Out Of Hospital Care: An Emerging Opportunity

Home has always been integral to human lives, but the Covid pandemic put the focus on home like never before. The marauding virus not only pushed people into the relative safety of their homes, it also forced us to reinvent the way we live, learn, work and conduct our myriad businesses, all from the safe confines of home. 

All this was made possible by technology, whether by way of online education, work from home, ecommerce, telemedicine, etc. Along with everything else, healthcare services too underwent shifts to cope with and manage the health crisis. 

It leaned heavily on home-based care to take the load off hospitals and provide care to patients with chronic conditions and mild Covid symptoms in their homes. Although home-based care has existed for long in some form or the other in most countries including India, it has acquired a new significance and heft in the wake of the pandemic, thanks to a host of factors. 

Home healthcare or homecare offers an extensive range of healthcare services that can be administered for an illness or an injury by trained healthcare professionals, physicians and nurses in the comforts of one’s home.

Also known as care away from hospitals, homecare is usually less expensive, more convenient, and just as effective as hospital care facilities. According to the NITI Aayog’s Investment Opportunity in India’s Healthcare Sector Report 2021, the home healthcare business model effectively operates at 15-30 per cent reduced costs compared to traditional hospital settings, saving on real estate and infrastructure. Out-of-hospital care can also reduce 65 per cent of non-urgent hospital visits and can bring down hospital costs by 20 per cent in India, says the report. 

SUNRISE SECTOR

Home healthcare is also being called a sunrise sector, as it is witnessing giant growth prospects, especially after the Covid-19 pandemic. The NITI Aayog report pegs India’s home healthcare market to expand to USD 21.3 billion in size by 2027, from USD 6.2 billion in 2020, growing at more than 19 per cent CAGR. Homecare is divided into three broad segments namely home healthcare services subsuming at-home nursing services, home healthcare devices which include monitoring devices, screening or self-diagnostic devices like pulse oximeters and home healthcare solutions such as telehealth and telemedicine.

As a part of at-home nursing services, postoperative care is now a crucial part of the home healthcare segment as many big hospital chains are offering out-of-hospital care with an extensive continuum of care, providing patients care in their homes and around their loved ones. Apart from the hospitals, technology-enabled home healthcare companies have been providing advanced facilities like respiratory services, sleep apnea care, cancer support care, post-trauma or accident care, senior care, palliative care and rehabilitation services for many years.

The actual home care follows different SOPs and protocols for different diseases including in-depth clinical exams of the patient, systematic clinical audits, qualified and trained ICU caregivers if ICU care is required, equipment augmented by futuristic technology, and remote patient monitoring and supervision by ICU doctors for critical intensive care procedures.

“Now with the use of technology, we can monitor a patient wherever they are. There are multiple devices on which you can look at the heart rate or rhythm, like heart monitors and ECG devices. We can also look at the patient’s oxygen level, temperature, blood pressure, and breathing rate, and use that to treat a patient wherever they’re located,” says Dr Sai Praveen Haranath, Senior Consultant, Pulmonary and Critical Care Medicine and Medical Director, Apollo e-ACCESS Tele-ICU. Today, even chemotherapy and haemodialysis care setups are stepping into the comforts of a home. 

KEY DRIVERS 

Globally, growth acceleration in homecare is bolstered by a solid consumer preference, adoption of digital care, digital tools and interventions. Besides, the sector’s reliability, sustainability, accessibility and readiness to scale have enabled it to become a mainstream care modality across the developing and developed world. India stands at a similar tipping point where the sector is ready to expand exponentially.

A significant driver of homecare in India has been the digital push. From symptom monitoring devices to round-the-clock remote patient monitoring, the adoption of digital tools has increased manifold in India and it is enabling the care delivery mode to shift from reaction to prevention. 

Currently, the homecare industry is witnessing a grand expansion of at-home services extending from acute and episodic care to chronic and long-term disease management backed by tech-enabled smart home environments. The pandemic spurred the homecare growth story as hospitals flooded with Covid patients made homecare an ideal alternative for patients with other diseases.

Covid accelerated the adoption of technology at home in terms of telehealth applications, home ICU settings, medical devices and remote patient monitoring which provided the homecare industry with the push it required for many years in India. Acceptance of homecare among patients and quality care provided by homecare companies is also driving the industry. 

A Deloitte ‘Changing Consumer Preferences Towards Health Care Services’ survey found that 74 per cent of patients prefer home sample collection for diagnostic tests and 48 per cent are ready to pay for care at home in India. A care setup at home requires training, supervision, continuous monitoring, advanced equipment, specialised experts and protocols. And Indian homecare com panies have managed to create these complex systems without compromising quality, which has earned the trust and built acceptance among the patients. 

EMERGING OPPORTUNITIES

Senior care, a part of at-home nursing services, is one of the most important segments of the home healthcare industry as more than half of the sector’s demand is sourced from the elderly. The home care industry provides care to the sick and elderly in their homes and around their loved ones, which doctors believe considerably improves the healing process while eliminating or reducing hospital visits of senior citizens and also saving them from hospital-borne infections.

By 2050 India’s elderly population is set to triple to constitute 20 per cent of the country’s population, hence an ageing population with a surging disease burden and a rising life expectancy is set to provide a great opportunity to homecare companies to capitalise upon.

Studies have found out that Indian seniors like their counterparts in the developed world prefer to age at home. The private players and the government are now trying to add value to the silver years of the elderly. Changes in family dynamics like more and more nuclear families, the surge in chronic illnesses and increasing affordability have made Indian seniors the biggest consumers of home care services in the country. “We will have 200 million people over the age of 60 years in the next seven years.

Now, if you dissect this in any way from income, urban, rural, and living independently, every category of this population will need care. So we need to have platforms which provide everything under one roof or we need firms to do parts of this puzzle piece,” stated Tara Singh Vachani, Executive Chairperson of Antara Senior Living.

Unlike the west, the stratification into primary, secondary, tertiary and quaternary care is yet to take place in India, leaving the country’s healthcare system overwhelmed with mounting care needs and inadequate resources in terms of doctors, nurses, and infrastructural requirements. Homecare effectively bridges this gap of demand and supply by decongesting hospitals and dealing with non-emergency diseases at patient homes. 

The asset-light model of homecare companies helps in bringing down infrastructural requirements and costs, making it much more accessible and affordable. Homecare is also set to play a crucial role in expanding care delivery from Tier-1, and Tier-2 cities to even penetrating rural and semi-urban areas. India is also witnessing a rapid phase of urbanisation leading to better facilities and infrastructure as a part of the country’s Smart Cities Initiative across 100 cities and towns.

These selected cities are home to over 130 million people with better IT connectivity and digitalisation. This giant pool of high-value health seekers provides a big opportunity for homecare companies to explore. According to the NATHEALTH report, the expedited growth of organised homecare companies will lead to the advancement of the organised sector from 1.1 per cent to 2.4 per cent out of the total home healthcare market by 2025, the thriving sector has the potential to create 2.6 to 3.1 million jobs overall by the same year.

KEY PLAYERS

In the homecare devices segment, diagnostic devices hold the largest market share and are expected to boom going forward, according to a Grandview Research report. This growth is expected to come as technology takes centre stage in enabling accurate and timely diagnoses with devices like digital heart rate monitors, iPhone heart rate trackers, and heart rate watches, as well as rising awareness and health consciousness. 

In the therapeutic device's domain, respiratory equipment holds the largest piece. The increasing prevalence of chronic diseases such as COPD (Chronic Obstructive Pulmonary Disease), bronchitis and asthma are driving the demand for respiratory therapy devices such as C-PAP (Continuous Positive Airway Pressure), Bi-PAP (Bi-level Positive Airway Pressure) which is used to treat sleep apnea, among other devices like ventilators and nebulisers.

In the homecare services sector, the skilled homecare segment saw the most traction in 2021. The segment witnessed growth due to increased lifestyle diseases and growing demand for home-bound patients recuperating from chronic injury or diseases which require continuous and coordinated delivery of care. 

The Grandview Research report notes that the market in India is highly fragmented, and includes many local and a few national players like Portea Medical, Apollo Homecare, Nightingales Home Health Services, India Home Health, Life Circles, HCAH, Senocare Services, Antara Senior Care, and Care Health Nurses, among others providers. Besides, Key players are presently building their services across the country by implementing cutting-edge technologies and engaging in mergers, partnerships and acquisitions. 

CHALLENGES AHEAD

Though on an expanding spree, the homecare sector remains largely unorganised and unregulated, leading to concerns over substandard treatments which could lead to adverse clinical outcomes. A report titled ‘Indian Home Healthcare 2.0’ by NATHEALTH recommends mandatory registration and licensing of all players providing out-of-hospital care, with defined minimum standards and infrastructural requirements for delivering quality homecare services.This will help regulate and mainstream the large unorganised segment and ensure safe care delivery to patients. 

“There is practically no regulation as such in the homecare space but an accreditation mechanism has come in through QAI (Quality and Accreditation Institute). Regulation-wise, we need to set some standards and it could be in the form of a regulatory environment or recognised standards set by the government, with the government saying that only if you follow these standards that you can get the government support in terms of funding and other subsidies. This will help in reducing the unscrupulous practices which are happening in the name of homecare,” say Vivek Srivastava, Co-founder and CEO, of HealthCare At Home (HCAH). 

Currently, anyone can now just pick up a phone, have two nurses and can become a home healthcare provider, with no regard to quality or patient safety, he adds. 

Another challenge is the slower inclusion of homecare services in health insurance by the private players and the government. According to a Deloitte report, Indian home healthcare at present constitutes around 3.6 per cent of the total healthcare expenditure as compared to 8.3 per cent in the developed countries. 

“Globally, the out-of-hospital sector is promoted by the payer which includes insurers and the government as they realise the cost of healthcare reduces dramatically and the outcomes remain similar, so insurance cover for out-of-hospital care is the most critical part which can change the dynamics of the industry,” Srivastava says. 

The Insurance Regulatory and Development Authority (IRDAI) released its guidelines in 2020 allowing the coverage of homecare services which is set to drive the adoption of homecare services. But a faster creation and inclusion of homecare insurance policies into schemes sponsored by the government like PMJAY, CGHS and ESIC and special packages including care of the disabled, palliative care and elder care will become crucial imperatives to drive the future growth in the sector. 

FUTURE OUTLOOK 

Due to the rising disease burden, changing dynamics of the population, increasing health inflation and roadblocks in access to care, the Indian healthcare system requires a prioritising mechanism to keep tertiary and quaternary systems dedicated to specialised care delivery. Homecare comes as a natural leader to support this transition and efficiently maintain the continuity of care.

“Currently the out-of-hospital care market stands at around USD 5 billion and probably around 3-4 per cent of the market size is in the organised sector today. While the whole market is growing at about 17 per cent CAGR, the organised sector is growing at more than 30 per cent CAGR because patients have realised that home healthcare starting from primary care, chronic disease management, post-hospitalisation and elder care cannot be provided by the hospital alone and the continuum of care can only be maintained with homecare which offers specialised services at a reduced cost” says Meena Ganesh, Co-founder and Chairperson, Portea Medical. 

Homecare players can connect the missing dots in the system and maintain continuity of care between clinicians and their patients by leveraging a trained workforce, standardised processes and digital interventions. Presently, treatment given to senior citizens is not included in healthcare services as defined by the service tax department and hence it is not eligible for the Goods and Services Tax (GST) exemption available to healthcare services. 

Government support in this regard will help the industry grow faster. The homecare sector stands at an inflection point, poised to transform itself into a sustainable, viable and hyper-scale segment by leveraging government support, technological innovation and market variables to construct the care continuum of the future. It is ready to transition from a mainstream modality to a preferred mode of care adding value to the whole healthcare sector.