House calls have come back in style. Under the Affordable Care Act, healthcare providers are incentivized to develop new value-based programs to address the needs of high-risk populations by improving outcomes, preempting the need for emergency care and ultimately lowering costs.
In an examination of one such initiative in Southern California, Health Affairs found house calls effectively reduced operating costs per patient, as well as hospital utilization.
HealthCare Partners Affiliates Medical Group, based in Torrance, Calif., launched the House Calls program in 2009. The in-home program provides, coordinates and manages care for recently discharged high-risk, frail and psychosocially compromised patients, according to the report. Its main goal is to reduce preventable emergency room visits and hospital readmissions.
House Calls, which is available to HealthCare Partners' Medicare Advantage and commercially insured HMO population, provides home-based medical and behavioral healthcare, palliative care management and support for high-risk frail and homebound patients, as well as those whose physical, mental or social limitations make access to regular sources of care challenging.
Here are six key findings on the House Calls program, according to Health Affairs.
1. House Calls care teams, called pods, are led by a physician and include nurse practitioners, social workers and medical assistants. Psychologists, psychiatrists, podiatrists and ophthalmologists are often called for consultations. Nurse practitioners develop a care plan for the patient and monitor him or her and stay in contact with his or her primary care physician. They also arrange referrals to specialists and community resources, such as volunteer-based support groups and senior transportation services.
2. Social workers conduct assessments of the patient and his or her home environment, noting and addressing potential issues such as fall risks, needed home modifications, medication organization, food and nutrition counseling, financial concerns, transportation needs, social isolation and support networks.
3. Between 2009 and 2013, House Calls served 11,184 patients, including 7,925 unique patients. The program is not representative of the overall Medicare population, but is highly skewed to those ages 85 and older.
4. Most House Calls patients have multiple comorbidities, with an average of 7.5. The top comorbidities include hypertension (81 percent), peripheral vascular disorders (60 percent), renal failure (59 percent), cardiac arrhythmias (47 percent), uncomplicated diabetes (43 percent), chronic obstructive pulmonary disease (42 percent), congestive heart failure (41 percent) and depression (40 percent).
5. On average, patients are enrolled in the program for 223 days (179 days for patients whose death ends their participation and 267 days for patients who are discharged alive).
6. In the three and six months prior to enrolling in House Calls, patients had high hospital inpatient and emergency department use and spending. After three months in the program, per month utilization and inpatient total spending by Healthcare Partners on behalf of House Calls enrollees decreased. Per month utilization and spending decreased further in the first three months and six months after disenrolling from the program.