How to bring direct primary care into the home - MedCity News

Homebound patients often struggle with complex medical conditions among the costliest in healthcare. One recent analysis concluded that homebound people aged 70 and older accounted for 11% of Medicare spending in 2015, even though they comprise only 5.7% of the Medicare fee-for-service demographic.

In addition to older Americans, research shows that homebound populations have more chronic conditions on average and are more likely to have been hospitalized in the past 12 months. Further, homebound Americans also commonly face health equity issues related to social determinants of health (SDoH), such as lack of reliable transportation, making it difficult or impossible for them to visit a clinic, hospital or doctor’s office for evaluation and treatment. As a result, their chronic conditions can worsen, leading to poorer health outcomes and higher healthcare costs.

Fortunately, there is growing recognition among healthcare organizations, patient advocacy groups and policymakers that patients tend to be happiest and healthiest when they’re in the home. “The home environment is the most authentic place someone can receive care, says  Monique Reese, senior vice president of Highmark Health. “It’s where people live, raise families, have dinner, and where they make difficult decisions.”

The increasing number of homebound Americans and the growing realization that patients do better in their homes is fueling a shift toward primary care in the home. McKinsey estimates that up to $265 billion worth of care services (representing up to 25% of the total cost of care) for Medicare fee-for-service and Medicare Advantage beneficiaries could shift from traditional facilities to the home by 2025.

Delivering basic healthcare services and providing help with daily activities require a team-based approach to primary care that includes non-traditional providers such as community-based organizations (CBOs) and social service agencies. This means a primary care provider may visit some patients in their homes two or three times a year, with allied and affiliated care providers delivering other services as needed to the patient, such as wellness visits, nutritious meals, groceries, and assistance with daily activities.

Having skilled nurses, social workers, lab technicians and other ancillary service providers in the environment where patients are most comfortable – their homes – enables homebound Americans to be monitored more closely and develop trusted relationships with primary care providers and care team members. Such a coordinated approach helps reduce a patient’s social isolation, a condition that can negatively impact mental and physical health among homebound populations.

A big part of a homebound patient’s success in managing one’s own care to the extent possible is having a trusted relationship with a primary care provider. For this reason, direct primary care (DPC) – an alternative payment system that eliminates fee-for-service payments and third-party billing – is becoming an increasingly popular care delivery model for patients concerned about rising healthcare costs and providers eager to reduce administrative burdens. DPCs are built upon and enhance those critically and clinically important patient/primary care provider relationships.

One recent study analyzing the impact of DPC on health outcomes and costs concluded that DPC members had 25.5% lower hospital admissions, while the cost of ER claims was reduced by 53.6%. The improved outcomes, better patient experience, reduced paperwork, and lower costs generated through DPC payment models can help smaller practices remain independent.

So too can strong working relationships with CBOs, allowing smaller practices to thrive while ensuring patient needs are met where they are. To successfully integrate CBOs into a care network, providers must deploy technologies that offer support for onboarding, data capture, digitization, and exchange. These technologies also must support SDoH, quality reporting and other use cases.

While many smaller providers have digital infrastructures in place, these are unlikely to offer support for enabling the many-to-many complex relationships between different entities required for coordinated care of patients in their homes. Integrating CBOs into a care network requires:

Homebound Americans are among our most vulnerable populations. As more primary care is delivered into homes through DPC and more traditional care models, a collaborative, team-based approach involving multiple disciplines and services is essential to improving health equity for those who need it most. A scalable, cloud-based digital infrastructure can allow independent providers and CBOs to coordinate care, services, and reimbursements.