Many people with high medical needs have limited mobility. It is also often the case that the environment in which a person lives can contribute to health problems. For these reasons, and others, there has been renewed interest in having highly trained medical professionals, including physicians, visit patients in their homes. A Health Affairs article reviews early results from several pilot home visit programs. (HA Article) The five models reviewed all used teams of registered nurses and other professionals to conduct home visits for older Medicare beneficiaries. Some of the services provided related to social and functional needs. Some of the models created remote monitoring functionality. Some addressed creating a safe home environment for the beneficiary. Some were very specifically focused on care management and health behavior change. For certain patients, a better approach to palliative care and pain relief was central. All the models seemed to be flexible and oriented toward creation of a care plan that specifically met a specific beneficiaries needs.
The authors matched beneficiaries in these demonstrations with similar beneficiaries in regular Medicare fee-for-service care. There were over 5800 beneficiaries in the pilots. Depending on the model, there were either significant reductions in some types of care, or in one case, little change. The best performing model reduced both inpatient and outpatient expenditures, particularly from readmissions and observation stays. Another resulted in significant reductions in ER use and hospitalizations. The beneficiaries in the pilots reported greater satisfaction with care and increased confidence in self-management of health issues. Obviously, these home visits can limit a health professional’s productivity, as travel time eats up a part of the work day. But often high-cost patients live near each other, often in senior housing. And technology can ameliorate some of the potential loss in productivity. But these models are also expensive to operate, so ongoing rigorous research helps ensure that they achieve a goal of lowering spending, even as they almost certainly result in improved quality.