September 7, 2022

The earth continues to turn as it has for uncounted eons.  Except for a microsecond here or there, our planet spins at essentially the same rate each day with precision and predictability.  But, while Earth is unchanging in its rotational cadence, the world of human endeavor and experience is in constant flux.  It seems as if we are always encountering change—change in the way we dress, in the devices we use, in the way we communicate and in our business methodologies.  We reside in a reality of continual change.  Part of that change is happening within healthcare.

We have seen a lot of transition over the last decade within the healthcare delivery space.  We’ve seen a boon in the building of ambulatory surgery centers (ASCs); urgent care centers have become ubiquitous; and telemedicine has taken off like a rocket in usage and popularity.  These changes are but a harbinger of the next big transition in medicine: a delivery model called “distributed care” (DC).

Definition and Description

Distributed care begins with the idea of decentralized medicine.  That means patients no longer being directed to hospitals; rather, care is brought closer to home.  This is done through a network of ambulatory clinics, including those increasingly located in retail settings (such as Wal-Mart), as well as home-based monitoring and treatment.  Here’s how one expert defined DC:

Distributed healthcare is the concept of providing decentralised care services, like monitoring vital signs and diagnostic tests, and moving these services closer to the person in need. This way a healthcare system can help to keep people healthy, and in their own homes, by providing the right care and support at the right time.

That may seem a little nebulous and nondescript.  However, as you dig deeper into articles that deal with this new delivery concept, it becomes clear that what many healthcare leaders are getting at in their descriptions of DC is the transitioning of certain types of care away from the costly hospital setting and providing it at lower-cost settings—if possible, the patient’s own home. 

The Past is Prologue

At the turn of the 20th century, most healthcare was still being delivered in the home.  With the advent of modern medicine, that paradigm shifted to clinics and hospitals.  What DC is attempting to do is bring us back to those days of old where care is delivered physically or virtually to the patient’s neighborhood or even residence—where, let’s face it, there is no major facility cost.  Obviously, not all care can be so delivered.  Hospitals and ASCs will still have their place and still be necessary for certain procedures, including surgeries, but so many preemptive healthcare measures can be accomplished in other settings that are more cost-effective.  While we may not be going back to the horse-and-buggy days, a doctor with a black bag showing up at your door may not be out of the question.  Of course, we’re more than likely talking about your digital door.

During the recent COVID emergency, one Australian health system developed a virtual patient engagement program, which makes use of home-based medical devices to collect patient-reported outcome data and biometric indicators, including blood pressure and oxygen levels.  Outcomes were reviewed in real time to proactively engage patients with personalized health coaching.  Early results showed a 28 percent reduction of potentially preventable hospitalizations in chronically ill patients. This may be a sign of things to come.

Why Transition is Needed

According to a new study conducted by medical device innovation leader Philips, healthcare leaders now view extending care delivery beyond the hospital as their highest priority after staff satisfaction and retention.  Health systems worldwide are facing increasing financial pressures, due to rising costs, among other factors.  According to Philips, “There’s a growing awareness that, in order for healthcare to remain affordable and sustainable, it needs to move into lower-cost settings whenever possible to address people’s health issues at a much earlier stage and ideally prevent them.”  That is the essence of DC.  That is the raison d’être of DC.

The study shows that hospitals are not sufficiently positioned to keep pace with rising demand, especially as the levels of diabetes, heart disease, cancer and other chronic conditions continue to rise.  Physician and nurse shortages contribute to the problem now faced by a growing number of facilities.  These factors are causing healthcare leaders to ask how they can divert care away from labor-intensive hospitals to more labor-efficient home and community settings.  Patients, also, are wanting better care experiences that involve less intrusion upon their time.  Indeed, it has been determined that 60 percent of patients find virtual care more convenient than in-person care.  So, a more localized and remote care model is becoming the expectation of the consumer.  All this factors into one of the key findings of the Philips study: 40 percent of hospitals are expecting to shift about 20 percent of their cases to patients’ homes by 2025.

The New Look of Care

The study’s authors believe that distributed care will manifest is four separate pathways.  They are as follows: virtual, mobile, walk-in and “new hospital.  Virtual care is envisioned as primarily home care using telehealth and real-time monitoring.  Mobile care is a concept that has medical providers coming to the patient, such as in underserved areas.  With the advent of clinics at stores, as well as the traditional doctor’s office and urgent care center, the walk-in model will continue to be popular with patients.  The new hospital care bucket contains patients seeking care in the hospital setting where specialized treatment is required.

As healthcare becomes increasingly distributed, hospitals will continue to play a critical role, though it will be more specialized.  Most hospitals will focus on delivering a narrower set of services, while simultaneously taking a more prominent role in managing population health in the community and at home.  As a Philips representative puts it, “Hospitals without walls will emerge, serving both as a central physical hub and as an orchestrator of a wider ecosystem of care.”

You can access the study here: Philips Future Health Index report.  To learn more about our services, please contact us at info@miramedgs.com.