60 Insurance Coverage and Cost of Patients Enrolled in an Acute Care at Home Pilot Project for Emergency Department Patients

Abstract

Accountable care organizations (ACOs) are increasing in number across the United States with the goal of providing value-based, high-quality care. Innovative health care initiatives will help facilitate this goal. The objective of this study was to describe the insured status of patients and cost of those who were enrolled in a pilot program in which patients were treated at home as an alternative to hospital admission for acute medical conditions. This was a prospective cohort study conducted at a tertiary care university hospital’s emergency department (ED) from March 15, 2016 through May 30, 2017. Included were patients > 18 years of age who met eligibility criteria for treatment at home for their acute condition as part of participation in a pilot program called Acute Care at Home (ACH). Part of eligibility for participation in this pilot program included a screen of the patient’s insurance coverage to ensure that insurance coverage for home health would be allocated to the patient. The primary insurance billed for home health services among included patients was used for analysis. Descriptive statistics of the enrolled patients’ insurance status is reported. During the defined time period, a total of 70 patients were enrolled in the ACH program. The most common diagnoses were cellulitis (48.6%) and pneumonia (17.1%). Thirty-two (45.7%) patients were female and 52 (74.3%) were age 65 or older. A total of 53 (75.7%) patients’ home health care was insured by Medicare. Another 15 (21.4%) were insured by a commercial plan and 2 (2.9) were insured as part of the state’s Medicaid program. Overall, the average cost for ACH care including ED facility charges, professional fees, and home health care was $3,360 and ranged from $1088 to $7,381. This is significantly lower than the average cost of inpatients services for cellulitis and pneumonia ($15,929 and $15,262, respectively). Offering home health care for patients with acute conditions as an alternative to hospital admission may be a value-based consideration to offer as part of a ACO, particularly a Medicare ACO, given the number of patients in this project who were insured by Medicare. Further comparison analysis of any cost-savings incurred as a result of alternatives to admission is needed.