The emerging role of home-based health care

In home health care is an increasingly effective and efficient option within the patient-centered, whole-person care model, especially for the most medically complex polychronic patients.

The polychronic population is said to increase in the coming years. By 2030, the number of Americans living with three or more chronic conditions is estimated to reach 83.4 million, which is more than two times the polychronic patient population since 2015.1

The growing number will drive increased complexity of care, capacity concerns and costs. Moreover, the traditional care model creates challenging experiences for polychronic patients. Addressing the needs of this population will require new approaches beyond traditional fee-for-service, condition-by-condition care models.

Related: Transforming care for an aging population

The shift to whole-person care

Because the American health care system is built primarily for acute care (i.e. single cause conditions, rapid onset and defined duration), the traditional care model no longer works for polychronic patients, their caregivers and providers. If anything, it creates a cycle of non-integrated care management, increased hospitalizations and added costs.

As a result, whole-person care models have emerged and gained popularity in recent years to help improve health outcomes and care efficiencies, enhance patient experiences and manage costs. Instead of focusing on one condition at a time, whole-person care encompasses the full range of factors that help determine health, including socioeconomic circumstances, lifestyle behaviors, food insecurity, social support and genetics.

A modern care model

Home-based health care is an increasingly effective and efficient option within the patient-centered, whole-person care model, especially for the most medically complex polychronic patients.

There are three main types of home-based care:

  1. Home-based primary care: provides the same primary care patients would receive in a provider’s office but in the comfort of their home. With this type of patient-centered care, the primary care physician or nurse practitioner monitors the patient’s chronic conditions through regular visits. They also provide annual wellness visit and preventive care, and prescribe medications and other treatments to improve the patient’s health and effectively manage their chronic conditions.
  2. Post-acute and transitional care: offers individualized care post-hospitalization to monitor recovery and facilitate the patient’s transition back home following treatment.
  3. Home health care: provides skilled nursing services and therapeutic services for homebound patients, including patients recovering from an injury or surgery.

Key drivers of home-based care 

Technology is a key driver behind the increasing viability of home-based care models. Sophisticated portable equipment makes it possible to administer medical tests (such as blood glucose and urinalysis) in a patient’s home. In some cases, test results are available in near real-time without requiring processing in a lab. Additionally, wearable devices, such as heart-monitoring devices, enable providers to remotely monitor chronic disease progression and identify significant health changes. Continuing advances in technology and electronic data management improve care delivery and make home-based care more accessible for more patients.

The COVID-19 pandemic also accelerated the adoption of home-based care models through telehealth, also known as virtual care. As a result, patients and providers are more familiar with care-at-home options. In fact, there was a 38x increase in telehealth usage in 2021 compared to pre-pandemic levels.2 Moreover, 40% of patients continued to use telehealth long after the pandemic and usage rates are projected to continue.3

Looking ahead, patient care journeys are likely to include a mix of in-office or facility, in-home and virtual experiences. The consulting firm McKinsey & Co. estimates that $265 billion in care services for Medicare fee-for-service and Medicare Advantage patients will shift from traditional facilities to home-based care by 2025.

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Home-Based Care
Evernorth Home-Based Care is a value-based approach with comprehensive in-home primary care solutions, including direct patient care and care enablement services. We work closely with 30+ clients (health plans, Medicare, dual eligible special needs plans (D-SNPs), commercial and more) — serving more than 26 million lives — to improve quality measures and health outcomes, reduce hospital readmissions, and upgrade the patient experience and care delivery coordination. Known for our flexibility, Evernorth is always willing to partner with your existing vendor relationships and clinical pathways to avoid disruption. This approach leverages our expertise and solutions while integrating our clients’ capabilities and third-party resources to maximize overall effectiveness.

1 Waters H, Graf M. The Costs of Chronic Disease in the U.S., Milken Institute, August 2018.

2 Bestsennyy O, Chmielewski, M, Koffel A, Shah, A. From facility to home: How healthcare could shift by 2025, McKinsey & Co., February 2022.

3 Id.