8 DECEMBER - 2022IN MY OPINIONAs a myriad of services and activities that were previously only available at hospitals, are now easily accessible at home, it should come as no surprise that patients and caregivers are embracing medical care at home with open arms. In addition to convenience and comfort, medical care at home allows clinicians to comprehensively evaluate the contributors to a patient's health status insights difficult to glean in an office-based visit. Especially in the last decade, home-based medical care (HBMC) has also been shown, through independent studies as well as a multiyear CMS demonstration called Independence at Home, to improve quality and total cost of care. These improvements are accomplished through several mechanisms: hiring and incentivizing clinicians to be risk tolerant instead of risk averse, 24/7 availability to detect and intervene upon issues before they escalate, closely following patients after hospitalization to prevent readmissions, and developing longitudinal relationships that allow for meaningful advanced care planning.Those who benefit the most from HBMC are those who are of older age and have multiple chronic conditions. Older adults with multiple chronic conditions tend to utilize the emergency room and inpatient care at high rates as they are unable to access traditional outpatient services when they feel unwell or have a change in condition. Furthermore, many of those practices are not designed for the responsiveness and risk tolerance necessary to help realize patient goals of remaining out of the hospital. Finally, many of these complex patients live with behavioral and/or social challenges that require team-based approaches and staffing. Recognizing the benefits of this care delivery model, leading Medicare Advantage (MA) plans and non-medical organizations have been starting or acquiring home-based medical care practices, turning a field that was once a sleepy corner of healthcare into a highly competitive growth arena. With major health care companies displaying increased interest in acquiring home-based care companies, and several other venture-backed and private organizations moving into the space, the message is clear: medical care in the home is growing in volume and may soon be available at scale for millions of MA and dual-eligible beneficiaries.As care in the home scales, the importance of developing The Rise of Home-Based Medical CareBy Karen Abrashkin, MD, FACP, Theresa Soriano, MD, MPH, and Kristofer Smith, MD, MPP at Northwell HealthKristofer Smith
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