How Physician-Led, In-Home Care Can Save Lives During the Pandemic and Beyond

August 13, 2020

Dr. Karen Vloedman shares her learnings that will help inform best practices to assist payers and provider groups when preparing for and navigating the CoVID-19 pandemic.

COVID-19 has overwhelmed our healthcare delivery systems and created new risks for millions of vulnerable Americans struggling with diseases and conditions that need to be closely cared for and monitored. With many providers temporarily closing their practices or moving to telehealth, these high-risk patients have lost critical in-person access to medical professionals.

The pandemic is not disappearing anytime soon, and that’s why we must be agile and use every tool at our disposal to adapt healthcare delivery in our country. An important tool is in-home physician-led care.

During this crisis, it has emerged as an essential service to help keep those at the highest risk safely at home and out of the emergency room (ER). At PopHealthCare, this is the backbone of our business – so when COVID-19 hit, we were already set-up to continue caring for our members at home. We work with health insurers and primary care physicians to provide high-quality healthcare in the home, while lowering overall payer costs by monitoring patients and identifying health events early on to avoid unnecessary trips to the ER.

As senior medical director, I oversee the development and execution of our pandemic preparedness plan to ensure business continuity while also keeping the health and safety of our providers and patients paramount. With cases on the rise in most of the U.S., it’s important for healthcare providers, payers, and in-home healthcare services to have a pandemic preparedness plan and train and educate teams to ensure everyone is safe.

Here are learnings that will help inform best practices to help payers and provider groups prepare for and navigate the CoVID-19 pandemic:

Focus work locally: Work with local health officials and providers to ensure you adhere to all requirements. We are all learning about the virus together, and health regulations may change week to week. Confirm you have good lines of communication with local health officials and are always on top of new information. Cultivating these relationships with local health and governmental officials, ensuring access to all current data and regulations to help make informed decisions and change protocols as needed is a game changer.

Train your staff: Ensure that your staff are educated and experienced in how to take on, use, and take off personal protective equipment (PPE) properly, to avoid contamination.

Prepare your staff on how to enter a patient’s home, speak with them, and explain to them why these precautions are necessary. Review how they not only keep them safe, but also keep the provider and subsequent patients safe. Seeing someone enter your home in full PPE can be traumatizing, ensuring there is communication between the provider and the patient is key.

Putting this into practice can be difficult - providers should undergo extensive video training on PPE requirements, practice with fellow providers, and continue to receive refresher trainings.

Think outside the healthcare box: High-risk patients may be homebound, or lack the ability to get essentials during a pandemic. Institute a community health network to ensure patients continue to receive medications, food and necessities.

Community health workers are integral to keeping our members safe at home, by providing key services and addressing social determinants of health. Countless times during the pandemic, these workers have brought groceries and medications to members’ homes who were unable to get these necessities themselves.

Communication is key: Quarantining alone, or even with a loved one, can be an isolating experience. Make sure you call patients regularly especially if your team is no longer seeing them in person and maintain monitoring via telehealth when necessary. Ensure that patients know the signs and symptoms of any conditions that may impact them due to their health so they can contact a provider to receive medical assistance immediately.

A perfect example of the importance of education and communication with patients is from one of our providers in the Baltimore area who did a in home, post-operative visit with a member who had just had a knee replacement. During the assessment, the provider educated the member regarding signs and symptoms of Deep Vein Thrombosis (DVT)& Pulmonary Embolism (PE). The next week the member began having symptoms and called their PopHealthcare team. The provider ordered appropriate diagnostic testing which revealed an acute DVT. The provider prescribed appropriate medication, arranged a follow-up visit and was in contact with the member’s surgeon and primary care physician (PCP). The member is recovering and avoided a possibly life-threatening health emergency, and a needless and expensive trip to the ER and prevented a post-operative patient from potential exposure to CoVID-19.

Be flexible: As states are beginning to reopen and close again, work with localities and business partners on how your company can pivot to get more providers back into the field safely and continue to serve your patients from the safety of their homes, while also being prepared to seamlessly revert back into pandemic mode if and when scenarios change.

Institute daily conference calls to review state and federal data, health requirements, and regulations. Develop a reopening plan for each market you work in that is based on statistics and sound medical ethics, that is also equipped with flexibility as states pause and rollback their reopenings.

In-home-based, physician-led, healthcare will continue to play a critical role in managing high risk patients during the pandemic. With the right preparation and training, specialized in-home care for high risk populations can help to transform healthcare delivery for our most vulnerable patient populations.

Dr. Karen Vloedman is senior medical director of PopHealthCare.