Clinical Home Visits Reduce Hospital Admissions for Medicare Beneficiaries

A new study finds that Medicare recipients can prevent hospital admissions if they seek medical assessment from clinical home visits, which increase the number of visits to the doctors while reducing the costs of health care because of treatment in less-costly sites.

Soeren Mattke, senior scientist at Rand Corporation, led the new study along with Dan Han, Asa Wilks, and Elizabeth Sloss. The study used quantitative and qualitative data from patients enrolled in the HouseCalls program operated by UnitedHealth Group’s information and technology-enabled health services business, Optum.

Under this program, a physician or nurse practitioner visits the Medicare recipient’s home and conducts an exhaustive geriatric assessment of their health. They also provide referrals to community providers and health plan resources to address any pending issues.

The team studied the experiences of the Medicare beneficiaries eligible for the HouseCalls program from 2008 through 2012. The scope of the study was spread across Arkansas, Georgia, Missouri, South Carolina, and Texas.

A majority of the Medicare recipients included in the study were 65 years old and were likely to have multiple chronic conditions in 2010. The beneficiaries also had troubles receiving primary care, either because of financial issues or social. This eventually would have increased the chances of their symptoms worsening resulting in emergency room visits, hospitalizations, and nursing home admissions.

The experiences of these beneficiaries were compared to other Medicare recipients enrolled both in traditional fee-for-service Medicare plans and in Medicare Advantage plans without this benefit.

The team observed that sending a physician or nurse practitioner to a Medicare recipient's home for a comprehensive health assessment resulted in fewer admissions to hospitals or nursing homes over the subsequent year. It also reduced the cost of getting admitted or being treated in hospitals that have their own costs associated.

When compared to other Medicare recipients enrolled in traditional fee-for-service health programs, the Medicare recipients enrolled in the clinical home visit program had 14% fewer hospital admissions in the next year. They even projected a lower risk of admission to nursing homes over the 12 months after evaluation.

The participants experienced an increase in their visits to the physicians and specialists. This increase to physicians was from 2% to 6% in the subsequent year after the evaluation. The program’s effects on the emergency department use was mixed and hence, inconclusive.

“We found that a home visiting program can lead to meaningful cuts in the amount of in-patient care used by Medicare patients,” said Mattke. “This is significant since many other strategies to reduce in-patient care among Medicare recipients generally have been unsuccessful.”

The findings of the study largely propose that a comprehensive health assessment provided at the beneficiary’s home encourages physician office visits and anticipates future illnesses that could result in costly institutional care.

The positive combination of the home environment coupled with the referral services is a promising approach to supporting aging in place. It also avoids hospital admissions, which could increase the cost of health care for the Medicare beneficiary.