Ten years ago, as a senior leader and client partner at a healthcare advisory firm, I was first exposed to the potential for home-centered care for oncology patients. It was immediately, viscerally and emotionally clear that treatment at home was a far superior experience for the patient and for family members. And in many cases, associated costs could be far lower than clinic-based care.
So, my question, as a physician and as someone who has experience of family members with cancer, was “Why don’t we do this routinely?”
My team and I did our homework, and we learned, first, that home-based treatment is and has been done routinely in other parts of the world. In Australia, the UK, France, and other countries, oncologists and their care teams have been treating some patients at home for years.
The evidence from those countries’ experiences has been and continues to be impressive. The value equation is extremely high. In trial after trial, quality and treatment safety are shown to be equal to clinic-based care. At the same time, these trials show significant safety increases due to avoidance of hospital-acquired infections as well as sustained cost savings both on per-treatment delivery and—more impressively—on read missions to emergency departments and hospitals.
However, we also learned that in the United States, there were a number of daunting barriers. Oncologists and their professional organizations did not yet trust that home-centered care was safe enough for their patients. And the economics of US healthcare and the existing fee-for-service payment contracts would have required providers to take unsustainable hits to their margins if they transferred the site of care to the home.
By 2020, when Devin Carty and I founded Reimagine Care, these headwinds were beginning to break.
The rise of new infusion technology as well as oral chemo- and immune-therapies had reduced the complexity of in-home treatment. The rise of value-based contracting and accountable care meant that payers, providers and employers were far more open to new ways of thinking about sites of care. And ultimately that year, the nation’s experience with Covid and telemedicine proved that innovation was possible in where and how we deliver care of all kinds.
Across the US, recent trials and pilots have proven that the same value equation for home-base care that we’ve seen internationally can exist in the US. Pilots at the University of Utah’s Huntsman Institute and Penn Medicine have demonstrated safe, effective care alongside dramatic reductions in hospitalizations and emergency room visits.
The experience is better. The evidence is here. The time is now.
