Home-Based Primary Care Can Lead To Modest Improvements In Avoidable Hospitalizations

The utilization of home-based primary care (HBPC) for high-need, high-cost patients could lead to lower rates of potentially avoidable hospitalizations after two years of care.

That’s according to a new study published in the Journal of General Internal Medicine. However, the study did not find any conclusive evidence that showed HBPC reduces avoidable hospitalizations in the first year.

“This suggests that the impacts of HBPC may take time to accrue,” Laura Kimmey, principal researcher with the data solutions and research firm Mathematica, told HHCN. “For example, developing a trusting relationship and effective communication through HBPC can allow primary care providers to become aware of acute issues and worsening chronic conditions so the provider can address the problem early.”

Kimmey and her colleagues conducted a matched retrospective study to examine patients two years before and two years after their first at-home primary care visit.

The results showed that at-home primary care reduced total hospitalization rates overall — although minimally — and reduced potentially avoidable hospitalization rates by 3.1% in the second year.

“This study cannot definitively answer why HBPC did not translate into statistically significant reductions in total hospitalization rates for high-need, high-cost patients,” Kimmey said. “It is possible that HBPC reduces total hospitalizations for high-cost, high-need patients in certain circumstances, but on average, we found that this was not the case.”

It’s important to note that the study involved all HBPC providers in the U.S. caring for Medicare patients. This encompasses many clinicians for whom HBPC isn’t the main focus of their care, Kimmey added.

Home-based care providers have recently been eager to delve into the world of HBPC, with the hopes that primary care in the home could unlock value and create long-term earnings capabilities.

Larger retailers have done the same.

CVS Health (NYSE: CVS), for instance, has shown its growing interest in primary care with the $10 billion purchase of the primary care provider Oak Street Health, which also provides home- and community-based primary care.

Walgreens Boots Alliance (Nasdaq: WBA) is doing the same with the primary care provider VillageMD.

CVS Health, Walgreens and Humana Inc. (NYSE: HUM) are banking on the idea that the implementation of home-based primary care programs can reduce health care disparities and enhance patient outcomes.

Kimmey believes there’s good reason to follow that logic.

“There are plausible reasons to believe these programs might reduce disparities,” she said. “Traveling to an office for primary care presents a financial burden for some people and HBPC might allow these patients to receive care that they would otherwise forgo. In some cases, providers may identify issues like poor medication storage and adherence or health-related social needs like food insecurity or unsafe housing.”

Home-based primary care also allows the clinician to collect information they wouldn’t be able to in an office visit.

As more assistance-level care shifts away from traditional settings and into the home, primary care is still more common in assisted living facilities than the home.

“Home-based primary care, among patients enrolled in traditional Medicare, is more common and growing faster in assisted living facilities than in private homes and apartments,” Kimmey said. “Yet those in private residences may face more barriers when it comes to accessing health care services. It’s important to compare the effectiveness of HBPC between assisted living facilities and private residences.”