The Evolution of Home-Based Care During the COVID-19 Pandemic: Lessons Learned & Implications for Federal and State Policy

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The experience during the COVID-19 pandemic has accelerated reaching the day when care in the home is a common and widely available option for patients. The advent of the widespread use of telehealth, remote patient monitoring, virtual disease prevention and disease management, caregiver support, medical record sharing, and new practices by providers and patients can make this possible. A massive growth of home-based care models has erupted, spotlighting new models and those that existed before the pandemic. Care in the home also contributes to health equity by giving historically disenfranchised communities the option to receive care on their terms. It promotes trust and communication by removing institutional barriers and placing the interaction in a familiar setting. A recent national poll confirms this, finding that 70 percent of those surveyed are comfortable receiving care in the home citing that a familiar environment helps alleviate anxiety.

In this report, Moving Health Home (MHH), a coalition of health care organizations with a bold vision to make the home a site of clinical services, explores the transformation that home-based care has undergone during the pandemic. Insights and findings from this report are based in part on in-depth interviews conducted by Avalere Health with leaders from organizations that have either based or adapted their clinical and business models to serve patients in their homes.

Based on the interviews with Landmark Health, DispatchHealth, Contessa Health, Ascension, and Advocate Aurora Health, MHH identified four lessons learned from the pandemic experience, including:

  1. Home-Based Care Encompasses a lot More than Home Health – Care in the home is no longer limited to traditional home health services and exists on a spectrum of intensity and type of services offered.
  2. Organizations with Experience Providing Home-Based Care Were Well-Positioned to Respond to the COVID-19 Public Health Emergency (PHE) – While many organizations quickly adopted to the pandemic, models that succeeded most rapidly typically leveraged existing home-based care programs and infrastructure.
  3. Home-Based Care Models Boost Patient Satisfaction, Improve Quality, and Reduce Costs – Beyond addressing capacity and caregiver fatigue issues, home-based care models have demonstrated the ability to improve quality, boost patient satisfaction, and reduce costs.
  4. Regulatory Flexibility is Essential to Success – The pandemic demonstrated that regulatory flexibilities are critical to fully enable care delivery in the home.

To fully realize the benefits of home-based care, including improved clinical outcomes, patient experience, and reduced caregiver burden, state and federal policymakers will need to implement permanent flexibilities and programs that build on the lessons learned from the temporary PHE waivers. The pandemic has gifted the opportunity to transform how health care is delivered, and this report is an important step in ensuring home-based care is part of our health care future.