New Analysis of VA Home Based Primary Care Program Offers Lessons to Medicare for Reducing Costs, Improving Patient Care

Washington, DC — An analysis released this week by the American Action Forum (AAF), “VA Home Based Primary Care Program: A Primer and Lessons for Medicare,” offers further evidence that the appropriate utilization of home healthcare services can be highly effective in improving patient care and reducing healthcare costs, according to the Partnership for Quality Home Healthcare.

The AAF primer, which offers a deep dive into the transformational U.S. Department of Veterans Affairs’ (VA) Home Based Primary Care (HBPC) program, describes how the department has successfully integrated a program designed to better manage care for Veterans living with multiple chronic disease conditions. The HBPC program currently serves 12,000 chronically ill Veterans annually who receive comprehensive treatment services in the home setting. These services have been successful in preventing additional complications related to existing diagnoses that could result in expensive treatments if left untreated.

The AAF’s research review highlights multiple data sources on the effectiveness of the HPBC:

• Lowering Costs: Hospital days for Veterans participating in the HBPC declined by 62 percent and nursing home days dropped 88 percent compared to those not enrolled in the program in 2002; resulting in a 24 percent reduction in healthcare costs
• Reducing Hospitalizations: A 2007 study reported a 69 percent reduction in hospital inpatient days of care directly related to allowing Veterans to remain in their home
• Improving Quality: According to a Journal of the American Medical Association (JAMA) study, a HBPC treatment group received higher scores for “health related quality-of-life” and higher scores for patient and caregiver satisfaction than patients in a control group

Often cited as a “model for the Medicare program,” the HBPC program has fewer restrictions than Medicare. The VA does not require patients to be “homebound” and enables participants to have access to comprehensive chronic care management services. Further, unlike Medicare, the VA program is structured to provide extended care in order to help patients avoid returning to hospitals and other institutional settings.

The AAF primer states, “Because patients with complex chronic conditions served by Medicare as well as those dually eligible for Medicaid and Medicare have similar care needs to the VA’s HBPC enrollees, it raises the possibility that the use of an HBPC-modeled program could similarly reduce hospital and nursing home stays within entitlement programs.”

The Clinically Appropriate and Cost-Effective Placement (CACEP) project, a recently released study that examines how to more effectively use the home health benefit within Medicare, cites the HBPC as a national program using home care to produce sizeable savings. “Effective home care for persons with complex chronic disease must be comprehensive, not problem-focused,” the study states. “If complex chronic disabling disease is the question, home care is the answer, and VA HBPC experience now provides the United States with substantial evidence to support this view.”

“The VA has long been recognized as a leader in advancing patient-centered healthcare, and the HPBC program is no exception. The real challenge healthcare policymakers face is finding solutions that reduce costs and improve quality of care — this program does just that,” said Chairman Billy Tauzin, senior counsel to the Partnership for Quality Home Healthcare. “The VA’s Home Based Primary Care program merits close consideration by lawmakers as a model for future Medicare reforms.”?

Nearly 3.5 million Americans currently receive Medicare home healthcare services, which nearly 9-in-10 seniors prefer over care delivered in institutional settings. Many healthcare treatments that were once only available in facility-based settings are now being safely and effectively provided in patients’ homes by skilled clinicians.