Payers 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.
Up to $265 billion worth of care for Medicare fee-for-service and Medicare Advantage beneficiaries could shift to the home by 2025.
"When patients enter a health care facility, their primary aims are to become well again and to go home," according to a McKinsey & Company report. "While increasing disease burden and rising health care costs in the United States have already contributed to a boost in care-at-home services, the COVID-19 pandemic has created a catalyst to truly reimagine their future."
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Based on a survey of physicians who predominantly serve Medicare fee-for-service and Medicare Advantage patients:
- Services representing up to 25% of the total cost of care for Medicare beneficiaries could shift from traditional facilities to the home in three years without a reduction in quality or access.
- This number would represent a three- to fourfold increase in the cost of care being delivered at home today for this population, although how the shift will affect reimbursement rates is not yet clear.
- Care at home could create value for stakeholders and improve patients' quality of care and experience.
At-home opportunities include primary care visits via telehealth, self-administered dialysis and skilled nursing-facility services, with remote patient monitoring and support for daily living activities. These interventions can be delivered to different patient groups, such as high-risk patients with chronic conditions or those who are healthy and at low risk, throughout the patient journey as either point solutions or a comprehensive offering.
Payers 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 also could 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. The eventual value from care at home likely will depend on which specific opportunities are pursued and adopted.
"The COVID-19 pandemic has created a catalyst to fundamentally reimagine care at home to help improve quality of care and patient experience while also creating potential value for payers, health care facilities and physician groups," the report concluded. "The ultimate value will depend on a variety of factors that are in the hands of stakeholders."
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
