BY CHRISTOPHER CHENEY |
AUGUST 03, 2020
Research indicates
homebound seniors and non-homebound seniors with complex medical conditions
benefit from home-based medical care.
KEY
TAKEAWAYS
There are about seven
million homebound seniors or seniors who have difficulty leaving their homes.
Among a sample of
fee-for-service Medicare beneficiaries who received home-based medical care
from 2011 to 2017, 75% were homebound.
Value-based contracts
are well-suited for home-based medical care providers.
For older patients, there are opportunities to
expand home-based
medical care, which can lower cost of care and improve clinical
outcomes, a new research article says.
In particular, there is untapped potential to
provide home-based medical care to homebound seniors. According to estimates,
there are about two million homebound seniors in the United States and about
five million seniors who can only leave home with assistance or significant
difficulty.
Home-based medical care, which includes services
such as primary care and medical interventions, is more intense than standard
home health services such as physical and occupational therapy.
Home-based primary care has been associated with
decreased hospitalizations and emergency room visits. A home-based primary care
program for high-risk seniors launched by the Center for Medicare and Medicaid
Innovation—Independence at Home Demonstration—lowered cost of care
significantly. "In its first two years, Independence at Home saved an
average of $2,700 per beneficiary per year over expected patient costs,"
the new research article's co-authors wrote.
The research article, which was published today by Health
Affairs, is based on survey data collected from more than 7,500
community-dwelling, fee-for-service Medicare beneficiaries. The study features
several key data points.
·
Almost 5% of the
Medicare beneficiaries had received home-based medical care during the study
period from 2011 to 2017
·
Among the Medicare
beneficiaries who received home-based medical care services, 75% were homebound
·
Compared to homebound
Medicare beneficiaries who did not receive home-based medical care services,
those homebound beneficiaries who did receive this kind of care were more
likely to live in a metropolitan area or assisted living facility
·
Compared to
non-homebound Medicare beneficiaries who did not receive home-based medical
care, non-homebound beneficiaries who did receive this kind of care had more
chronic illnesses, more functional impairment, and higher healthcare
utilization
·
Compared to
non-homebound Medicare beneficiaries who did not receive home-based medical
care, non-homebound beneficiaries who did receive this kind of care were more
socially disadvantaged
·
For healthcare
providers, there is a golden opportunity to provide home-based medical care to
homebound seniors and medically complex non-homebound seniors, the research
article's co-authors wrote. "The significant unmet needs of this
high-need, high-cost population and the known health and cost benefits of
home-based medical care should spur stakeholders to expand the availability of
this care."
FEE-FOR-SERVICE
MODEL ILL-SUITED TO HOME-BASED MEDICAL CARE
Fee-for-service payment models are a primary
barrier to expansion of home-based medical care, according to the research
article.
"Our finding of higher rates of home-based
medical care among those living in assisted living facilities and in
metropolitan areas likely reflects the fact that favorable factors related to
geography and the built environment create operational efficiencies and
opportunities to improve the financial sustainability of home-based medical
care practices," the research article's co-authors wrote.
Value-based payment models are a better fit with
home-based medical care, the lead author of the research article told HealthLeaders.
"Even in the absence of broader payment
reform, many home-based medical care practices are pursuing value-based
contracts with insurers that provide per member per month reimbursements to
care for high-risk patients," said Jennifer Reckrey, MD, an associate
professor at the Icahn School of Medicine at Mount Sinai in New York City.
There are strategies that home-based medical
care providers can pursue to make fee-for-service payment models financially
sustainable, she said. "Examples include forgoing physical office space
and relying on advanced practice nurses or physician assistants to provide the
majority of patient care."
HELPING
UNDERSERVED PATIENTS
The finding that non-homebound seniors who
received home-based medical care tend to be socially disadvantaged is highly
significant, Reckrey said.
"Because home-based medical care provides
highly personalized team-based care in the home, it is uniquely able to care
for high-risk patients who are not currently well-served by the healthcare
system. While the homebound as a group have difficulty accessing care, among
the non-homebound social factors like poverty, lack of access to
transportation, and racial and ethnic discrimination are also potentially
powerful barriers to accessing needed care. Home-based medical care may be an
important way for these individuals to build trust with an engaged care team
and receive needed care."
Christopher Cheney is the senior clinical care
editor at HealthLeaders.
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