The home is the next great frontier in care and healthcare. Home-based care innovation, ranging from preventative health to acute care, is booming. Some drivers include a tightening of healthcare facilities’ budget to expand infrastructure, resulting in providers pushing the experience to the home, to patient’s preferences to being treated in the comfort of their own home. A 2022 McKinsey survey estimates that up to $265B worth of care currently delivered in traditional facilities for Medicare FFS and MA beneficiaries could shift to the home, representing a 3 - 4x increase in the current spend at home.

Importantly, this movement of home care comes with additional work and expectations on the informal caregiver to provide and care for the patient. Informal caregivers will need training and support if they are to pick up where the formal healthcare sector leaves off in this new hybrid healthcare climate.

Where and how consumers get their healthcare is being reimagined, not just because of technological advancement, but also because of unlikely collaborations. Amazon bought Pillpack and acquired One Medical. CVS purchased Oak Street Health. Humana acquired Kindred at Home. Apple is cozying up to insurers around the Apple Watch. And a sea of other activity.

When you look across the landscape, two key patterns emerge: non-care companies buying trusted care entry points (as is the case with Amazon and Pillpack/One Medical) or existing care companies deepening their relationship in the health ecosystem (as is the case with much of the retail pharmacy companies). Winning combinations and experiences still feel up for grabs, as is the role of the home as an anchor of these new experiences.

According to Rock Health’s 2022 Survey, telemedicine has hit the 80% adoption mark overall, becoming the preferred channel for prescription care and minor illness.¹ What’s even more encouraging is that the survey reports notable adoption increases among groups that have long been underserved by the healthcare system - from older adults aged 55+, rural areas, women, Hispanics, and the uninsured. 

However, the long-term adoption of telemedicine will be determined by policy changes, and while some of the flexibilities have been made permanent, some are still temporary through December 31, 2024, including key provisions such as Medicare patients being able to receive telehealth services in their home. 

Before 2019, Medicare Advantage plans offering supplemental benefits were limited by a narrow definition of what counted as primarily health related. A reinterpretation of the rules by CMS has opened up a wider range of care related benefit options in Medicare Advantage plans.These changes acknowledge the importance of delivering both medical and non-medical services to enhance health outcomes and address the needs of Medicare beneficiaries. Notably, recent developments have allowed MA plans to offer tailored benefits that cater to specific diseases and conditions, including non-medical services such as transportation and meal delivery. 

One example is the recent announcement of a new payment program for dementia care coordination services within the Medicare health plan called the Guiding an Improved Dementia Experience (GUIDE) Model. The program includes personalized assessments, care plans, and round-the-clock support for patients, all aimed at delaying the need for long-term nursing home care. The pilot program will test a per-patient per-month amount payment model for people who provide support services to patients with dementia. These improvements to Medicare come at a crucial time, providing valuable support for both patients and caregivers.

The pharmaceutical and biotechnology industry play critical roles in care. Advancements in drug development, diagnostics, medication, and procedures can have significant impact on a caregiver’s responsibility. 

An example of this would be in Alzheimer’s disease, where in Jan 2023, the FDA accelerated an approval for a drug, Lecanemab, shown in clinical trials to slow
cognitive decline in patients in the early stages of the disease. The impact on caregivers could be significant, as it means more adjustment time and fewer caregiving needs as symptoms would be slowed down.

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With the proliferation of data in the home, major questions have come up around privacy, data protection, sharing and ownership. Consumers seem to have general awareness and understanding of the cost and consequence of sharing their financial data, but this doesn’t necessarily translate to their way of thinking about sharing health and home data or monitoring how their children are using devices. According to a Global Consumer Insights Survey released by PWC earlier this year, when asked about their level of concern regarding personal data privacy, 32 percent of respondents said they are extremely or very concerned when engaging with consumer companies. Simultaneously, according to that same survey, 82 percent of respondents said they would be willing to share some kind of personal data in exchange for a better customer experience. This dichotomy highlights that consumer-facing companies, such as those in household management, have to actively protect consumer data while providing value with the data consumers do share.

Consumer wearable technology has long held a promise of changing the nature of monitoring and assessment when it comes to  health behaviors. While adoption has grown, ownership disparities persist among consumer communities that leaves out those who could benefit most from medical care management. Moreover, most wearables are purchased directly by consumers rather than being integrated into healthcare programs, limiting their use in managing medical conditions effectively. Other barriers include limited reimbursement pathways, challenges with EHR integration, and data overwhelm which impedes healthcare providers from encouraging wider adoption. 

To overcome these challenges, partnerships between wearable manufacturers and healthcare providers, employers, payers, and clinical trial sponsors are crucial. Further, demonstrating the value of wearables in clinical applications is essential. Progress has been made, with some wearable makers identifying digital biomarkers for screening premature birth and monitoring Parkinson's symptoms. By bridging the gap between wearable technology and healthcare, care delivery can be revolutionized.

Medicare has been shifting from a government program to a public benefit provided through private companies, brought about by Medicare Advantage. This shift has significant implications for patients and payers. A Kaiser Family Foundation analysis found that insurers were making more money per patient in Medicare Advantage than with their individual or employer-sponsored plans. Furthermore, in November 2022, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans. 

In another report by the NYTimes, it was found that the Medicare Advantage plans overbilled Medicare between $12B and $25B in 2020. While it’s popularity has grown significantly in recent years, the vision of curbing spending in healthcare has fallen to private plans taking advantage of a public program and exacerbating a care crisis.

The impact of rising inflation is being felt across our economic system. In healthcare, inflation has created significant pressure on costs and is being felt by employers and providers of care especially in terms of profitability. In order to preserve bottom lines, providers have pushed the burden of costs to employers who, in turn, have pushed increasing premiums down to consumers, forcing care-related consequences and trade-offs. Employees are selecting plans with higher deductibles and therefore deferring a lot of care to consumers - which then becomes a care crisis. E.g., deferring diabetes treatment and then ending up being a caregiver challenge later on. 

Rural America is facing especially dire circumstances, with a  recent survey by The Commonwealth Fund’s 2020 International Health Policy group reporting that 36 percent of rural Americans did not get the care they needed due to costs and 25 percent of rural Americans reported serious problems with being able to pay their medical bills or not being able to pay them at all.