In this episode of Vital Conversations, Tim Coan from Focus Solutions sits down with Dr. Chris Chumley of Meridian Health to discuss the evolving landscape of home-based medicine for at-risk seniors. Meridian Health focuses on providing primary care to seniors in their residences, whether in assisted living facilities or private homes, helping to manage complex chronic conditions. Dr. Chumley highlights the advantages of this model, such as improved patient compliance, longer face-to-face visits, and a more personalized approach that includes evaluating living conditions and even diet through what he calls a "fridge biopsy." The discussion underscores how home-based care reduces hospitalizations and ER visits, ultimately improving patient outcomes while lowering costs. The conversation also delves into the technological and data challenges of this care model. Dr. Chumley explains how advancements like cloud-based EMRs, 5G connectivity, and interoperability tools help overcome hurdles in accessing and sharing patient data across multiple healthcare systems. However, he notes that the industry still has a long way to go in optimizing data utilization for improving patient care and scaling home-based medicine. The episode concludes with an optimistic outlook on the future of value-based care and innovations like hospital-at-home programs, emphasizing the need for continued efforts to refine healthcare delivery for the most vulnerable populations.