We're Late to the Party and Don't Even Know It: An Immediate Fix for America’s Ailing Healthcare Delivery System

In the United States, we spend significantly more of our GDP on healthcare than our peer nations. Yet, we rank at the bottom when comparing the quality and efficiency of healthcare delivery in our country – we all can agree that this is a problem that must be addressed. And it could be partially to blame for why one in five healthcare workers are walking away from the profession. One silver lining of the COVID-19 pandemic has been the added visibility given to alternative methods of healthcare delivery and sites of care. By reconsidering how we deliver care, namely the superior efficacy of care in the home, we are finally on the cusp of transforming the stifling cost of medicine in our country, while addressing our nation's overall health and well-being. 

In Washington state, the epicenter of the U.S. coronavirus outbreak, the state's largest community-based non-profit health system MultiCare, partnered with DispatchHealth to address COVID-19 related surges in hospital capacity and fear-based deferral of health care. We worked collaboratively to meet the changing needs of the community by launching two pivotal programs, Hospital at Home and Clinic Without Walls. Two different Hospital at Home models launched: one under the CMS Waiver Program where patients were admitted from the hospital ER and one through DispatchHealth’s "Advanced Care" offering where patients were admitted through Dispatch’s on-demand, in-home mobile ER services. Clinic Without Walls addressed patients deferring treatment out of fear or inability to leave home by bringing the care to them. These patients were typically inappropriate for a simple video visit due to memory impairment or the complexity of their medical conditions. Leveraging technology and an enhanced video visit facilitated by an in-person, highly trained medical technician, the strategy allowed providers to remotely complete a more complex exam on those patients with chronic disease and comorbidities without the patient ever leaving home. An early snapshot of data revealed unprecedented patient satisfaction in both programs with an NPS score of +98. The partnership enabled MultiCare, a health system with more than a centuries-long legacy of excellence, to quickly right-size its care model while still focusing on a superior patient experience and the high-quality care its community expects.  

In the United States, our healthcare system spends an unsustainable four trillion dollars (17% GDP). Research and experience back an estimation that 60% of patients in the emergency room setting, 25% of inpatient admissions and 20% of skilled nursing facility stays, roughly $340 billion of our annual spend, qualify for substitutive care in the home, where costs are 20% to 40% lower on average. Imagine the ability to use those dollars for issues like homelessness, hunger, and education.  

To say the COVID-19 pandemic sparked a boom in complex home-based healthcare is like calling the musician who has worked years at mastering their craft an overnight success –DispatchHealth has been perfecting the practice of high acuity healthcare in the home for almost a decade and that work was built on the shoulders of maverick clinician-pioneers who came before DispatchHealth. And globally, we're late to this party! For example, every metropolitan and regional hospital in Victoria, Australia, has a hospital at home program. What the pandemic has done is raise broader awareness of care outside the four walls, as well as the inequity of care for some of our homebound and access-challenged populations. We've witnessed hundreds of thousands of patients use telemedicine for the first time or have their first house call in the case of DispatchHealth. ER utilization hasn't rebounded to pre-COVID levels. I suspect that those patients got a taste of a more convenient personalized care solution that costs a lot less.  

For executive leaders managing health systems, meeting the changing demands of patients is time sensitive. The value of partnering to scale complimentary service lines that enable fewer avoidable emergency room visits, hospital admissions, or stays at skilled nursing facilities using an evolved hospital-like setting without walls. This enhanced approach to care empowers clinicians to go beyond traditional clinical treatment settings and meet patients where they are, with the type of convenient care they are growing to expect.