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Perspective

Health care home visits making a comeback

| Aug 01 2016
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Among the Medicare population, close to  90% of deaths are associated with chronic illnesses, including cancer, diabetes, chronic liver disease and dementia.

Doctor home visits were a mainstay in patient care back in the 1950s. By 1980, house calls represented less than one percent of doctor visits in the U.S. Now as health care becomes more patient-centered again, home visits are making a comeback.

Today’s house calls are not your grandparents’ house calls. Home visits can involve high-tech equipment including in-home tests for infections and portable x-ray machines. These visits are typically led by physicians and nurse practitioners and can also include physician assistants, pharmacists, social workers and other staff depending on the needs of the patient.

For patients and families this means better, more coordinated care. The advantages are substantial because a home-based care team can get a more timely and comprehensive view of the individual patient’s needs. High-quality, home-based care can also alleviate the difficulty in getting to a doctor’s office for people with many chronic conditions and challenges performing daily life activities.

The trend may also help attract higher numbers of talented young doctors who are drawn to new models of team-based care.

Medicare Advantage beneficiaries who had an in-home assessment experienced a 14 percent reduction in admissions to hospitals compared to their traditional Medicare counterparts.

The Centers for Medicare & Medicaid Services (CMS) is also testing a new model in Medicare fee-for-service called Independence at Home. The initiative is designed to help frail seniors avoid unnecessary emergency room visits and hospitalizations. The assumption is that doctors and nurses making a home visit are more likely to notice changes in their patient’s condition before a crisis arises.  Early detection can improve health outcomes and reduce costs for Medicare beneficiaries with multiple chronic conditions. 

Recent results from Independence at Home found that over 8,400 participants were able to receive high quality care in their home and saved Medicare over $25 million in the first performance year of the three-year study. That translates to about $3,000 of savings per patient.

older woman thinking

The results show that these modern house calls can work. The high level of access and coordination improves the quality of care while lowering costs.

Perhaps most important, though, is the approach allows people to be where they want to be — at home.

Author’s note: At Aetna, physicians in our network completed over 15,000 home visits for people in our Medicare plans in the past year, in addition to tens of thousands of nurse-led home visits to provide skilled care.  The company offers annual home visits for many Medicare members to identify home safety issues, review medication regimens, assess chronic condition status and encourage age-appropriate health screenings. Sometimes the most success is found by meeting people where they are, which is how Aetna is moving toward building a healthier world.