McKinsey on Home Health Care

The need for home health care is growing rapidly as the population ages and there is a desire to keep people out of expensive facility-based care.  A McKinsey Quarterly article discusses the role of technology in home health care.   (McKinsey Article) About $70 billion is spent annually on home health care in the US, but almost two-thirds of that is for labor and only a small amount is spent for monitoring and other technologies.   For home health care to truly be a replacement for nursing homes, hospitals and assisted living facilities, the pace of development and adoption of technology needs to accelerate.

With the growth of chronic illness in the older population, increasingly patients’ needs meet three criteria set out by McKinsey for appropriateness for technology-enabled home care.  These are that the disease is chronic, that it can be treated by nonphysicians following repeatable and standardized protocols and it is nonintensive–it does not require round the clock human attention and monitoring.  Diabetes, hypertension, CHF, COPD and fracture prevention are high-prevalence diseases that meet these criteria.

McKinsey identifies eight factors in three categories that ensure likely success of home health care technology, including financial factors such as alignment between payers and providers and a clear return on investment and use for both patients and payers; effectiveness factors like having a strong clinical effect, creating actionable data that is delivered in a timely fashion to the patient or a provider and that provides feedback against treatment goals; and accessibility factors such as being easy to use when and where the patient needs the technology and being able to be used repeatedly.

Misalignment in payment incentives is flagged as potentially the largest barrier to greater technology use in home care.  More evidence on the quality and cost effects of the technologies is needed to spur adoption and encourage payers to reimburse for their use.  As the authors point out, in addition to the potential quality of care and cost saving dimensions of greater use of home health care, there is the social and individual benefit of allowing people to live in their own homes as long as possible, with greater dignity and freedom.