House Call Program Reduces Monthly Spending, Delivers Meaningful Care

A program for homebound patients reduces spending and improves care in high-risk older Medicare beneficiaries.

A study of a Southern California house-calls program developed to provide and coordinate care for recently discharged high-risk, frail, and psychosocially compromised patients found that the areas served by the program experienced a reduction in operating costs per patient and substantial reductions in monthly per-patient healthcare spending and hospital utilization compared with the period before enrollment in the service. The study, by Glenn A. Melnick, PhD, of the University of Southern California, and colleagues, appears in the January 2016 issue of Health Affairs.

The study’s data also showed that the structure, staffing patterns, and processes used by the program, HealthCare Partners Affiliates Medical Group, differed across the geographic areas it served and evolved over time in different ways. Despite more than 5 years of experience, the program structure continues to evolve and adjust staffing and other features to accommodate the changing nature of this complex patient population.

“House Calls was launched to help enhance patients’ quality of life by helping ensure the provision of cost-effective appropriate care through systematic management of patient transitions from hospital to home and postacute care, delay the need for institutional long-term care, and maintain chronically ill patients in their homes with appropriate support,” the authors wrote.

The House Calls program was launched in 2009 as a pilot program. It is available to HealthCare Partners’ Medicare Advantage and commercially insured health maintenance organization patients, who have no co-pays for home visits or necessary medical services. HealthCare Partners was organized into 6 nonoverlapping geographical regions that are socioeconomically, ethnically, and geographically diverse. Within 18 months of launch, the House Calls program moved from a pilot to a fully established program featuring multidisciplinary house calls care teams led by a physician and including nurse practitioners (NP), social workers, and medical assistants. Specialists may be called upon for consultations.

When a new patient enrolls in House Calls, a NP coordinates a 1-hour intake and patient-screening session that includes assessments of the patient’s ability to perform activities of daily living and independent activities of daily living, gait and balance, cognitive function, advance care planning, environment, and depression. A care plan is created for the patient by the physician and NP, and the NP monitors patients and cares for them, maintains contact with the patient’s primary care physicians, monitors medication adherence, advises patients and families about palliative and end-of-life care options, and arranges for referrals with specialists. Social workers conduct in-home assessments and work with caregivers.

The study’s authors note that demographic trends are creating a growing pool of high-risk older Medicare beneficiaries who will need assistance in managing their care and accessing services outside their homes, and programs like House Calls can help achieve goals for the more appropriate use of health care services. More study is needed to show net savings that can be used to finance similar programs without adding to overall costs.

“Given the high spending rates of this population and the program’s relatively modest monthly costs, it is likely that further research will reveal net savings that can be used to finance similar programs without adding to overall costs,” the authors concluded.