Abstract
This article describes the forces behind the resurgence of home-based primary care (HBPC) in the United States and then details different HBPC models. Factors leading to the resurgence include an aging society, improved technology, an increased emphasis on home and community services, higher fee-for-service payments, and health care reform that rewards value over volume. The cost savings come principally from reduced institutional care in hospitals and skilled nursing facilities. HBPC targets the most complex and costliest patients in society. An interdisciplinary team best serves this high-need population. This remarkable care model provides immense provider satisfaction. HBPC models differ based on their mission, target population, geography, and revenue structure. Different missions include improved care, reduced costs, reduced readmissions, and teaching. Various payment structures include fee-for-service and value-based contracts such as Medicare Shared Savings Programs, Medicare capitation programs, or at-risk contracts. Future directions include home-based services such as hospital at home and the expansion of the home-based workforce. HBPC is an area that will continue to expand. In conclusion, HBPC has been shown to improve the quality of life of home-limited patients and their caregivers while reducing health care costs.
Highlights
Home-based primary care (HBPC) provides quality, patient-centered care for people underserved in the current healthcare paradigm where the patient must travel to the provider
While HBPC practices take many forms based on their particular goals and business plans, these models are united by their focus on providing high quality, compassionate care in the home for those with the highest level of medical need and achieving cost savings
The change in course is due to overcoming the barriers for HBPC, as well as new factors that invigorated demand: increasing number of individuals with multiple chronic conditions and disability, federal legislation that allows people who would otherwise be institutionalized to remain at home, and an increasing focus on value-based care driven by Medicare
Summary
Home-based primary care (HBPC) provides quality, patient-centered care for people underserved in the current healthcare paradigm where the patient must travel to the provider. The ability to seek medical care is further diminished when a person has little social support and/or financial resources, such as family members to take them to appointments or funds to make accessibility modifications for their home. These access barriers lead to missed appointments, fragmented care, and poor control of chronic conditions. HBPC provides a way for patients with high-cost, complex, and function-limiting conditions to receive comprehensive, longitudinal primary medical and social care in their homes, and thereby avoid emergency room visits, acute hospitalizations, and institutionalizations. Operating in the home environment gives the provider an opportunity to learn things that one could never discover in a typical clinic, such as the way a patient stores their medication (or not), the fall hazards a patient faces on their way to the bathroom, the empty refrigerator accounting for that involuntary weight loss, or the stress of a grandchild who had to quit her own job in order to serve as full-time caregiver
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