Why It’s Time for In-Home Care to Catch Up to the Value-Based Care Movement

From primary care to hospital systems, many sectors have embraced the transition to value-based care (VBC), showing improvements in health care costs, patient satisfaction and outcomes. Yet one critical segment has been slower to adapt: in-home care.

Despite playing an increasingly central role in care delivery – particularly for aging populations and individuals managing chronic conditions – in-home care has largely remained tied to traditional fee-for-service models. 

In-home care sits at the intersection of clinical need and patient preference. It offers a unique window into a person’s daily environment, making it an ideal setting for proactive, personalized and preventive care, which are all hallmarks of successful VBC models. In turn, when in-home care is approached with a focus on coordination, data-informed decision-making and clinical best practices, it works toward improving patient outcomes and experiences while reducing healthcare costs.  

So, why the lag in adoption? 

Part of the answer lies in structural challenges. The home health sector is highly fragmented, with many agencies lacking the scale or infrastructure to invest in the tools required for population health management. Further, current billing and claims processing platforms are entrenched around FFS payment models, making it a challenge for innovative providers to manage the revenue cycle for more advanced payment models. Things like predictive analytics, clinical integration platforms and comprehensive care coordination are still in their infancies for many home health providers.

At the same time, regulatory rules and payment systems have also contributed to the lag. While Medicare Advantage and some newer payment models are encouraging innovation, most in-home providers are still reimbursed through the traditional fee-for-service system, which rewards volume over outcomes.

It makes sense that without stronger financial incentives to focus on long-term results, individuals are less motivated to invest in value-based approaches.

A path forward

To realize the full potential of in-home care in a value-based world, a few key shifts must happen. 

We must first recognize in-home care as an integral part of our health care system, especially as demographics shift and more patients prefer to age in place. There also must be a broader adoption of shared accountability models between payers and provider networks, designed to encourage investment in long-term outcomes.

Within the in-home space and more broadly across the healthcare ecosystem, we also need more seamless information sharing and stronger collaboration. In-home providers, physicians, hospital systems and health plans are all working towards the same goal, yet communication barriers create bottlenecks, ultimately hindering the delivery of timely, appropriate care. 

The move toward value-based care is inevitable and in-home care must not be left behind. However, this will require intentional design, collaboration across the ecosystem, and a commitment to outcomes over volume.

Community nurse using a digital tablet to record details of senior patient

Photo: Alistair Berg, Getty Images

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