House calls: A blast from the past and a way to embrace value-based care

Costs, unnecessary care continue to fall even after program ends
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By Aine Cryts

House calls can help reduce preventable emergency room visits and hospital readmissions, according a recent study published in Health Affairs.

Case in point: Since 2009, Torrance, California-based HealthCare Partners Affiliates Medical Group has provided its House Calls program to recently discharged high-risk, frail and psychosocially compromised patients. House Calls sends providers into patients' homes to provide, coordinate and manage care for the medical group's Medicare Advantage and commercially insured HMO patients.

After being involved with the program for three months, patients were admitted to the hospital less often--and per-month utilization and spending continued to decrease, even six months after patients left the program.

On physician-led care teams, called pods, nurse practitioners (NPs), social workers and medical assistants work with 7,925 patients, most of whom have multiple comorbidities, such as 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).

NPs are the linchpin in the program, where they develop patients' care plans while monitoring them and communicating updates to primary care physicians. Social workers assess patients in their home environments, where they can isolate potential issues such as fall risks, medication organization, social isolation and financial concerns and provide food and nutrition coaching. 

The program isn't the only one that has had success with house calls. About 1,400 miles southeast of Torrance, an Austin, Texas-based urgent case business sends out a two-clinician team in a van with medical supplies to sick children and adults in their homes. Remedy Urgent Care commits to arriving at the patient's home within 90 minutes and allows patients to avoid a trip to the doctor's office or emergency room, FiercePracticeManagement previously reported.

Still, not all forays into providing house calls are successful: While his patients were able to schedule appointments online and he had access to their patient records, Jay Parkinson, M.D., was unable to see more than eight patients each day because of the need to travel to each patient's home and always be stocked with the right supplies.

To learn more:
- read the study abstract

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