Personalized Medicine: There’s Nothing More Personal Than In-Home Care

“Personalized medicine” has become something of a buzzword, with many different meanings. However, the overriding goal is the same whether referring to targeted medicines or caring for a patient’s general health: Avoid one-size-fits-all solutions by tailoring patients’ care to address their individual traits, needs and health goals.

For many physicians, the systems we work within can make that aspiration extremely challenging to put into practice. The limited time primary care physicians have with patients during a typical office visit is rarely enough to obtain a clear picture of the many factors impacting a patient’s health and provides a very narrow window into the life that person actually leads. The opportunity to understand the reality of a patient’s circumstances is even more restricted in the emergency department and in-hospital settings. In the ED, we’re focused on getting the patients in and out as quickly as possible, while admitted patients are often so depersonalized, they’re known primarily by their room number or diagnosis.

These structural barriers prevent health practitioners from learning about important aspects of our patients’ lives, leaving many of us frustrated and feeling we’re doing little to fix the underlying issues causing their health problems—which means we’re also doing little to stem their recurring visits to the ED. At the same time, patients feel unseen and lack the necessary information to care for themselves once home, often leading to costly overuse of the healthcare system. I can’t count how many times I have seen a patient present to the ER because they were confused about their medication list or unable to refill their prescription.

Back to Our Medical Roots with In-Home Healthcare

There is a more personalized and equally effective way to care for patients: It’s in their home.

In-home healthcare is not only preferred by patients, it also allows clinicians a much fuller understanding of a patient’s life and health circumstances, enabling us to provide more individualized, continuous care.

As health practitioners, we know well the limitations of medical treatment. Clinical care accounts for just 20% of health outcomes, while 80% are attributable to social determinants of health (SDOH). There’s no better way to identify the environmental and lifestyle factors impacting health, as well as the support systems available to a patient, than seeing someone in their home environment. The intimacy of a home setting is also more conducive for building a strong relationship with a patient, promoting conversations that help us know more about the person, understanding their health challenges, and better educating patients and caregivers about their condition and treatment.

The pandemic helped accelerate interest and acceptance of in-home care. At Humana, we are working to make it a first-line option for patients for the long term, expanding access to a wide range of at-home services including primary, emergency and hospital care. 

In partnership with DispatchHealth, we doubled the number of ER home visits treating low and moderate acuity cases from 2019-2020, lowering the cost of emergency care by up to 80% compared to a facility setting. Based on our successes with ER home visits, we will be expanding into Hospital at Home care this year. We have also seen a 25% reduction in ER visits among patients who engaged Humana at Home behavioral specialists compared with a matched population. And through our home services, Humana has made over 86,000 referrals to address SDOH and clinical gaps in care so far this year.

There was a good reason why doctors once made house calls. Care at home is truly personalized medicine.

Amal Agarwal, D.O., MBA, is Vice President, Home Solutions Business Development and Strategy at Humana, and a board-certified emergency room physician. He serves as clinical faculty–gratis at the University of Louisville and continues to practice emergency medicine at the Louisville Veterans Affairs Medical Center. He also advises several healthcare start-ups.