Insurance Cos. to Overhaul Home Healthcare Policies?

By Sandhya Mishra

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Dr. Gaurav Thukral decoding the role of home-based care in reducing the overall cost of healthcare in an interview with Sandhya Mishra.

Home healthcare is now no more perceived to be a luxury (as a doorstep service) among common man. In fact, people now want to avail personalized care and get it at the cost cheaper than what they could in a hospital away from home. For ageing and debilitated patients, domiciliary care is a boon. This has fueled the proliferation of home healthcare services sector in India offering almost every service that you can imagine under a hospital roof.

Yet, lack of comprehensive insurance plans to cover domiciliary service is the biggest hindrance, the sector is facing right now. This is mainly because the potentials of home healthcare remain untapped by insurance companies not realizing that it can actually lead to low claim ratios and cost effective treatments. Nevertheless, this is about to encounter a drastic overhaul.

“All over the globe home healthcare is either insurance or state-funded in sharp contrast to India where it’s totally out of pocket expense,” says Dr. Gaurav Thukral, Executive Vice President and Chief Operating Officer at Health Care at Home India Pvt. Ltd.

Dr. Gaurav Thukral, Executive Vice President and Chief Operating Officer at  Health Care at Home  India Pvt. Ltd.

Dr. Gaurav Thukral, Executive Vice President and Chief Operating Officer at Health Care at Home India Pvt. Ltd.

 “In the USA, enrollment of home healthcare agencies is growing at 7 % CAGR year on year. The protocols for care delivery with triggers of escalation and de-escalation are very well defined and monitored by the payor in US, UK, Qatar, parts of Europe, China and Japan. Also across these countries the revenue shares of these home healthcare is 3 - 5 % of total healthcare revenues.

There are innumerable ways by which insurance companies can benefit from home-based healthcare as listed below;

  1. Avoid admissions for availing 24 hours’ cashless claim: Not admitting patients in hospital makes little or no difference to patient outcomes. Ailments like fever, dengue category A and B, gastroenteritis, jaundice can be safely treated at home with well-defined triggers of hospitalization in case of deterioration of condition. This will lead to average cost saving of 10 -20 k per admission

  2. Be an alternative to hospital admission: Most of us are more comfortable in our own home and close to those we love. Recovery is also faster in the environment that promotes patient’s independence and ability to lead a normal daily routine. Dialysis, chemotherapies, adjuvant therapies can replace hospital day care with home day care treatments in a cashless manner with a cost saving of 10 – 15 % per admission

  3. Provide out of hospital care post discharge to avoid re-admissions: Post discharge care to maintain continuity of care to prevent readmissions. This perceived as additional expense today can lead to low readmission rates leading to overall cost reduction. Medicaid in USA has proven that readmissions rates (within 30 days of discharge) in the subset of home healthcare group were 17% vis a vis 25 % without home healthcare. In India, Health Care at Home has readmission rates of 19 %. In an isolated pilot of post Total Knee replacement (TKR) care with an insurance provider Health Care at Home India demonstrated 4 readmissions in 262 cases over a year.

  4. Average length of stay (ALOS) reduction through home healthcare collaboration: With treatment in hospital getting expensive its beneficial to have integrated packages where surgical care is extended with post-operative care at home with extended protocol. eg. post TKR patient generally having a package stay of 7 days can be discharged on post-operative day 3 with two weeks of rehab at home. This will save the cost of stay for 4 days in hospital and still be cost effective by 25k per surgery package

  5. Early step down to home ICU set ups: Prolonged stay in ICU can be substituted by step down ICU facilities at home in managed care setups with remote monitoring by intensivists. This can lead to an average INR 30k saving on a daily basis in a metro city hospital ICU.

  6. Chronic disease management to reduce overall burden of acute care treatment: Out of hospital chronic disease management programs can incentivize people to manage their health, lifestyle, medication compliance and keep them fitter through preventive plans and hence reducing the cost of emergency care. This will applicable to cardio diabetic, COPD and heart failure patients.

In a country where 95 % of homecare industry is unorganised with no regulation in place, self-regulation will pave the way forward. Quality Accreditation Institute (QAI), a member body of International Society for Quality in Health Care (ISQUA) has formulated the standards of home healthcare in India. Such accreditations that sets up minimum quality standards will enable above mentioned models.

Also the electronic health record (EHR), telemedicine and app-based delivery models amalgamated with homecare delivery will lead to transparency and lead to almost nil fraudulent claims encashment for the insurance. Thus, technological add ons will support multi generational goals and clarity among all stakeholders.

The payer should move away from ’pay for activity’ to ’pay for performance’ model which will incentivize the home healthcare to deliver best outcomes with every other patient. Eg: payment should be governed by a threshold of readmission rates or complication rates and people performing better should be paid better. Thus patient engagement or autonomy can make them more accountable for their own health behaviors, increase adherence to physician’s recommendation and ultimately increasing the performance.

Domiciliary care is still being covered in almost all plans with 60 days post hospitalization covering medicine, labs and physio in some cases. The amount relegated here is paltry and not in tune with managed home healthcare delivery. Though, IRDA encourages insurance to run innovative pilots on new products of the likes of home healthcare, many aspects of healthcare remain untouched.”