New Report Finds Home-Based Primary Care Leads to Lower Medicare Costs

WASHINGTON – A new report published in The Journal of American Geriatrics Society (JAGS) underscores the value of home healthcare for America’s aging seniors and the Medicare program, said home health leaders from the Partnership for Quality Home Healthcare. The JAGS report seeks to determine the effects of home-based primary care (HBPC) on Medicare spending and the health and mortality of older and disabled seniors living with multiple chronic conditions.

The report, “Effects of Home-Based Primary Care on Medicare Costs in High-Risk Elders,” concludes that HBPC reduces Medicare costs for ill elders. Researchers found that a HBPC model led to 17 percent lower total Medicare costs over two years. The cases examined in the report had lower costs for hospital care, physician fees and skilled nursing facility (SNF) care. Specifically, the cases had nine percent fewer hospitalizations, 10 percent fewer Emergency Department (ED) visits, 27 percent fewer SNF stays and 23 percent fewer specialist visits.

HBPC is defined as “a mobile care innovation that focuses on the most-ill subset of elders. Interprofessional HBPC teams deliver medical and social services to elders with severe and disabling chronic illnesses who find it difficult to get to a doctor’s office.”

According to the report authors, “The results of this study are consistent with those of other studies that suggest that a house call model can reduce costs and produce solid clinical outcomes for high-risk elders. Given the move toward more value-based payments, providers will need to create such innovative models that provide better-quality, lower-cost care to elders with severe chronic illness.”

The Partnership has long touted the U.S. Department of Veterans Affairs’ (VA) HBPC program, operating 150 HBPC sites nationwide, which they call a model for the delivery of home health for Medicare beneficiaries. The VA HBPC program provides comprehensive disease management and patient care to Veterans with chronic conditions. By providing comprehensive in-home care delivered by skilled interdisciplinary teams, HBPC enables Veterans and their dependents to receive the care they need without having to leave their homes for more costly institutional care.

Similar to the JAGS report results, the VA HBPC program has reduced costs. VA data indicate the HBPC has reduced inpatient hospital days by 62 percent and long term care days by 88 percent, resulting in a 24 percent decrease in total healthcare costs for HBPC participants.

“This report confirms again that greater investment in the delivery of home healthcare can lead to lower Medicare spending and improved healthcare for our nation’s most vulnerable and frail seniors,” said Eric Berger, CEO of the Partnership. “The HBPC model of care has the potential to add great value to the Medicare program by expanding access to healthcare in the home, which is widely recognized as cost effective and patient preferred.”

Recent data analyses also reveal that Medicare home health beneficiaries are older, sicker, poorer, and more likely to be members of ethnic or racial minority populations than all other Medicare beneficiaries. In addition, the analysis finds that Medicare home health patients have greater functional limitations and disabling conditions and have greater difficulty completing routine tasks than all other Medicare beneficiaries.

“Existing programs have shown the potential for lower costs with good outcomes when patients receive home health for both post-acute and primary care,” said Steven H. Landers, MD, MPH, President and CEO of the VNA Health Group. “This most recent JAGS study contributes necessary analyses to a growing body of research that confirms what health professionals and patients have understood for some time now – that the appropriate use of home health has great potential for making our nation’s healthcare system more efficient, more effective and more patient-focused.”