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 Needs and Opportunities - Why Home-based Primary Care? The rising age wave. High health care costs. Poorly coordinated care. The unmet needs of our complex, frail elderly population are no secret. The good news is that there is quite strong literature evidence pointing to the beneficial impact of interdisciplinary, mobile, coordinated, in-home medical care when applied to these high-risk patients. Homecare patients and health care providers experience:
The following supporting evidence was reviewed in detail in the February 2009 Clinics of Geriatric Medicine: Targeting high-cost, function-limited, medically complex patients and delivering care in a way that reduces need for and use of acute care settings are primary keys to success both in quality care and cost containment. Sadly, only about one tenth of the estimated home visits needed to adequately care for this population are now made. The main barrier is the inadequate payments and lack of incentives to support in-home medical care. This gap in public policy must be brought to the attention of our national leaders at this pivotal time as we are considering substantive health reform for the first time in decades. The Public Policy Committee of the American Academy of Home Care Physicians has led in the design and promotion of federal health care legislation to serve the needs of this population. We have also advocated that care coordination proposals should be funded on a shared savings basis, so that the programs cover their own costs and offer significant savings to the Medicare program by aligning incentives. The Academy and its representatives have been educating Congressional staff on the health reform legislation-writing committees about the needs and opportunities for service to this very sick, high cost Medicare population, highlighting the value of this home and community-based approach to health care reform. We estimate that these programs would be able to reduce acute care (hospital, ER and ambulance use) by 25 to 30 percent in this population, while improving their care and outcomes. Additionally, one of the important, immediate benefits will be to create an economic engine to grow the workforce of geriatric medical care providers as recommended by the Institute of Medicine. The segment of the population aged 85 and over is growing. If we do not act, this high cost, sickest segment of the population will continue to contribute to the bankruptcy of the Medicare program. AAHCP has proposed the only initiative that has a reasonable chance of changing the care trajectory for this very sick group; all others, including the Patient-Centered Medical Home, bundling of payments to hospitals and transitional care benefits, are either designed for other populations, or are too weak, too slow, or too transient. AAHCP has articulated the only answer that will really work for these particular patients, and it is truly patient-centered. |
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