Home healthcare: Stepping up to the COVID-19 Crisis

By Dr. Gaurav Thukral

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Hospital beds are overwhelmed more than ever as the pandemic continues to grow. With self-quarantining and remote monitoring taking a front seat, home healthcare offers not only a more economical option but also quality assurance.

 

The COVID pandemic has changed the healthcare landscape in many ways as compared to earlier times. Challenged with COVID-19, many healthcare providers shifted to remote monitoring of patients and digital visits to continue caring for vulnerable patients while minimizing the risk of virus transmission and reducing the strain on limited hospital resources. It has brought new and urgent propulsion to adopt digital health solutions on a scale, with telemedicine alone this year projected to grow by 500% in India alone out of which 80% are first time users.

The home healthcare market in India has come its age with COVID-19 pandemic giving it the long awaited recognition to be part of mainstream healthcare. For a long time, home-based care in India was an unorganized and fragmented sector but with the advent of higher centers of healthcare providers and entry of skilled providers, this field is on its way towards an organized, technology-led industry with standards and protocols. The market shows plenty of possibilities to grow over the coming years due to the shift in preferences and types of services demanded amid the pandemic. The current market structure is fragmented with a high proportion of unorganized players as compared to organized players, but COVID-19 has extended the market for home-based care providers, empowering them to give both home-based care and remote healthcare and services, aside from connecting with corporates and industries.

According to a recent report by PricewaterhouseCoopers (PwC) Health Research Insights (HRI), the spread of the novel coronavirus is transforming the healthcare consumerism environment, with patients already starting to engage with the medical industry in unprecedented ways.

Recent research by KEN has projected the home-healthcare industry to grow as one of the largest sectors in the healthcare spectrum revenue and employment. In the past 5 years, the home care market size has grown at a CAGR of 17.2%.

The sector has a vital role to play in delivering out-of-hospital services, along with video monitoring and telehealth technology. Chronic disease patients can be handled more at a lower cost than hospitalization at home with advanced care and physiotherapy. Besides, with a rise in the number of Covid-19 infections, insufficient healthcare facilities and poor funding, home healthcare may help resolve a part of the current healthcare need.

We need to ease the burden on increasingly overwhelmed healthcare systems by creating hospital-like capacities at home. This will not only bridge the gaps between hospitals and patients but will also reduce healthcare costs and mortality rates. It can reduce the risk of COVID-19 transmission, especially in vulnerable patients.

Remote monitoring of health at home may even be equally critical after patients have sought hospital care. Typically, patients are disconnected from healthcare supervision following hospital discharge–contributing to potentially avoidable hospital readmissions. Especially people who need critical care and supervision, home-based critical care has become an integral part of patient recovery, especially among long-stay patients. Skilled nursing care delivered in patients' homes may prevent, foresee, or limit costly hospital readmissions. A recent study showed that readmission rates can be significantly reduced in home care environment by 1:1 staffing and careful monitoring of critically ill patients. Adequate training and improving staff knowledge on critical information has certainly prevented incidences of unplanned readmissions to the hospitals. A hospital admission avoided by good primary outpatient care is, after all, an extra hospital bed for a patient who needs emergency care for COVID-19. The government fretted with challenges of creaking hospital infrastructure clubbed with fear psychosis and stigmatisation around the infection, has vehemently promoted isolation at home. The first guidelines by GOI released 10 May 2020 have been groundbreaking in acceptance safety and efficacy of home based treatments. GOI has formally engaged with industry leaders like HCAH to manage thousands of asymptomatic and mildly symptomatic patients at home . The Delhi model with receding new cases speaks volumes on the efficacy of such remote monitoring models. Further,dengue and many other acute and chronic diseases can also be managed at home by technology-enabled models.

A positive outcome of this pandemic is that insurance providers now also have added benefits related to the treatment of coronavirus to their current health insurance coverage plans. Those include honoring requests for COVID-19 at-home care, retaining no-claim bonus value even in the case of a claim for hospitalization, and for the waiting period. This was something we have been hoping for long. It would help all consumers who want to take advantage of treatment for any disease in their home 's secure atmosphere rather than a hospital, thereby ensuring social distancing. Homehealthcare can provide quality, affordable care in managing Telemed OPD, medical admissions by preventing admissions, daycare at home for cancer treatments and dialysis, and post discharge care to prevent readmission rates.

This would attract several players and tremendous investment in the sector. Unfortunately, this has also led to a lot of by night operators and we see a new company every week yet customers should be careful that all these players may not have the necessary clinical expertise to deliver care and would be worse off for them. Customers should look at players who have the experience, demonstrated clinical outcomes, high patient satisfaction scores, and most important accreditation under QAI (India’s homecare standards).

In the end, the home as a place of care will be one in which tech-enabled devices and sensors, combined with artificial intelligence and voice or video interfaces, are seamlessly and discretely integrated to support health and well-being of people; all linked to digital integrated platforms connecting patients, service providers and payers, with strict security and privacy controls in place. Today, people are grateful that in these challenging pandemic times they have benefited from home-based care because, in the present situation, it is a cost-effective form of treatment compared to hospitals. Besides, with an increase in the number of COVID-19 infections and inadequate healthcare facilities and resources, home healthcare may help address a part of current healthcare needs.

Governments should continue to expand primary care and hospital-at-home services even after the COVID-19 pandemic settles. I hope that both during and after the pandemic, patients and primary care providers will agree that these services improve the care experience and outcomes.

It will help connect the dots across the healthcare ecosystem for people, supporting value-based healthcare that focuses on long-term health outcomes rather than acute-care episodes.


Author:

Dr. Gaurav Thukral

DNB (Internal Med), COO & Executive VP, Healthcare at Home (HCAH)