What’s the ‘optimal reimbursement’?

There's a new consensus around the importance of home care, but will payments for technologies that help make it happen, like telehealth, follow?
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Tuesday, November 24, 2020

HARTFORD, Conn. – Seventy-two percent of consumers say they prefer to recover at home, and 97% of payers say home-based care is in the best interest of consumers and payers, according to a new report, “Health-at-Home 2020: The New Standard of Care Delivery,” published by CareCentrix.

The slow-moving health care industry is finally catching up, says Dr. Jasen Gundersen, chief medical officer for CareCentrix, leveraging telehealth in a big way to increase care in the home. 

“The use of telehealth has been around for a long time but a lot of regulatory and payment barriers prevented widespread adoption,” he said. “COVID just gave us an urgency.” 

Gundersen spoke with HME News recently about the ways in which COVID-19 will continue to accelerate the shift to the home. 

HME News: Many providers, including HME, are in the home already. How does that improve the patient experience? 

Dr. Jasen Gundersen: Those providers that are already working in the home understand the nuances—you are in someone’s home —and how to work in those environments. You get (information) that you can’t gather in an office. Seeing someone doing physical therapy and walking around their home rather than in a controlled environment—they are able to respond (to that). We are seeing more and more evidence on how much of a factor social determinants play.  

HME: What barriers to home-based care still exist? 

Gundersen: General knowledge of what can be done in the home and how safely it can be done. I think people have viewed the hospital and facilities as where they go and need things done. Now, patients have knowledge of what can get done, and by making sure they are asking (for it), we continue to advance the technology and payment reforms to support those. 

HME: Is reimbursement catching up? 

Gundersen: It’s in development across the board. If you look at the payer side, 95% of payers say it’s more cost-effective than treatment in long-term care facilities. COVID quickly moved that. How we land on that longer term—we need to see it play out over the next few years to figure out what is the optimal reimbursement.