People who are chronically ill and homebound represent nearly half of the costliest 5% of all patients (Remington Report). As a population, their needs are not fully addressed by ambulatory, urgent, outpatient, emergency, or hospice care. For such people, chronic conditions, functional impairments, isolation, and other challenges often place healthcare out of reach, and the result is frequently a worsening of conditions and escalation of hospital utilization and costs. While medically directed home care doesn’t have all the answers, this article discusses its role in preventing hospital admission and readmission.

Primary care at home: Strong evidence of success, and strong resistance

There’s evidence that directing healthcare resources to the post-acute care gap pays dividends. The Independence at Home (IAH) Demonstration, which provides primary care at home for chronically ill Medicare patients, reduces hospital readmissions (and frees up beds) while saving more than $1000 per patient. The pandemic has increased the need to transition patients out of acute care settings as quickly as possible, and primary care at home can help.

However, although its economic advantages may seem clear, home-based healthcare delivery has encountered resistance from two main sources: Providers, who may perceive greater risk (medical and legal) associated with care delivered in a nonclinical environment, and payers, which have been slow to accept proof of cost savings and set reimbursement rates that make it viable.

Home care as a postacute care option

A 2019 study by the University of Pennsylvania’s Leonard Davis Institute of Health Economics examined outcomes of patients discharged to home care versus a skilled nursing facility (SNF).

Of significance is the scope of the study: 17 million hospitalizations were studied.

It found that “the two groups did not differ in terms of improved functional status during postacute care nor in 30-day mortality,” indicating that home care can produce similar results to SNF care.

Not surprisingly, when it came to cost, home care outperformed SNF care considerably. Medicare payments for initial hospitalization and 60 days of postacute care in SNFs exceeded $10,000. In home care settings, those payments were less than half that amount.

Home Care vs SNFs: Hospital & Postacute Care Expenses

Illustration of small stack of dollar bills Illustration of large stack of dollar bills

A 2016 study from Penn Leonard Davis Institute for Health Economics reported on the economic advantages of post acute care delivered by home health care versus a skilled nursing facility. Costs are based on Medicare payments for the initial hospitalization and postacute care in the 1st 60 days following admission.

Closing the gap in postacute care

The pandemic continues to exert pressure on critical care facilities. Clinicians, discharge planners, care managers, and others will need to manage finite resources with limited discharge options. This may set the stage for medically directed home care to play an expanded role in cost reduction and patient wellbeing.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
Remington Report (2021)
Science Direct (2021)
Commonwealth Fund (2021)
Penn LDI (2019)
Georgetown/McCourt School of Public Policy (2021)

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