Proponents of home health care technology believe it can play a critical role in keeping patients out of the hospital. But is the current public policy environment killing any chance these new technologies have of becoming widely adopted? While policymakers have shown some interest in home health tech’s potential, they’ve offered limited leadership in creating new policies to expand its use.
Here are some of the issues:
- Infrastructure and integration into an already fragmented health care system. It may be that the biggest obstacle to widespread adoption is not the devices themselves, but what to do with the data that’s transmitted by those devices. The data is often not integrated into the overall care process and may never reach a patient’s primary care provider – who may not even have the technological infrastructure in place to monitor and act on the data. When patients themselves are picking up the cost of a device, the data is especially likely to go to a third-party vendor, like a visiting nurse association.
- The need for patient education. The current generation of elderly patients may lack the health literacy and familiarity with technology to use home health devices. Someone has to train them to use it effectively, and these costs must be absorbed by the system – are they reimbursable or not? The good news is, AARP research shows that two-thirds of the seniors surveyed said they would learn how to use new technology if it meant they could continue to live at home.
- Cost, reimbursement, and business model issues. A key obstacle to expanding the use of home care technology is the lack of clear reimbursement policies. Devices that are considered “first generation” home care technologies (like glucose meters and CPAP machines) are usually covered by insurance companies, but more advanced technologies like remote monitoring are usually not – even though insurers will sometimes pay for in-person home visits by a nurse or physical therapist. Industry analysts believe the market for remote health monitoring would benefit if reimbursement moves toward a pay-for-performance model. And there have already been some Medicare pilot projects to reward providers for improved outcomes, like reducing hospital readmissions.
- Does it constitute evidence-based practice? This may be the biggest obstacle of all – the lack of documentation to prove that home health monitoring is both cost-effective and leads to improved outcomes. Many home health devices can be approved based on the manufacturer’s data and without a clinical trial – so providers may be reluctant to get on board without proof their patients are likely to benefit. And payers withhold reimbursement because there is not yet a clear business case. More data is needed – like that which is emerging from the Care Coodination & Home Telehealth program (CCHT) being piloted by the Veterans Health Administration. The program has documented preliminary success in improving health outcomes, as measured by fewer hospitalizations and emergency room visits and improved health-related quality of life.
A RAND Corporation study titled Health and Well-Being in the Home: A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology explored some of the above policy issues and several others. It concludes that “”removing these obstacles to the adoption of home health care tools is not a trivial task; it will require concerted efforts from many stakeholders.” (You can download the report or read it online here.)
Policymakers in government, accountable care organizations, and the health insurance industry must first create a clear vision of the appropriate role of home health technology. Then, everyone must work together to align payment systems and financial incentives with these policy goals. Health care providers at all levels can help by promoting health literacy among patients and changing their roles to support patient empowerment, as well as by engaging with technology developers to provide feedback.
And how does this fast-growing movement affect you and your career? If you’re interested in nursing informatics, there will be opportunities for you to be involved with developing and implementing new home health technologies. Case management skills will also be in demand, as the health care system seeks ways to manage a population of patients who are aging in place at home.
This may be a good time for you to develop new skills and empower yourself with knowledge through an online RN to BSN or RN to MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in areas like infection control and executive leadership.