Study reinforces home care’s role in reducing hospitalizations for seniors

Photo: VCU Libraries via Flickr

Photo: VCU Libraries via Flickr

Home care has long been held up as a model to help avoid preventable hospitalizations or readmissions. A new study from RAND, just published in Health Affairs, confirms its benefits. [Note: AHCJ members get free access to Health Affairs.]

Medicare recipients enrolled in a clinical home visit program between 2008 and 2012 had 14 percent fewer hospital admissions and a lower risk of admission to nursing homes over the 12 months after they were evaluated, when compared to other Medicare recipients enrolled in traditional fee-for-service health programs. The decrease was smaller when compared to Medicare recipients enrolled in Medicare Advantage plans but still “significant,” researchers said.

“We found that a home visiting program can lead to meaningful cuts in the amount of in-patient care used by Medicare patients,” said Soeren Mattke, the study’s lead author and a senior scientist at RAND Corporation, a nonprofit research organization. “This is significant since many other strategies to reduce in-patient care among Medicare recipients generally have been unsuccessful.”

While sending a physician or nurse practitioner to a Medicare recipient’s home to provide a comprehensive geriatric assessment, with referrals to community providers and health plan resources to address uncovered issues may result in more physician visits, it ultimately saves money by reducing more costly institutional admissions, and supports the goal of aging in place, the study concluded.

Almost 70 percent of Medicare recipients aged 65 and older were estimated to have multiple chronic conditions in 2010. Many of these beneficiaries face barriers to receiving office-based primary care, increasing the chance their symptoms may worsen and result in emergency room visits, hospitalizations and nursing home admissions.

Mattke and his team analyzed the United HealthCare Group’s House Calls Program, a Medicare Advantage program offered in Arkansas, Georgia, Missouri, South Carolina and Texas. They compared results to traditional fee-for-service Medicare plans and in Medicare Advantage plans without this benefit between 2008 and 2012. A total of about 2 million beneficiaries were analyzed, he said.

Participants’ visits to physicians – primarily to specialists – increased by 2 to 6 percent in the year following an evaluation. The program’s effects on emergency department use was mixed.

As this Visiting Nurse Association of America report describes, payers and providers have experimented with approaches to improve care for these patients, but with little success. One favorable initiative is the CMS demonstration project, Independence at Home. This year-old program works with 13 medical practices and one consortium to test the effectiveness of delivering comprehensive primary care services at home and whether this effort improves care for Medicare beneficiaries with multiple chronic conditions. CMS called the results to date “promising,”

Traditional Medicare does not pay for home health services unless a physician deems skilled nursing, physical, speech or occupational therapy services as being medically necessary. So programs that bring home services to older adults without these requirements are still novel.

In an email message, Mattke said it is possible that race, geography and income played a role in the results, but could not tell from the data. He said that while there is no reason to believe results would differ in other states, more data and analysis would be needed.

“Assuming that these results with the HouseCalls program can be replicated, this particular combination of an in-home assessment and follow-up on recommendations has the potential to help elderly patients safely age in place, access office-based care and avoid costly institutional care,” Mattke said.

The study appears in the Dec. 7 issue of Health Affairs.

For journalists:

  • Are there any innovative home and community services in your community that allow older adults to age in place, and help them manage their chronic conditions?
  • Check out this tip sheet on covering home health care issues.
  • CMS Independence at Home Fact Sheet
  • National Association of Home Care and Hospice forum of state associations

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