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[TECH] Transforming Home Health Care with AI


    It’s 2021, so it’s no surprise that artificial intelligence (AI) is rapidly growing in the healthcare industry. A recently published survey on home health care revealed meaningful insights into many agencies’ challenges and areas of growth. The 2021 Home Health Care News Outlook Survey and Report showed that one of the top three takeaways was on telehealth and the rise of remote patient technology.

    Specifically, 52% of surveyed home health agencies identified chronic disease management as the top telehealth and remote patient monitoring technology to consider for the coming year, followed by vital signs monitoring at 47%. According to the survey, improving patient outcomes was the top reason for prompting a change in technology, followed by the need to reduce operating costs and payment/reimbursement issues. Following adjusted regulations due to the COVID-19 pandemic, this area is projected to be ripe for growth in the years to come.

    With technology adaptation being in the minds of home health players, AI now has a growing potential to revolutionize home health care. AI is expected to reinforce remote patient monitoring and data analytics by enabling real-time extraction and processing of large amounts of data, which is very useful in improving care quality and creating efficiencies in staffing utilization.


    Potential Roles for AI in Home Health Care

    Virtual health assistance

    AI-powered virtual assistants are available 24/7 to make and receive calls easily to and from a large number of patients to check on their physical well-being and medications, and entertain questions about their care. Patients can also be connected to their physician, other services, or a loved one if they need help. All these areas of aid free up valuable clinical resources. Virtual health assistants can also help patients manage chronic conditions at home or after they’ve been discharged from the hospital. This increases patient engagement and improves self-management skills to prevent chronic situations from getting worse. By removing barriers to care and enhancing communication among patients, their families, and their providers, these virtual assistants can empower people to age in place, improve care, and deliver better outcomes while reducing costs.

    Empower patients to age in place 

    It cannot be denied that there is a huge gap between what healthcare providers know is best for a patient and what patients are able to do about it, especially if they’re homebound. For instance, a diabetic who lives alone several miles from the nearest grocery store and cannot drive wouldn’t be able to practice the ideal diet fit for them. Using home health care software, AI providers can identify which patients have limited to no access to the resources they need to fulfill doctor’s orders, and help them find what they need.

    Remote patient monitoring

    AI-powered devices (e.g. wearables and sensors) that learn patients’ routine over time make it possible to provide patients with reminders and interventions in real-time to prevent and detect health issues before they get worse. The data collected by these devices allow clinicians to see changes in patients’ behavior patterns and activity to identify and prevent potential health problems. For instance, there are sensors that can track a patient’s biometrics 24/7 even while they are sleeping or resting. Abnormalities including a slower heartbeat or an increase in pulse rate or body temperature will automatically send alerts to caregivers for potential issues.

    Vanguards of fraud

    Fraud in home health care is a growing problem. Despite the efforts of CMS, Medicare fee-for-service (FSS) estimated the improper payment rate at 6.27%, which represents $25.74 billion in improper payments in 2020.

    Medicare processes and pays about $4 million FSS claims daily and over $900 million claims annually. Majority of these need immediate medical review before being processed for payment. This is an area where AI could potentially assist, according to CMS.

    CMS is also exploring AI-powered tools to provide help in overseeing value-based payment programs. They have implemented a number of value-based payment programs that have improved quality and managed cost, but also bring new challenges in identifying improper payments, beneficiary safety and quality issues, and other program integrity concerns. Moving forward, as part of its Medicare integrity efforts, CMS will focus on stopping bad actors, preventing fraud, and mitigating emerging programmatic risks.

    Other fraudulent acts include medical identity theft and false claims. Hackers sell data at a high price to buyers who use it to create fake IDs to buy medical equipment or drugs that can be resold, or file made-up claims with insurers. AI and machine learning systems can analyze the vast amounts of data that the healthcare industry generates on a daily basis that even a team of human experts can’t do. They can sort, categorize, and analyze immense quantities of information in a fraction of the time without the possibility of human error. AI systems can comb through years of patient history and related data in seconds, rather than just looking at recent data, which can help find signs of fraud and anomalies that human analysts might overlook.

    Documentation accuracy

    While improper payments do occur in home health, industry leaders point out that they are often not a result of intentional fraud. Many times, these are due to inconsistencies in the documentation.

    While CMS continues to prevent fraud, it also intends to help reduce the burden of providers and the risk of documentation errors by leveraging new technology tools, including artificial intelligence.

    When claims are medically reviewed, or when the patient medical record is looked over to confirm compliance with Medicare FFS documentation rules, CMS sees a five-to-one return on investment when comparing cost to recoveries, the agency noted.


    The Future of Home Health Care with AI

    The transformative power of AI is truly life-changing. Today, AI’s power is being harnessed in homecare settings for documentation accuracy, fraud reduction, as a preventive measure as far as patient health is concerned, and as a powerful data analysis tool. While it is not meant to replace the human touch, it can improve care by making it more efficient, safer, and compassionate with more personalized and effective treatment plans that meet people where they are: at home.

    Can AI replace doctors and healthcare providers in the future? Maybe not. There’s the element of empathy that machines do not possess. After all, they are supposed to enhance people’s lives and should not be seen as enemies or threats. Collaboration between humans and technology is the ultimate response. Imagine the innovation possibilities of home health care if the creativity and problem-solving skills of humans were combined with the infinite data processing and cognitive power of technology. That door of opportunity is already here. We just need to enter and embrace it.

    Read more about the survey here.