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How decentralizing care reduces inequities in traditional models of care delivery

By Medically Home Newsroom

Fast facts: how decentralizing care reduces inequities in traditional models of care delivery

Caring for patients in the comfort of their own homes, in familiar surroundings, close to loved ones and caregivers, is the epitome of patient-centered care and the primary mission of Medically Home. Moving care to the home not only can be done in an equitable way but can also help reduce health inequities. By nature, brick and mortar hospital care is health-system centric rather than patient centric which can often lead to inequity, despite the best of intentions.

Case in point: 

  • A 2019 study of 2,000 patients with heart failure exacerbations showed Black and Hispanic patients were less likely than White patients to be admitted to the cardiology specialist service, independent of clinical acuity, and that being on the cardiology service was associated with decreased 30-day readmissions.
  • Another 2019 study of 273,000 adults with diabetes showed that Black patients had significantly higher 30-day hospital readmissions compared to other groups, and this was most pronounced among lower-income patients.

Decentralizing care for serious or complex illnesses is more convenient for patients and their families:

  • Patients are more comfortable and independent in their homes. 
  • Recovering in the home leads to better sleep, better appetite, and more physical activity.
  • The medical team are guests in the patient’s home which shifts the dynamic between patient and clinician. The care team must take into account the patients preferences including when they sleep, and when they want to spend time with friends and family.  “The doctor will see you now” becomes “the patient will see you now”.
  • Providing care in a patient’s home is a game changer for patients who may distrust the healthcare system or who may have experienced bias firsthand. 
  • Families can participate fully in their loved one’s care and have instant access to their care team. 

Both patients and their caregivers rate home hospital care – and communication while at home – higher than traditional models. 

Decentralizing care to patient’s homes allows patients’ social determinants of health (SDoH) to be addressed in a better way:

  • It becomes possible to discuss medication in front of the medicine cabinet and to provide dietary education while looking in the patient’s pantry.
  • Care decisions and conversations can take place with the patient on their turf and in their place of comfort. 
  • Having the ability to connect patients to things like food pantries, meal services, repair services, legal aid, transportation, and home health aide services.

Care in the home by definition means better transitions of care:

  • This is especially the case with programs that have a post-acute, restorative phase which is important for transitions and helping patients stay out of the bricks and mortar hospital and live their lives to their fullest. 

Decentralizing care is feasible and impactful, even for those with fewer resources:

  • A 2022 comparison of hospital-at-home (HaH) patients and inpatients – Medicaid and non-Medicaid – showed home hospitalization is feasible for patients with fewer resources.In 2022 Atrium Health showed in a small study that for patients with COVID, disease progression occurred among inpatients with worse area deprivation index (ADI) scores, while for HaH patients, ADI scores were not linked to disease progression.
  • UMass’ Hospital-at-Home program is ~25% Medicaid, ~25% dual eligible, and those groups have had the biggest decrease in 30day readmissions – a 50-75% reduction compared to benchmarks.

Those with fewer resources can and will access telemedicine: 

  • After the 2020 Medicare telemedicine coverage waiver was issued, use of telemedicine increased 23-fold, with the highest rates of adoption among people residing in the most disadvantaged neighborhoods.

Equity via access – the scalability of decentralized care:

  • 15-20% of Americans live in rural areas with thin limited access to healthcare.
  • Medically Home is already operating in rural markets across the country, including Washington, Oklahoma, Wisconsin, North Carolina, and Oregon.
  • We are constantly reading that more small community hospitals closing. In order to keep healthcare in vulnerable communities we must stand up virtual hospitals and keep a skilled workforce in those communities. 
  • With the use of virtual visits combined with in-home clinicians, the potential to scale (and reach patients with traditionally poor access to care) is exponential. 

Costs of decentralized care are revealing themselves to be lower:   

  • Studies have shown that the cost of providing the care itself are revealing themselves to be lower.
  • By bringing care to patients’ homes, it is possible to lower the direct and indirect costs of hospitalization borne by families. Family members no longer have to take off work and spend time commuting to the hospital, sitting in traffic, paying tolls and parking fees, or find childcare. 
  • Practically speaking, for patients and caregivers who are still in the workforce the reduced length of stay (LoS) seen with hospital-at-home means they can go back to work faster. 

November 07, 2022