Promoting Better Clinicians Through Care at Home

The rapid growth of the continuum of healthcare in the home since the COVID-19 pandemic is testament to the success of this approach to care. Delivering high-quality medical care in the home environment has required innovation in treatment approaches, technology and workflows. Especially in the case of high-acuity and post-acute care, it has also required providers to be nimble and adopt new strategies. 

For these providers, these new ways of approaching care delivery and decision-making have a significant impact on their overall skillset and ability to provide high-quality care and outcomes. Not only does it polish their care delivery in the home, but it also gives them an additional set of strengths to take back to their patients in the hospital setting. 

The traditional clinical approach to care in the hospital 

Over-utilization of resources is a hot topic in the healthcare world. A serious challenge in care delivery, in the United States, wasteful healthcare spending reaches as much as $935 billion each year, according to some estimates. And excess cost is not the only concern; for example, alarms have been raised around the risk of radiation exposure through over-use of computed tomography (CT) scans.  

In response, value-based healthcare initiatives have attempted to address the balance between cost and high-quality outcomes. Increasingly, this approach to care is a necessity— although participation in value-based care is not currently mandated, the Center for Medicare and Medicaid Innovation (CMMI) is behind a push to increase mandatory value-based payment models. 

As hospital systems and burned-out providers grapple with capacity strain, over-utilization of resources such as ancillary services is common. One reason for this is that heavy utilization of testing helps to return data quickly in busy care environments. The faster a provider can glean data, even if it is excess data, the faster he or she can make treatment decisions and deliver care. 

Why advanced healthcare in the home limits over-utilization of resources 

By its nature, bringing high-acuity and post-acute care into patients’ homes limits the use of ancillary resources. In the home, there is not a pharmacy across the hall, a CT scanner downstairs, an in-house laboratory or even a rapid response team on hand. Instead, providers are often relying on virtual care via telehealth and remote patient monitoring in combination with highly trained nurses as the “boots on the ground” for patient care. 

This requires a lens shift by providers. Dr. Kamia Thakur, Penn State Health’s Medical Director for their Home Recovery Care program, states, “We are revolutionizing the practice of medicine, a rare occurrence within the field of hospital medicine. This program positively transforms the patient-doctor relationship despite its tele-nature, and alters our perspective on this form of healthcare delivery.”  

What are the alternatives, without compromising safe and effective care? Some key changes in approach to care delivery occur: 

• Providers must be more thoughtful and deliberate about their choice of ancillary services. They are less likely to order unnecessary tests and consults. 
• Providers are more likely to spend time listening to patients’ stories and to rely on patient symptoms, which creates a better patient-doctor relationship. 
• Providers lean into their nurses who are in the home with patients, leading to improved team collaboration. 
• Providers must also leverage more proactive thinking. What can they do to prevent a problem from developing, rather than only reacting to a situation because they have the full suite of hospital solutions at hand? 

• Ultimately, this develops better critical thinking. 

Altogether, this results in a reduction in the cost of care through delivery of care in the home. The American Journal of Managed Care notes that studies have shown that hospital-at-home programs cost less, likely via reduced laboratory testing, reduced consultations, reduced nursing labor expenses and decreased length of stay. 

Continued benefits of better clinicians, beyond care at home 

While it’s easy to see how this measured and thoughtful approach to care hones a particular skillset for providers, it’s also important to note that this new and enhanced “provider toolkit” is one that can be carried back to the hospital setting.  

Clinicians who provide care in the home often dedicate a portion of their time to continuing to work in the inpatient setting within the hospital systems they work for. The skills they hone while delivering high-acuity and post-acute care in the home transfer with them back to the hospital. They are more confident in their decision-making, they work collaboratively, listen intently to patients and may use less resources. Their proactive nature equals better outcomes— for example, potentially less use of rapid response teams.  

What’s more, they are happier clinicians. Dr. Thakur shared, “Traditional care models have streamlined the practice of medicine to such an extent that it is very easy to treat every patient and situation identically. There is very little room for art in the practice of medicine. We lack the time to truly engage with the patient and their families. For me, the Home Recovery Care program has reintroduced the art of medicine, where every patient and their situation are unique.”    

Care at home is a cutting-edge opportunity for developing clinical skills 

The continuum of care at home is only continuing to expand, and as it does, it will require that providers continue to refine care delivery and with it, the skills they leverage. Along with the opportunity to reduce over-utilization of resources and deepen provider-patient relationships, this model of healthcare will continue to produce more polished clinicians and happier patients. Without a doubt, this is a win for hospital systems, payers, patients and providers themselves.