Home‐Based Primary Care: A Needed Primary‐Care Model for Vulnerable Populations

Abstract

Home-based primary care has a long history in American medicine, and its prevalence is again increasing slowly in the United States in response to a changing demographic, societal, and health-policy climate. There are many models of home-based primary care, including private practice, academic, Veterans Affairs-associated, and concierge practices. There is a growing body of literature supporting the effectiveness of the medical house-call model. New healthcare reform initiatives could further impact the number and size of home-based primary-care practices, including the Independence at Home and the Accountable Care Organization demonstration projects.

The Critical Role of Social Workers in Home-Based Primary Care

“…The Independence at Home demonstration project is an example of how shared savings from cost-effective, home based care of frail elders can then be used to financially support the costs of a team based approach to care (Center For Medicare And Medicaid Innovation, 2012). Accountable Care Organizations and Patient Centered Medical Homes may provide further opportunities for funding of home based primary care programs that incorporate social work services into routine medical care (DeCherrie et al, 2012). …”

“…Concierge medicine practices, where an annual fee is paid to cover the costs of enhanced physician services, may offer home based primary care. Yet these models of care rarely employ a multidisciplinary team that includes social workers and instead providers refer to community based services as needed (DeCherrie, Soriano, & Hayashi, 2012). While multidisciplinary teams are more common in academic and Veterans Affairs home based primary care programs, the structure of these teams is highly variable (DeCherrie et al, 2012; Hayashi & Leff, 2012).…”

“…Yet these models of care rarely employ a multidisciplinary team that includes social workers and instead providers refer to community based services as needed (DeCherrie, Soriano, & Hayashi, 2012). While multidisciplinary teams are more common in academic and Veterans Affairs home based primary care programs, the structure of these teams is highly variable (DeCherrie et al, 2012; Hayashi & Leff, 2012). While physicians may provide direct patient care, they may also function in a supervisory role while other providers such as nurse practicioners and nurses provide the bulk of direct patient care.…”

Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program

“…Like other home-based medical services, current fee-for-service reimbursement is often inadequate to cover significant operational and personnel costs of home visits including travel to and from patients’ homes (Desai, Smith, & Boal, 2008). While future health care reforms that focus on reducing unnecessary utilization may provide alternative funding sources to treat the most complex patients (DeCherrie, Soriano, & Hayashi, 2012), in a fee-for-service system in-home psychiatric consultation is only financially viable if a high volume of visits per day is possible. While home visits may generate inpatient psychiatric admissions, the goals of HBPC program are usually to keep patients out of the hospital and inpatient admissions should be considered a minor source of sustainability.…”

A Home-Based Intervention’s Impact on Caregiver Burden for Veterans With Dependence Performing Activities of Daily Living: An Interdisciplinary Approach

“…The VHA's Office of Geriatrics and Extended Care (GEC) offers the Home Based Primary Care (HBPC) program, which has been shown to maximize both the veterans' and the caregivers' well-being (Campbell, 2012;Campbell et al, 2014;DeCherrie, Soriano, & Hayashi, 2012;Edes, 2010;Ornstein, Smith, & Boal, 2009). HBPC is a longstanding evidencebased national program offering home based professional interdisciplinary interventions and services to veterans and their caregivers (Beals & Edes, 2009;U.S.…”