The Executive Suite: The role of in-home services in primary care

It's not hard to see which way the winds are blowing when it comes to in-home primary care programs. From Walgreens increasing its investment in VillageMD to CVS announcing its planned $10.6 billion acquisition of Oak Street Health, there are massive moves being made by some of the industry’s largest players because they see the potential of this sector. Even Amazon is joining in with its purchase of One Medical.

We are seeing heightened interest as we look at our business as well. As a testament to the strong demand for in-home advanced primary care services, Emcara Health will see roughly 40% growth in 2023. This demand comes not only from our traditional health plan clients, but also from health systems who are trying to solve problems like addressing the needs of underserved patients through community-based outreach.

What’s driving this trend? The short answer is: pretty much everything. Our population is getting older and sicker every year. We are experiencing a dramatic shortage of primary care professionals and high rates of burnout among those who continue to care for patients. Rural hospitals are closing at an alarming rate, creating care deserts for many with serious health concerns. Meanwhile, health care costs continue to escalate at the same time many providers are struggling to stay afloat.

This confluence of factors has led us to an explosion in services aimed at bringing care to the patient’s home. These services offer the ability to extend the impact of providers, drive improved cost and clinical outcomes for health plans and most importantly, create access to highly coordinated, high-quality health care for Americans who are vulnerable and underserved.

Unfortunately, any time this type of rapid growth occurs in a sector of health care, things get complicated and confusing. There are many different types of home care offerings, and not all of them are created equally. Not all of them will effectively integrate with the existing system. Not all of them will lead to positive changes for patients.

The perfect example of this is the recent proliferation of point solutions--technology designed to address a specific problem--headed to the home. Independently, these condition-specific approaches have merit, but picture an older individual with multiple health concerns. Depending on this person’s needs, there may be numerous different providers coming to their home for services such as diabetes support, chronic kidney disease treatment, physical therapy and so on.

These point solutions further fragment an already splintered system, making care coordination nearly impossible. But even if health care organizations think holistically in terms of the partners and solutions they choose, it’s not enough to ensure success. As an industry, we must play and pay differently or risk watching a much-needed service crash and burn.

We have to play differently

This means more collaboration among health plans and providers and deeper, more coordinated care. It means that all stakeholders will have to get comfortable with innovation and with partnering in a more profound way on behalf of the people they serve. Health plans must provide more support to help providers be successful. Providers need to embrace new resources and re-imagine how they deliver care, particularly when care is needed beyond their four walls.

An advanced approach to in-home primary care requires collaboration and coordination. It requires better sharing and leveraging of data, and that we broaden our view of the patient and holistically address their needs as we engage them in the home. It means supporting patients in an integrated, highly coordinated way while managing issues such as behavioral health, medication management and social determinants of health in addition to acute and chronic medical concerns.

Accomplishing all this requires access to a multidisciplinary care team that includes clinical staff, behavioral health specialists and community health workers. In many cases, health plans and providers need to bolster internal resources by partnering for this type of team effort, which again underscores the growth our company has seen in recent years.

We also have to pay differently

This means transitioning from traditional fee-for-service payments to a value-based approach. We need to see more focus on value-based payment models in the primary care setting, particularly in support of high-risk patients with complex medical, behavioral and social needs. Even with access to high-performing medical groups, many of these patients will still fall through the cracks.

Augmenting a provider network with in-home services for vulnerable and underserved individuals creates another layer with which to cover care gaps. When you wrap a value-based model around this support to align incentives, both community and in-home care providers are rewarded for delivering optimal patient outcomes. Increasingly, it seems obvious that value-based models are the path forward, particularly for advanced primary care efforts.

Wind is a powerful force, and if harnessed correctly it can carry you to new heights. But if aimed in the wrong direction, it can level your house. We are reaching a pivotal point in the delivery of in-home primary care that can usher in an entirely way to support millions of Americans in need. It’s up to all of us as an industry to ensure we make the most of this opportunity.