Caregiver Stories HBPC in the News HCCIntel

Family Caregivers’ Experiences With Health Care Workers in the Care of Older Adults With Activity Limitations

frail elderly and caretaker
JAMA Article
Original Investigation  |  Geriatrics

January 24, 2020

Authors: Jennifer L. Wolff, PhD; Vicki A. Freedman, PhD; John F. Mulcahy, MSPH

Key Points

Question  What are family and unpaid caregivers’ experiences with health care workers in the care of older adults with activity limitations?

Findings  In this national survey study, most caregivers reported that older adults’ health care workers always (70.6%) or usually (18.2%) listened to them and always (54.4%) or usually (17.7%) asked about their understanding of the older adult’s treatments, but fewer caregivers reported being always (21.3%) or usually (6.9%) asked whether they need help managing older adults’ care.

Meaning  These findings reinforce the need for health system strategies to support family and unpaid caregivers, who are the main source of assistance to older adults with physical and/or cognitive limitations.

Read the article

HBPC in the News HCCI in the News HCCIntel

Being Treated at Home Can Help People Save Money and Heal Faster


  • A new study found that the home hospital model can potentially improve care while reducing costs.
  • The cost of care was nearly 40 percent lower.
  • Trial participants receiving hospital care in their homes had a 70 percent lower rate of readmission to the hospital.

People check into the hospital expecting to get better, but there are risks — and some even wind up getting sicker.

You can face the danger of complications, like bleeding or infection. There are also the constant check-ins from nurses or physicians that can disrupt sleep.

And none of that includes the cost.

Additionally, when in a hospital, people are stuck in their hospital beds and many experience negative health impacts from this physical inactivity.

However, a pilot study by investigators at Brigham and Women’s Hospital in Boston finds that the home hospital model can potentially improve care while reducing costs. The findings were published in Annals of Internal MedicineTrusted Source today.

“Hospital at Home (HaH) as the name states, cares for hospital-eligible patients at home. Models vary, but generally patients seen in the emergency room that require hospital-level care are given the option of intensive care at home,” said Thomas Cornwell, MD, founder of Northwestern Medicine HomeCare Physicians and chief executive officer, Home Centered Care Institute (HCCI).

First study of its kind

“To date, there has not yet been a randomized controlled trial of home hospital care performed in the U.S. other than our small pilot,” David Levine, MD, MPH, MA, the study’s corresponding author, told Healthline.

The results of Dr. Levine and team’s randomized controlled trial (RCT) can strengthen the case for home hospital care, showing that it reduces costs and readmissions while increasing physical activity compared with usual hospital care.

“We wanted to show with a very high level of evidence that home hospital care could be delivered to acutely ill adults with lower cost, better physical activity, high quality and safety, and excellent patient experience,” said Dr. Levine.

“In addition, we feel this gives all Americans the information they need to choose the care for themselves and their loved ones should they need hospitalization,” he said.

Cost of care was nearly 40 percent lower

Levine and team enrolled 91 adult patients into the trial.

Each participant had been admitted via the emergency department at Brigham and Women’s Hospital or Brigham and Women’s Faulkner Hospital with acute conditions that included infection, worsening heart failure, worsening chronic obstructive pulmonary disease (COPD), and asthma, that lived within 5 miles of the hospital.

They were randomized either to stay at the hospital for standard care or to receive care at home, including nurse and physician visits, intravenous (IV) medications, remote monitoring, video communication, and point-of-care testing.

Researchers measured the total direct cost of care, including costs for nonphysician labor, supplies, tests, and medications.

The findings indicate that patients receiving at-home care had total costs that were almost 40 percent lower than for patients treated conventionally.

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HCCIntel Practice Management Tip of the Month Training & Education

Evaluating Your Staffing Model

Home-based primary care staff

Staffing costs are responsible for the largest share of a house call program’s expenses, so it is essential that staffing is appropriate to meet the needs of patients in the service area without sacrificing productivity. To enhance sustainability, a house call program should be evaluating its staffing on a regular basis. Some questions to consider:

  • Are schedules full? Are patients able to schedule timely appointments?
  • Are patients experiencing long hold times or abandoned phone calls?
  • What is the average wait time for a new patient?
  • Does schedule allow for prompt post-acute follow up?
  • Are patients able to obtain timely RX refills, prior authorizations, and referrals or do you receive complaints often?
  • Are all team members working to the top of their scope or burdened with administrative tasks?
  • Are in-basket (EHR) or incoming messages addressed or reviewed by end of the day or do several remain unopened and/or unaddressed for the next day?
  • Are lab and diagnostic test results reviewed and responses provided to patients in a timely manner?

Also, don’t forget that your practice can leverage a variety of data and metrics to evaluate if the staffing is appropriate. For example:

  • Incoming call volume
  • Average messages per day addressed by clinical staff and provider team
  • Productivity per providers and practice as a whole
  • Average increase of new referrals and referral source
  • Days from referral to first visit and days to transitional care visits from discharge
  • Annual patient, provider, and employee satisfaction surveys

Remember, there is no “one size fits all” staffing model. Consider your program’s mission, business plan, and patient population to determine what’s best for your practice, and then capture and regularly review meaningful practice metrics. By keeping a regular focus on these critical data, you will be able to ensure your program’s staffing is aligned with productivity targets and is appropriate to meet needs within the service area.

HCCIntel Training Training & Education

New HCCI Online Course Helps Take the Mystery Out of Home-Based Primary Care

About the Article:

Have you ever wondered what a career in home-based primary care would be like? According to Heather Hodge, Director of Education for the Home Centered Care Institute (HCCI), the organization’s new online course, House Calls 101: An Introduction to HBPC, is a great way to find out.


While home-based primary care (HBPC) is a growing field, many providers may not fully appreciate the numerous benefits of seeing patients in a home-based setting, nor understand how practicing within an in-home environment may differ from an office-based setting. In addition, many HBPC practice managers and operations staff are seeking a better understanding of house call components.

The Home Centered Care Institute’s (HCCI) new online course, House Calls 101, was developed to offer providers, practice managers and operations staff the unique opportunity to virtually shadow an HBPC physician and her medical assistant on a simulated house call.  The course also provides a detailed breakdown of the steps to be taken before, during, and after a home visit, and offers insight into the characteristics and personal qualities of successful HBPC providers.

House Calls 101 is HCCI’s newest online course.  According to Heather Hodge, HCCI Director of Education, the course was developed as a tool to expand the HBPC provider talent pool and give practice managers and operations staff a closer look at what goes into a house call.  “Only about 15% of the patients who truly need HBPC services receive them,” Hodge said, “which correlates directly to the need to expand the HBPC provider network and provide a strong practice management foundation.”

Hodge’s background in the design and development of continuing medical education programs played a key role in creating the 30-minute course. She sat down with HCCInsights to discuss her perspective on the course and its ability to realistically demonstrate what it’s like to be an HBPC provider.

HCCInsights: What was the main objective behind the development of the course?
Hodge: The course is part of HCCI’s overall commitment to developing the HBPC workforce. The demand for HBPC providers currently exceeds the supply, but not every provider is suited for a career in HBPC.  We created this course to give prospective HBPC providers, practice managers and operations staff a realistic and impartial look at what HBPC is like in the real world.

HCCInsights: What are some of the unique features of the course?
Hodge:  It’s more of a primer or introduction to HBPC in general versus some of our other online course offerings that focus on one specific topic, such as Telehealth or Coding. It also introduces video as part of our instruction material for the first time — and is highly engaging with interactive elements.

HCCInsights: What do you think course participants will find most valuable?
Hodge: House Calls 101 de-mystifies the house call process. It walks through each of the main components of a house call ─ from preparing for the day all the way through to completing post-visit activities. In addition, the course covers what it’s like to travel with a Medical Assistant (MA) and takes a deep dive into the Social Determinants of Health (SDOH) that can significantly impact a patient’s health and well-being, and health care utilization. Finally, the course profiles the characteristics and personal qualities required to be successful as an HBPC practitioner.

HCCInsights: Why is it important for HBPC providers, practice managers and operations staff to understand the “Geriatric 5Ms” covered in the course?
Hodge: The “Geriatric 5Ms” is a framework for caring for complex patients. It aligns perfectly with the home-based primary care model; this is what the providers do every day.  It focuses on key areas: Mind, Mobility, Medications, Multi-complexity and Matters Most. These areas are critical to understand because most HBPC patients are older adults with multiple chronic conditions and functional impairments.

HCCInsights: Can course participants earn CME by taking House Calls 101?
Hodge: Yes. House Calls 101 was planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of PeerPoint Medical Education Institute, LLC and HCCI.

To learn more about House Calls 101: An Introduction to HBPC and to register, click here.

HCCIntel Legislative News

HHS and CMS Announce Brad Smith as CMMI Director, Senior Advisor for Value-Based Transformation

January 6, 2020
Press Release from U.S. Department of Health & Human Services

Today, the Department of Health and Human Services and the Centers for Medicare & Medicaid Services announced that Brad Smith will serve as Director of the Center for Medicare & Medicaid Innovation at CMS and Senior Advisor to Secretary Azar for Value-Based Transformation.

Smith most recently served as the Chief Operating Officer of Anthem’s Diversified Business Group and was previously co-founder and CEO of Aspire Health, a healthcare company focused on providing home-based palliative care services to patients facing serious illnesses.

“Brad will help HHS and CMS continue and accelerate the value-based transformation work that we have begun under President Trump,” said Secretary Azar. “Delivering better value in healthcare is a key piece of how we’re executing on President Trump’s healthcare vision. Paying for outcomes rather than procedures through CMMI models is an important tool for the value-based transformation of healthcare that President Trump has prioritized. Brad has impressive experience with innovative care delivery and paying for value, and he will help expand Administrator Verma’s and CMS’s efforts to ensure Medicare and Medicaid beneficiaries are getting better care, and better health, at a lower cost.”

“Brad’s experience thinking outside-the-box to improve healthcare as a successful entrepreneur, along with his stellar academic and policy background, have prepared him well to lead CMMI and bring innovative solutions to our healthcare system’s most pressing challenges,” said CMS Administrator Seema Verma. “I am excited that we have selected Brad to join the ranks of CMS and help us build on the important work the Trump Administration has undertaken to transform our healthcare system to deliver better value to patients.”