The Future of Ambulatory Health Services: The Healthy Home

Industry Insights from Paul Meade, M. Sc, MPH

Ambulatory care is the basic building block of primary healthcare in the United States. From its early origins of a family physician visiting sick patients in their homes to sophisticated group practices that offer secondary and even tertiary care, ambulatory care has evolved to a point where it competes with institutionalized care. However, not to be outdone, larger institutions have encroached the playing field of ambulatory care. Thus, the U.S. healthcare delivery system has gradually dissolved the clear demarcation between ambulatory care and institutional care. So where is this all heading?

There is one more geographical migration of primary healthcare that I believe will occur over the next few decades. But before I present this new frontier for primary care, let me highlight some of the developments that are occurring, and will continue to take place, within the healthcare delivery system that will accelerate this new migration. Information technology is finally changing the landscape of healthcare. Better technology to manage an explosion of new medical knowledge, making this information available anywhere and anytime, is enhancing our ability to manage the health of the nation. With the impetus from managed care to make people more fiscally and clinically accountable for their health and wellness, the average person has become much more aware of his or her medical status. However, this fiscal and clinical accountability brings with it a greater awareness of the eternal struggle between cost and quality. Not only are managed care organizations and health plans demanding that providers become more aware of cost and quality, but consumers are becoming a partner in this endeavor as well.

With healthcare providers becoming more aware of the cost of healthcare, and consumers becoming armed with more clinical information, there is a knowledge shift occurring that is resulting in a heightened awareness of balancing quality and cost, with both parties taking more responsibility than ever before. This “health partnership” is rebuilding the physician-patient relationship that existed decades ago. The difference is that the knowledge distribution and fiscal accountability has become a shared responsibility. There is a healthy balance when both the provider and receiver of healthcare services share a common vision of achieving the optimal healthcare quality at the best available cost.

So where do these developments take us, with regard to ambulatory moving to the next frontier? They lead us to what I call the evolution of the “Healthy Home.” Increased sophistication of portable diagnostic and monitoring equipment that can be placed in the home, coupled with access to health information available 24/7 between provider and consumer, will lead to the site for primary care being in the home of the patient. Ambulatory care, or “walking patient” care will become “stationary patient” care. The patient will receive most of the necessary primary care without ever having to leave home. Sophisticated diagnostic devices and biosensors embedded into monitoring devices will send electronic messages to remote healthcare providers from the consumer’s home on a regular basis. If the consumer needs a prescription for an illness, an e-prescription will be sent to a local pharmacy and delivered to that person’s door within a few hours. If needs for more healthcare services develop, a mobile unit could be discharged to the consumer’s home to take care of a disorder requiring more complex equipment. Lastly, if even more services are needed, either an ambulance could be sent, or the patient could find their way to a tertiary healthcare center.

Thus, I believe ambulatory care will migrate back into the homes of consumers, and this transition will take healthcare delivery one step closer to finding the optimal balance between cost and quality.

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