Home visits by teams led by registered nurses or lay health workers can reduce costs and utilization of services, such as emergency department visits and hospitalizations, according to a paper published in Health Affairs.
Home visits by teams led by registered nurses or lay health workers can also reduce costs and utilization of services, such as emergency department (ED) visits and hospitalizations, according to a paper published in Health Affairs.
Past research on home-based care has focused on care delivered by teams led by primary care providers. The current study evaluated the effectiveness of 5 home visit models under the Health Care Innovation Awards of CMS. The models used patient-extender teams to provide care to Medicare beneficiaries and address aspects of service delivery not based in primary care.
“Home visits offer an opportunity to reach high-risk, high-needs patients before a change in condition necessitates a higher level of care and can mitigate access barriers such as lack of transportation or limited mobility,” the authors wrote.
The models studied were:
The 5 models addressed 6 categories of needs: care coordination, beneficiary or caregiver education, referrals to home and community-based services and supports, disease management, advance care planning, and environmental assessment or redesign.
The researchers determined that 4 of the models reduced total Medicare expenditures or utilization. CAPABLE reduced total expenditures relative to comparators and reduced readmissions and observation stays. DASH had significant reductions in ED visits and hospitalizations. AIM had a significant reduction in hospitalizations and Medicare expenditures in the last 30 days of life. Stroke Mobile significantly reduced readmissions. No significant findings were observed for ABC.
“Though the models shared key components related to care coordination and patient/consumer engagement, given the models’ diversity in target populations, staffing, and set of components, it is important to consider each home visit model on its own terms," the author concluded. "The similarities among models that were correlated with positive findings present a strong case for considering the value of having practice extenders provide home visits."