Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use

Abstract

While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population.

Medicaid Cost Savings of a Preventive Home Visit Program for Disabled Older Adults

“…The magnitude of these savings in relation to the average cost of CAPABLE per participant of $2,825 suggests that the CAPABLE program is likely to save Medicaid significantly more than it costs. This is in addition to the more than $10,000 per year in Medicare savings for CAPABLE participants, in inpatient and outpatient care …”

“…An external evaluator contracted by CMS found CAPABLE to be associated with lower Medicare costs over a 2‐year period than in a matched comparator group, but the evaluator did not examine the effects of CAPABLE on Medicaid‐covered services or expenditures. Therefore, the current study sought to estimate the cost savings to Medicaid for participants who received the CAPABLE program.…”

Targeting Function at Home in Older Adults: How to Promote and Disseminate Promising Models of Care?

“…Medicare savings also were demonstrated for CAPABLE; therefore, fee‐for‐service Medicare providers engaged in accountable care organizations and Medicare Advantage plans are likely to consider offering CAPABLE to their dually eligible members as a benefit. CAPABLE investigators are beginning to test their service in partnership with these types of providers …”

“…All study enrollees were required to have self‐reported difficulty performing at least one activity of daily living (ADL) or two instrumental ADLs (IADLs). Although this study demonstrated Medicaid cost savings, previous publications have shown that receipt of CAPABLE services is associated with clinically significant improvements over time in self‐reported performance of ADLs and IADLs and with savings in Medicare costs . Although none of these studies were randomized trials, the comparator group was constructed using rigorous matching techniques, and as the authors noted, they are conducting a randomized trial of CAPABLE in which the control group receives attention similar to that given in the CAPABLE protocol.…”

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components

“…Evidence for a positive effect of coordinated preventive care interventions on quality of life and independent functioning among older persons is mixed (Beswick et al, ; Wind et al, ; Mayo‐Wilson et al, ; Ruiz et al, ). This may be explained by differences in groups reached by the intervention, fidelity to the intervention and context of implementation.…”