Home-based Primary Care: A Personalized Solution for Aging Homebound Adults

As the baby boomer generation continues to age, older individuals will accumulate myriad chronic diseases that impact their mobility and leave them homebound. Therefore, it will be important to devise innovative and cost-effective means for delivering care to homebound individuals. Home-based primary care is one method to bring primary care to patients who are unable to participate in traditional office-visits. While it is important to talk about these innovative care models in theory, the actual implementation of these models is key to understanding how home-based services can positively impact homebound patients. This post will outline two successful home-based care delivery programs: one at Mount Sinai Hospital in New York City and the Center for Medicare and Medicaid Services Independence at Home Project.

Home-Based primary care (HBPC) is characterized by four traits:

  1. The provision of primary care in the patient’s home utilizing an integrated health care team.
  2. Frequent communication amongst members on the health care team. This ensures the patient can remain in his or her home and maintain a high quality of life.
  3. After-hours availability of health care team members.
  4. Focus on reducing emergency department (ED) visits.

This combination of services aims to integrate the patient into his or her care by bringing the primary care team to his or her home; in doing this, it is inherently personalized and patient-centered. Some evaluations of home-based systems have shown that participation in the program led to reductions in hospitalizations and emergency department visits. Such programs also provide caregivers with the support they need to care for ailing family members.

Mount Sinai hospital in New York City has operated the Mount Sinai Visiting Doctor (MSVD) program since the late-1990s. This program sought to bring primary care services to homebound patients in Manhattan. The idea behind MSVD was that bringing primary care to those who cannot participate in traditional office visits could encourage patient participation in their care plan. Using a multidisciplinary team, MSVD has been able to coordinate patient care and increase positive outcomes for patients who participate in the program. Evaluations of the program have indicated that MSVD has higher rates of vaccinations compared to ambulatory and nursing home populations, 80% for the influenza vaccine and 74% for the pneumococcal vaccine. They were also able to decrease the burden on individuals taking care of homebound loved ones. While MSVD has yielded these outcomes, its budget relies largely on hospital and philanthropic funds. Regardless of funding, it is an example of the impact that home-based primary care can have for individuals who are homebound.

In 2011, the Center for Medicare and Medicaid (CMS) announced the Independence at Home Project. This three-year project selected 15 practices to deliver home-based primary care tailored to the patient’s needs and to coordinate the patient’s care. Year two findings, released in January 2017, indicated that this model may be an effective means of delivering primary care services to chronically-ill-homebound patients. A press release by CMS announced that the Independence at Home Project was able to save the Medicare program more than $10 million ($1,010 per beneficiary). It also delivered quality care to these patients. This ongoing project provides health care providers with an innovative, cost-effective approach to implementing patient-centered care.

 

Ultimately the MSVD and the Independence at Home Project show that home-based care can be cost-effective and increase patients’ involvement in their care. These implementation experiences provide health care professionals with a foundation to begin utilizing home-based health care for patients who have multiple chronic disorders or other debilitations. With proof-of-concept complete, home-based care could be a setting for the implementation of patient-centered care models or interventions, such as Personalized Health Planning.

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