Volume 62, Issue 10 p. 1954-1961
Models of Geriatric Care, Quality Improvement, and Program Dissemination

Better Access, Quality, and Cost for Clinically Complex Veterans with Home-Based Primary Care

Thomas Edes MD, MS

Corresponding Author

Thomas Edes MD, MS

Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia

Address correspondence to Thomas Edes, Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420. E-mail: [email protected]Search for more papers by this author
Bruce Kinosian MD

Bruce Kinosian MD

Division of Geriatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania

Geriatrics and Extended Care Data Analysis Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Search for more papers by this author
Nancy H. Vuckovic PhD

Nancy H. Vuckovic PhD

Health Strategies and Solutions, Intel Corporation, Portland, Oregon

Search for more papers by this author
Linda Olivia Nichols PhD

Linda Olivia Nichols PhD

Caregiver Center, Veterans Affairs Medical Center at Memphis, Memphis, Tennessee

Preventive and Internal Medicine, University of Tennessee, Health Science Center, Memphis, Tennessee

Search for more papers by this author
Margaret Mary Becker LCSW

Margaret Mary Becker LCSW

Veterans Integrated Service Network 1, Geriatrics and Extended Care, Veterans Affairs New England Healthcare System, U.S. Department of Veterans Affairs, Bedford, Massachusetts

Search for more papers by this author
Monir Hossain MS

Monir Hossain MS

Medicare and Medicaid Analysis Center, Field Office, Office of the Assistant Deputy Under Secretary for Health for Policy and Planning, U.S. Department of Veterans Affairs, Braintree, Massachusetts

Search for more papers by this author
First published: 21 October 2014
Citations: 170
[See Editorial Comments by Peter A. Boling and Bruce Leff, pp 1974–1976]

Abstract

In successfully reducing healthcare expenditures, patient goals must be met and savings differentiated from cost shifting. Although the Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program for chronically ill individuals has resulted in cost reduction for the VA, it is unknown whether cost reduction results from restricting services or shifting costs to Medicare and whether HBPC meets patient goals. Cost projection using a hierarchical condition category (HCC) model adapted to the VA was used to determine VA plus Medicare projected costs for 9,425 newly enrolled HBPC recipients. Projected annual costs were compared with observed annualized costs before and during HBPC. To assess patient perspectives of care, 31 veterans and caregivers were interviewed from three representative programs. During HBPC, Medicare costs were 10.8% lower than projected, VA plus Medicare costs were 11.7% lower than projected, and combined hospitalizations were 25.5% lower than during the period without HBPC. Patients reported high satisfaction with HBPC team access, education, and continuity of care, which they felt contributed to fewer exacerbations, emergency visits, and hospitalizations. HBPC improves access while reducing hospitalizations and total cost. Medicare is currently testing the HBPC approach through the Independence at Home demonstration.