December 7, 2015
Sending a physician or nurse practitioner to a Medicare recipient's home for a comprehensive health assessment can result in fewer admissions to hospitals or nursing homes over the subsequent year, according to a new RAND Corporation study.
Such a program results in patients visiting doctors more often, but is likely to reduce costs by trimming the amount of care provided in the most-costly settings, according to results published in the December edition of the journal Health Affairs.
“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, a nonprofit research organization. “This is significant since many other strategies to reduce in-patient care among Medicare recipients generally have been unsuccessful.”
The study evaluated experiences of patients enrolled in the HouseCalls program operated by Optum, UnitedHealthGroup's information and technology-enabled health services business. The program sends 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.
The study evaluated Medicare beneficiaries eligible for the HouseCalls program during 2008 through 2012 in Arkansas, Georgia, Missouri, South Carolina and Texas. Their experiences were compared to other Medicare recipients enrolled both in traditional fee-for-service Medicare plans and in Medicare Advantage plans without this benefit.
Mattke and his team found that Medicare recipients enrolled in the program 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.
Participants' visits to physicians — primarily to specialists — increased by 2 percent to 6 percent in the year following an evaluation. The program's effects on emergency department use was mixed.
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.
Both payers and providers have experimented with approaches to improve care for these patients, but with little success. For example, efforts to improve management of disease through nurse-staffed call centers have shown little promise thus far in reducing the use of costly in-patient services.
“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,” said Mattke, who is the managing director, RAND Health Advisory Services, the consulting practice of RAND Health.
Support for the study was provided by UnitedHealthGroup. Other authors of the study are Dan Han, Asa Wilks and Elizabeth Sloss.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on population health, health care costs, quality and public health systems, among other topics.