico Farrugia, M.D., president and CEO of Mayo Clinic, in a release. "Our partnership with Kaiser Permanente and Medically Home will create the next generation of patient-centric, compassionate health care that seamlessly integrates advanced technology with clinical expertise. By bringing best-in-class clinicians and services to patients in their homes, we'll be able to provide more people with individualized care that's tailored to meet their specific needs."

The parties said that their investment supports delivery of a "broad spectrum of clinical applications that can be addressed with this model [and[ unlocks an additional site of care ― a patient's home ― increasing health system capacity and resiliency, while meeting the needs and wants of patients who prefer to be cared for at home or at a homelike setting."

What the future looks like

Carl Marks' Claster sits on the board of Northwell Health, a nonprofit hospital system based in New York. During his time on the board, he has watched Northwell create a fully integrated home health program–a phenomenon he expects to see explode across the nation in the next few years.

"As a not-for-profit, it is our mission to provide every service needed by our patients, whether it is profitable or not," he says. "We have always offered full home health, and we are integrating home health with telehealth now as new products emerge. We even have remote emergency room monitoring where an ER doctor who is not physically present is monitoring the patient. "As telemedicine continues to evolve, it will be integrated with the home health services so that more people can get what they want–medical care in the safety and comfort of their own homes."

Increasingly, that is what customers will demand. Ultimately, they pay the freight–either individually or through their workplace plans. Home medical care provides a higher quality medical experience for millions of patients, and as their health improves and ER trips and early hospital readmissions are reduced, the nation will save billions in unnecessary health care spending.

The house call is back, better than ever.

Read more: 

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• Private investment in primary care, onsite clinics surging
• Hospital outpatient versus the doctor's office: The difference could save employers $11.2 billion