Study: Special Home-Visit Program Could Promote Prevention

A special Medicare program that stresses home health visits for patients with chronic diseases helped keep diabetes patients out of the hospital and may have lowered costs using time-honored prevention methods, researchers reported on Monday.

Their findings, reported in the journal Health Affairs, supports changes made in the 2003 Medicare Modernization Act and could point to ways to help keep health costs down by preventing expensive complications.

“The comparative analysis indicates that people with diabetes in the special-needs plan” particularly nonwhite beneficiaries” had lower rates of hospitalization and readmission than their peers in fee-for-service Medicare. For example, risk-adjusted hospital days per enrollee among special-needs plan participants were 19 percent lower than for fee-for-service Medicare enrollees,” Robb Cohen of XLHealth Corporation Baltimore and colleagues wrote in their study.

The XLHealth and America’s Health Insurance Plans experts studied 36,000 men and women in five southern states who were enrolled in Medicare Advantage programs called Chronic Condition Special Needs Plans.

“This special-needs plan emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care,” the researchers wrote. “A key component of the model is the HouseCalls program, which sends specially trained nurse practitioners and physicians to enrollees’ homes. In 2010 XLHealth performed more than 82,000 HouseCalls home visits across all of its operations. Approximately 85 percent of special-needs plan enrollees received at least one HouseCalls visit in that year.”

Such house calls may appear to be pricey but the researchers said the reduced need for hospital care should offset the cost. With diabetes, controlling a patient’s blood-sugar levels can reduce damage to organs that causes kidney failure, heart disease, or blindness and which can force amputations of toes and legs” all very expensive complications.

“Preventive care performed as part of the HouseCalls program can include a complete health history and physical; a medication inventory; a social-needs review; foot exams; flu vaccinations; blood-pressure monitoring; urinalysis; depression and pain screening; and assessments of functional, cognitive, and fall-risk status,” the team wrote. They looked at patients in Arkansas, Georgia, Missouri, South Carolina, and Texas.

“Although this study does not include a cost analysis, we believe that savings from reduced hospitalizations are likely to more than offset the additional costs of enhanced primary-care programs. Our study suggests that the Centers for Medicare and Medicaid Services may be able to adapt methods used by the Chronic Condition Special Needs Plans program to improve care and outcomes for beneficiaries with a broad range of chronic diseases,” they concluded.