For the patient, multiple outreach mechanisms are needed along with assigned care managers. To really activate patients to take a more direct approach to levels of self-management, home health solutions matched to those needs and individual conditions are a growing core approach.
Home health is taking on many forms, with each approach offering connected data to the provider and care team. This is also how care management can scale.
Remote monitoring, telehealth and in-home medication adherence are emerging examples we are also integrating into health systems. Technology that can scale in the office must also scale in the home or at other delivery sites, and make data available.
If you’re watching the policy/incentive trends, you know that patient-generated health data, application programming interfaces and third-party apps are moving toward mandatory capabilities within CMS ambulatory and hospital rules, and within ONC interoperability roadmaps and its impending data blocking rule. At the same time, Apple is integrating EHR data into consumer devices, and hospitals are being told to find ways to make EHR data available to patients upon discharge.
Offer financial incentives to all assigned beneficiaries who undergo qualifying primary care services.