Payers Urged to Lead Home-Based Healthcare Shift Amid Rising Potential

As healthcare evolves, home-based care is positioned as a cost-effective and patient-friendly alternative to traditional facility-based services. Despite the technology available to support sophisticated solutions like hospital-at-home and virtual consultations, adoption has slowed post-pandemic due to reimbursement

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challenges, unclear policies, and cultural resistance. Seniors, for instance, often prefer in-person visits, while providers hesitate to offer lower-priced virtual services. Industry experts believe payers have a crucial role in reshaping this landscape through innovative network design, consumer engagement, and benefit structuring.

To fully realize the potential of home-based healthcare, payers must integrate diverse services such as virtual monitoring, in-home infusions, and house calls, ensuring coordinated, value-driven delivery for specific member segments. This requires internal collaboration across silos and strategic partnerships with providers. Additionally, members need greater awareness of in-home options, which could drive demand. With an estimated $300 billion annually that could be shifted toward home-based care, payers, especially those with provider-owned models, are uniquely positioned to capitalize on emerging technologies while improving patient experiences and maintaining clinical quality.

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