A home-based primary care program decreases costs and utilization for high-risk Medicare enrollees.
MedStar’s Medical House Call program in Washington, D.C. began in 1999 when providers witnessed poor outcomes for patients who could not physically get to their doctor’s office. The program provides home-based primary care services to frail older adults with multiple chronic conditions or serious illnesses. This case study details the program’s target population, key features, program financing, promising results included reported cost savings, and lessons learned.
The program serves a population of frail older adults who are mostly Black women with low incomes and more than two chronic conditions. Patients are only eligible if they are at great risk of incurring high costs. Key program features include: (1) an interdisciplinary care team comprised of a geriatrician, a nurse practitioner, social worker, and a licensed practical nurse that provide 24/7 on-call coverage; (2) access to CRISP, a regional health information exchange to track hospitalizations beyond MedStar Washington Hospital Center; (3) referrals to social and emotional resources for patients and their caregivers; and (4) emphasis on end-of-life care, when needed.
Medstar was part of a cohort of three programs (Mid-Atlantic Consortium) under the Independence at Home demonstration that reduced Medicare spending by 20 percent and yielded $1.8 million in shared savings in the first two years of the demonstration (2013-2014). These findings are comparable to another study done on the MedStar program, which found total savings of 17 percent for all patients enrolled in the program and 26 percent for those in high-risk frailty categories when compared to fee-for-service Medicare beneficiaries. There were also decreases in the use of hospitals, emergency departments, and skilled nursing facilities.
Home-based primary care programs like MedStar show promise in reducing utilization and costs, especially for high-risk patients. Other programs interested in starting a home-based primary care program can review the components and lessons learned from MedStar’s experience to help get started.