I rang the doorbell and waited patiently, wondering what my colleague and I would experience on the other side.
When it comes to home visits, clinicians rarely know exactly what we’re walking into. Even I – someone who has only made a handful in my years of practice as a nurse – have walked into apartments where the heat was set low in the dead of winter because a patient had to decide between warmth and food, seen desolate pantries and living room floors cluttered with makeshift beds to make room for extended family.
But on this cold, winter day in Michigan, we were met with a pleasant surprise: a warm welcome from a petite, older woman, her genuine grin stretching from ear to ear.
As we walked into her home, it was immediately evident that our patient was prepared for company. Everything was clean, tidy, and in its rightful place. That sense was confirmed by how frequently she told us she was glad we were there. We checked her blood pressure, drew blood for labs, and talked through how she had been feeling. When we wrapped up our visit, she gave us each a hug and asked when we’d be back.
For this patient, having company mattered as much as the care she needed. Covid shredded the social fabric of older adults’ lives; a visit from a healthcare professional has become a point of connection, a reassurance that the healthcare system is available and accessible.
When healthcare delivery strategies shifted to the home out of necessity during the pandemic, healthcare consumers began to question the value of navigating the old system, one that requires time off work, transportation, childcare, and long waits just to have basic needs met.
People adapted quickly when physician offices closed during Covid, learning to navigate care virtually or from their homes. Years later, that shift has not fully reversed. Preventive services like eye exams still lag behind pre-2020 levels, as older adults continue to limit in-person visits they feel aren’t completely necessary. Medicare members in particular have grown comfortable with virtual care for routine needs, but have also signaled a desire for more support than can be provided over a screen alone without giving up the convenience they’ve come to expect.
For many people, expectations for care delivery have changed. There’s no going back. For health plans, that’s a good thing: the home is not just preferred, but reveals clinical and social realities the system could never catch on its own. The home reveals details you’d never expect to surface in a clinic visit, even if clinicians ask the right questions.
There’s a vulnerability in the home that a clinician can’t get anywhere else – a clear picture of all the little details that impact health. When you see the conditions a person lives in, you understand why they might not be following their care plan, why they frequent the ER, or why they miss appointments. Many of the people we label as “disengaged” without a second thought are, in reality, making compromises no person should ever have to make – tradeoffs that quality metrics don’t account for.
In this business, it is never safe to assume anything about the people we treat. In-home clinicians and care staff are often met at the front door with frustration, with embarrassment, but more often than not, with relief. People want to be cared for by the healthcare system. They want to be listened to, and they want the person treating them to take action.
So much becomes visible when care moves out of the clinic and into the spaces where people live their lives. That’s the place healthcare should be starting. From there, connections to case management and community resources can follow, often before small gaps become medical crises.
The value of the home as a healthcare setting has not diminished for health plans or members. For plans, access to care enabled by the home drives engagement, engagement improves adherence, and adherence shapes outcomes and downstream costs. When people cannot realistically be expected to go to the system, the system absorbs the consequences – avoidable hospitalizations, acute events, exacerbated chronic disease.
And for people, they’ve now seen another way is possible. They know care can be modified to fit into their busy lives instead of requiring them to rearrange everything else around it.
The question facing the industry is whether care delivery will continue to evolve around how people actually live, or whether it will revert to expecting patients to adapt to the way things used to be.
Photo: selimaksan, Getty Images
Jane Flaherty is a seasoned healthcare executive and registered nurse with deep expertise in managed care strategy, quality improvement, and innovative care delivery models. She currently serves as Head of Managed Care at Sprinter Health, a company reinventing in-home, hybrid care experiences to better meet patients where they are and improve access to quality healthcare for disengaged members. In this role, Jane works with health plan partners to launch programs that send Sprinter’s fully-employed phlebotomists and nurses directly to patients’ homes to close gaps in care, targeting the millions of members who fail to engage in preventive services each year.
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