5 innovations moving care out of the hospital

July 19, 2019

For years now, care has continued to shift out of the hospital to various, lower cost sites of care. A recent study even projected a 2% decline in inpatient discharges over the next 10 years while they forecast 15% growth in outpatient volumes.¹  Surgery centers, hospital outpatient departments, telemedicine, walk-in clinics, and home health care all continue to grow, driven by consumers’ demand for convenience, advancing technologies, and health systems and payers’ need to lower costs. At Olive, this shift in care is especially exciting as it will help improve the quality and quantity of life for many Americans across the country. Alongside technologies like artificial intelligenceprocess automation, and other emerging technologies, these advances help make care more affordable and accessible to all. Let’s look at some of the new innovations that are helping healthcare providers care for patients out of the hospital:

Improved surgical techniques

While it’s not a new innovation, continued surgical and anesthesia improvements have allowed more procedures to move from inpatient to outpatient settings. Surgeries that once required long hospital recoveries are now able to be done in Ambulatory Surgical Centers (ASC), office-based surgical practices, and Hospital Outpatient Departments (HOPD). Examples of surgeries that have been able to transition to out of home facilities are spine fusions and disc replacements, total joint replacements, retina procedures and more. Even cardiovascular procedures are beginning to move out of the hospital. A study performed by the Ambulatory Surgery Center Association found that Medicare would save over $2.4 billion per year if half the eligible surgical procedures shifted to the ASC setting (as opposed to taking place in a HOPD).² And with the ongoing success of these surgeries in other settings, CMS has begun removing procedures from its in-patient only list, such as knee replacements, which will help speed up the shift to other sites of care.

Telemedicine appointments

Remote doctor visits, commonly known as telemedicine, have increased tremendously in recent years, but there’s still room for continued growth. Telemedicine’s potential is largely due to improved communication technologies. Studies show that 77% of U.S. adults now have a smartphone..³ And with more access, higher-resolution video capabilities, and better security, doctors are able to have meaningful conversations and evaluations via video. This innovation is particularly important in rural areas where patients often have to drive hours to be seen by a provider. While still mostly used for common illnesses such as pink eye, rashes, or an ear infection, telemedicine also has the potential to reduce readmissions, especially when combined with other technologies such as remote patient monitoring.

Remote patient monitoring

Remote patient monitoring (RPM) is a key piece of technology that will help telemedicine reach its full potential. RPM uses at-home sensors or tests to remotely transmit health data to healthcare professionals, where it is reviewed to detect potential health problems. RPM is especially important for managing chronic conditions, which affect six in ten American adults.4 Due to the high number and costs of visits required to monitor these patients, many routinely miss appointments and do not do schedule proper follow-up care. With RPM, these patients can be monitored more regularly without the burden of having as many in-person visits. The data can also identify potential problems so intervention can occur sooner, improving outcomes. RPM is already being used for people with diabetes, heart failure, atrial fibrillation, pacemakers, and women with hypertension during pregnancy. But with new developments in consumer wearables and wireless technology, the possibilities of RPM will surely expand.

Remote lab tests

We’ve already seen direct-to-consumer sites like 23andMe and EverlyWell begin offering genetic testing and panels for thyroid, hormones, and food sensitivities. These companies send a testing box requiring the consumer to send back blood, saliva, or urine that is then analyzed at the company lab. Although these aren’t in the same category as actual health care at the moment, they are a glimpse into what could be possible in the future, as companies have proven that there is a demand for at-home testing options. They have also paved the way for improved testing by making consumers more comfortable with the idea of having lab work done at home. Currently, telemedicine companies are looking to add lab services to their offerings, for example an at-home test kit for strep throat or UTIs. In the meantime, home health care patients are already benefiting from more sophisticated remote lab testing. For example, LabCorp’s Lab-in-a-Box and Lab-in-an-Envelope offerings allow home health care providers to collect blood samples for a variety of tests at the patient’s home and send to LabCorp via FedEx.

At-home care

There has also been a growing interest in more at-home primary care, especially for patients with severe chronic conditions who have trouble leaving the home. These patients are often the highest users of healthcare services, but their limited mobility makes it difficult to see a doctor regularly. Instead, they often resort to using ambulances and emergency rooms to access care. Because of these factors, this patient group has extremely high rates of hospitalization and hospital readmission. Similarly to telemedicine, primary care house calls for those with chronic conditions could help manage these conditions better and preemptively identify problems sooner, leading to lower rates of hospitalization. It’s a shift towards prevention-based care instead of intervention, and so far, the numbers appear to support this approach. In the Independence at Home Project, 17 practices providing home-based primary care all saw reduced ER visits, hospitalizations, and 30-day readmissions during the five-year project period.5 There are also companies looking to bring urgent-care type services to the home, such as Heal. Their app enables physician house calls for conditions commonly treated at the emergency department or urgent care, such as sprains and ear infections. On another front, Mercy Care and Philips have teamed up for a pilot study with seniors that can provide home health care for urgent care using the Lifeline medical alert system. The program is trying to reduce readmissions and improve patient quality of life. As programs and companies such as these continue to emerge, it seems likely that more and more care will take place at home.

The future potential

It’s exciting to see innovations happening in the medical field, especially in the other sites of care. And as the industry as a whole moves to value-based care and preventive medicine, these fields become increasingly more important to connecting the entire continuum of care. We’ve already seen hospitals building, acquiring, and partnering with ASCs, outpatient facilities, and home health providers, which leads to an interesting question about the future: how can all of these points of care help integrate care for the patient and the providers to improve care? Connecting health at home to the hospital and every other point of care in between is a huge opportunity for consumers and providers alike – it would improve engagement, cost, and outcomes. As patient care continues to move to a broader set of care sites, the need for interoperability will increase, as well – an area where many emerging technologies like operational AI will have an enormous impact. Together, AI and the data provided by home health providers and remote patient monitoring devices could hold the key to unlocking health and wellness insights that will improve care for everyone.