Care Without an Address: A New Paradigm in Healthcare

As global populations age and technology advances, the demand for home- and community-based care is rising. 

Dedicated to shaping healthcare’s future, the Future of Health (FOH) Community, a proactive forum of senior leaders from the world’s premier health organizations, which was co-founded by Sheba, has recently partnered with the Duke-Margolis Center for Health Policy to explore the “Care Without an Address” model, aimed at providing patient-centric care regardless of location.

An article published in the prestigious New England Journal of Medicine Catalyst, with contributions from several leading experts, including Sheba’s Chief Transformation and Innovation Officer, Prof. Eyal Zimlichman, delves into the resulting recommendations and the challenges involved with the implementation of such a model. 

While the COVID-19 pandemic acted as a catalyst, contributing to a surge in telehealth that made home-based acute care become more common, challenges persist. 

Nevertheless, several factors accelerate the shift towards home care, including patient preference for home-based care, technological advancements enabling remote care, and a potential reduction in health expenditure.

The Future of Healthcare

In the current shifting landscape, traditional healthcare organizations must prepare for a future that might not necessarily be hospital-centric. Whether traditional institutions or innovative newcomers will streamline this change remains a subject of debate, and therefore, clear recommendations are necessary. 

Accordingly, FOH teams have identified four key steps that healthcare executives and policymakers need to prioritize as part of this paradigm shift: 

1. Establishing partnerships with external innovators
   Healthcare organizations currently face a pivotal role in relation to external innovators. Traditional institutions might view these innovators as threats due to their flexibility and detachment from conventional models. However, such an approach would be shortsighted. Established healthcare organizations often lack the infrastructure for out-of-clinic care, while innovators bring unique capabilities, enabling growth and flexibility. One example is Sheba’s rapid pandemic response, which included the launch of Beyond, a virtual, home-based hospital, made possible through partnerships with tech developers like TytoCare. To navigate this paradigm shift, organizations are recommended to pursue innovation partnerships that prioritize patient outcomes irrespective of care setting.
2. Training workers in new care delivery methodologies
   For a successful implementation of “Care Without an Address,” healthcare organizations must prioritize building a versatile healthcare workforce. This involves training multidisciplinary teams, applying technology efficiently, and ensuring that the future workforce is adaptable and diverse. Using non-clinical personnel, such as community health workers, can also enhance care efficiency. Additionally, it’s essential for the workforce to offer culturally competent care, understanding the unique needs of diverse communities. Education plays a pivotal role, for example, by integrating a home-care-focused curriculum in medical training and standardizing community-based certification programs, which can also assist in delivering on-site models of care.
3. Establishing location-independent high-quality care standards
   Healthcare organizations must build a strong foundation for “Care Without an Address,” with current gaps in standardized protocols potentially risking patient safety. On their part, policymakers must prioritize patient-centric quality measures reflecting the shift from brick-and-mortar to home-based care. These standards should encompass patient values, preferences, safety, risk mitigation, and health equity. 

Care Without an Address Challenges

Despite these recommendations, several challenges stand in the way of reaching the full potential of the ‘Care Without an Address’ model. These include financial pressures, such as high labor expenses, supply chain issues, and decreased revenue. An additional hurdle is the adoption of value-based payment models, an alternative to the current fee-for-service model- a shift that might not be well received. A further concern is social inequalities. Although the ‘Care Without an Address’ model aims to increase access to care, moving care to home settings can also worsen disparities, as not all households can afford the necessary equipment.

Overall, the transition to a ‘Care Without an Address’ model is both necessary and inevitable, driven by pressing societal and technological changes. However, ensuring that this transition is inclusive, efficient, and patient-centric will require collaboration, innovation, and a re-evaluation of traditional healthcare paradigms.

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