Healthcare to the Home

The novel coronavirus pandemic accelerated the rate of adoption of telehealth—the virtual provision of healthcare via computer or mobile phone in the US healthcare system. Telehealth, however, is only a piece of what promises to be one of the biggest trends in US healthcare in the coming quarter century: the return of healthcare to the home. In “Healthcare to the Home: Enabling Distributed Health Service Delivery by Removing Barriers to Entrepreneur­ial Exploration,” Philip E. Auerswald examines how to overcome the regulatory barriers to realizing the benefits from this opportunity.

Home-Based Healthcare—Benefits and Barriers

Home healthcare can include medical house calls in addition to telehealth. Current technology already permits many routine and some nonroutine health services to be provided in the home. This increases access to care, reduces costs (primarily by reducing hospitalizations), and improves quality of life. Exponential technologies for healthcare include the development of artificial intelligence–based clinical decision support tools that will amplify the capabilities of home health and personal care aides.

Significant barriers to returning healthcare to the home remain, mostly in the form of government obstacles that impede entrepreneurs and innovators from making home healthcare a widespread reality in the United States. If Americans are to enjoy the benefits of such care, the barriers to entrepreneurial exploration must be removed—both labor market barriers and barriers to technological innovation.

Removing Regulatory Barriers Affecting the Scope of Practice of Healthcare Workers

• Remove restrictions on nurse practitioners that prevent them from providing the broad range of activities that—with proper physician oversight and technological support—they are capable of providing.
• Develop a new category of certified, digitally empowered health workers who act simultaneously as health coaches, social support case workers, and frontline diagnosticians. This could attract new, tech-savvy talent to the health service field and provide a pathway for formalizing and extending the skills of home health workers.

Removing Regulatory Barriers to Technological Innovation

• Innovators must contend with 50 different state laws related to telehealth licensure, privacy, and other areas. State policymakers should reduce the impediments such laws create for innovators by reducing their complexity and increasing their consistency across jurisdictions.
• Federal and state authorities should reinforce de facto standards for data sharing that emerge among communities of those who collect and use healthcare data.
• Policymakers should renew their commitment to reducing regulatory barriers to the deployment of ubiq­uitous, high-reliability broadband service (on which mobile healthcare provision depends).

Key Takeaway

The century-long experiment of providing healthcare primarily in institutional settings (hospitals and clinics) may have run its course. Significantly increasing the share of health services provided directly to the home has the potential to improve health outcomes, reduce costs, and generate large-scale growth in jobs for less-skilled workers. Doing so may be less about designing and implementing new programs than about removing barriers to entrepre­neurial exploration