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Keeping Humanity in House Calls: How One Question Can Change So Much

May 15, 2020

About the Article: HCCInsights sat down with Dr. Thomas Cornwell, Executive Chairman, Home Centered Care Institute, to learn how he keeps humanity in house calls, especially during the COVID-19 pandemic, when stress and feelings of isolation can be elevated in many patients and caregivers.

HCCInsights: What is key to keeping humanity in house calls – especially during COVID-19?  And, how do you draw out what’s going on with patients when you’re seeing them in a home setting?

Dr. Cornwell: Overall, it’s important to stay focused throughout on the geriatric 5Ms, which are Mind, Mobility, Medications (polypharmacy can be a problem and we need to be skilled at de-prescribing), Multi-complexity which is why most of these patients cannot leave the home, and the most important “M” of all, which is What Matters Most to the patient. We don’t just start with their conditions and symptoms.

What Matters Most is part of every house call I make. It’s important to make the patient feel valued and ensure they know there is a caring practitioner available to help them 24/7 whenever they have a problem. When you ask a patient what matters most to him or her, it also opens a window to their emotions. It can help you understand how they’re being affected by any given situation in their life, gauge their level of loneliness, identify whether they’re experiencing anxiety or changes due to things like COVID-19, and so on.

Understanding what matters to the patient helps guide all care. For example, if you find out that what matters most to your patient is avoiding the hospital, that piece of knowledge will help guide your decisions and the advice you offer because you’ll know to focus on things that can be accomplished within the home environment.

[Editor’s Note: See also the “4M’s” approach that appears in Age-Friendly Health Systems,” an initiative of The John A. Hartford Foundation and Institute for Healthcare Improvement in partnership with the American Hospital Association and Catholic Health Association of the United States.]

HCCInsights: You’ve mentioned that you like to ask new patients to talk about something they’re proud of.  Why is that such an important question?

Dr. Cornwell: It’s part of my approach to patient-centered care and establishing a relationship and moving it forward. Not surprisingly, most of the time, I hear they’re most proud of their children and grandchildren.

Some other examples also come to mind. Like I’ve had female patients in their 80s and 90s tell me about earning their Ph.D. back in the 1930s or 40s when it was an exceedingly rare achievement for women. It is incredible to hear their stories about what it was like breaking through the barriers they faced at the time.

I’ve also heard stories from someone who was a Top Gun pilot and another who was an Olympic athlete. Also, one of my patients worked with Neil Armstrong.  Another served as a military driver to Jacqueline Kennedy Onassis. Rather than starting with their problems, I start with their life highlights.

When patients begin to share some of their personal information, it also opens them up to sharing other things, like how their mood has been, whether they’ve been feeling depressed or anxious, and so forth. Talking with the patient about their feelings helps reinforce that I listen and care. It also helps me better understand my patient on a more personal level.

I actually started asking this question years ago after one of my patients with advanced dementia passed away. That patient was never able to talk with me, and it was only from his obituary that I learned he had been a famous inventor and past president of a national professional organization.

You know, much of the home-based patient population is currently comprised of members from “The Greatest Generation.” They are amazing people with amazing stories who have lived history, and I feel it’s important to affirm to both the patients and their families how great an honor it is to care for such remarkable individuals… and every one of them is remarkable.

HCCInsights: How do you stay engaged on a personal level with the patient’s caregivers?

Dr. Cornwell: There are multiple aspects to that. First, I intentionally praise the caregivers all the time. If it weren’t for caregivers and all the sacrifices they make, home-based primary care providers wouldn’t have jobs. It’s because of the caregivers that two to three million patients are being cared for at home today – patients who suffer the same degree of infirmity as the million or so patients who are in nursing homes. A major difference is 100% of nursing home patients have a provider in the nursing home, while only 15% of homebound patients have a provider that makes house calls.

It’s also important to acknowledge caregivers as the real heroes. They find themselves in nursing roles they never imagined being in and that they were never really trained to do. In fact, there’s often an incredible lack of training provided to caregivers when their loved one leaves the hospital and it can be overwhelming.

So, in addition to praising caregivers, we also do a lot of training around medication management, wound prevention and treatment, tube feeding, how to use oxygen equipment and walkers, and much more. Through training, we help them feel more confident and comfortable in their roles and we do it because we want them to know we’re in this together.

That’s an important thing for them to know because, as seen during a focus group with caregivers conducted in the past with the University of Illinois at Chicago, we learned it was vitally important to caregivers to know they were not alone and that a competent, caring provider was available 24/7 to assist them with care of their loved one. As we also know, there’s a real need in the human spirit to not feel alone and it’s especially true when we’re talking about caregivers for homebound patients.

Remember also that many of these caregivers are part of the “sandwich” generation, meaning they are taking care of their children and their parents simultaneously, and it’s amazing that without formal medical training, they are caring for such medically-complex patients so lovingly at home. Acknowledging their role and contributions, and providing training and emotional support, plays a big part in making it all work.

HCCInsights: What do you do when a patient is having a bad day?

Dr. Cornwell: The old cliché goes something like, “Hope for the best, plan for the worst.” I prefer to say, “Hope for the best, plan for the rest.” Plus, it even rhymes better!

On the patient’s “darker” days, in addition to the treatment I provide, I ask them again to tell me what they’re proud of in their lives. For example, I had one patient who had been repeatedly hospitalized for anemia. One day, as he was sitting in a wheelchair, in a vulnerable state, being taken care of by his son and daughter, I sensed his despair. So, I asked him, “Can you tell me something you are proud of?”

He paused and said, “You know, I’m proud of having been on Normandy Beach.” Then he went on to mesmerize me with a story from World War II about being on a Navy ship that was shelling the cliffs of Normandy when the ship got grounded. His platoon had to abandon ship and somehow miraculously survived. Sometime later, while stationed in the Pacific, my patient hurt his ankle and couldn’t join his fellow sailors on one of their missions – a mission in which their ship was torpedoed. Lives were lost, and he didn’t know who lived or died.

In the end, the most amazing thing about this man’s story was that his children had never heard it. He had never talked about it before. Apparently, he had thrown his medals from his time in the service away ─ maybe he suffered from PTSD before we knew what PTSD was. But his children made the effort after hearing his story to call the VA, which replaced his medals. They also found an article online about the ship that had been torpedoed. One of his best friends from the war was interviewed in the story, so he learned his friend had not been among those who perished.

All this came from just one question and at the end of that visit, what did I tell my patient?  I said, “Thank you for my freedom.” It was such a blessing to be able to be a part of that with him and his family.

HCCInsights: How has the COVID-19 pandemic affected your ability to keep humanity in house calls, especially when you’re doing so many virtually right now through telehealth?

Dr. Cornwell: Over the past 45 days or so, 90% of my visits have been through telehealth. I have done face-to-face visits when procedures such as tracheostomy and g-tube changes were required, but in full Personal Protective Equipment (PPE), mainly to protect the patient.

I have been surprised at how effective audio and visual telehealth visits have been. These are supported by the fact that, because of the complexity of our patients, many have blood pressure cuffs and pulse oximeters at home ─ so I can get vitals. Using the audio/visual technology, I can also see how they are looking, how their leg edema or wounds are doing and so on.

Two cases have been particularly rewarding. One patient was at an assisted living facility and I was able to do a three-way video call with the daughter at her home and the nurse with the patient at the facility. It was the first time the patient was able to see her daughter in over a month, and I just sat back and let them get caught up for the first five minutes of the visit. Another younger patient had been having great difficulties. I was able, with telehealth, to make weekly virtual visits that I could not have done if I had to drive to his home every week. It really helped improve his care.

Overall, the patients and caregivers have greatly appreciated the telehealth visits. These visits, of course, are not a long-term replacement for in-home visits but complement them, especially during this challenging time.

HCCInsights: Being a house call provider is obviously not easy, so what is it about home-based primary care, and that human aspect of it, that makes it so rewarding?

Dr. Cornwell: There are many things that make home-based primary care rewarding.  As a provider, I am meeting patients in their home, seeing their artwork, their photographs, and their environment. I am seeing who they are through a completely different lens versus seeing patients in a nursing home or other clinical setting where it’s so much easier to lose the personal touch.

When you see patients in their homes, you must slow down. Home-based care is a 100% immersive experience and you learn an enormous amount about a patient within seconds, even before a single word is exchanged.

This type of care also requires the provider to be humble, as the traditional “balance of power” is shifted to the patient and family when you are in their home versus an office or clinic setting.  At the same time, you need to be sensitive to cultural differences which is another part of keeping humanity in the house call.

The home environment itself is also a factor in the patient’s overall well-being that must be considered. For example, if the patient is someone in a hoarding situation who also has problems with leg swelling, you may find that their environment makes it difficult to elevate their legs, making their condition worse, and so you must deal with that.

Finally, the difference you can make in the lives of homebound patients is unbelievable. Most homebound patients receive fragmented care, often through repeated hospitalizations. For elderly patients with multiple chronic problems, not only is this poor care, it is expensive care. Home-based primary care makes such a profound difference in their lives and the lives of their caregivers, by giving patients quality, longitudinal primary care in their homes and dramatically reducing hospitalizations and going to nursing homes.

HCCInsights: How do you manage conflicting family dynamics when they arise?

Dr. Cornwell: Family dynamics can be challenging. That’s another unique aspect of house calls: it’s impossible to ignore certain situations. If a patient is having difficulty getting medicine or food, for example, the provider needs to step in and ensure the right services are being used.

Conflicts about the patient’s plan of care sometimes must be mediated as well. For example, I like to start with “agreement” among the family members. I might first ask the family members, “Do we all agree that we love Mom?” Once that is agreed on, we move on to treatment decisions where there may be conflicts and try to reach agreement. This is always done by repeatedly asking the family what they think their mom would say if she could speak right then.

Focusing on what matters most to the patient can help reduce emotional tensions and guilt that can arise in making difficult decisions for loved ones.

HCCInsights: Though it’s not often mentioned in technical healthcare conversations, “love” seems to be behind much of what you’ve talked about today. What has your role as a home-based care provider taught you about love?

Dr. Cornwell: It has taught me that, of all the things the patient’s caregivers are doing and responsible for, their single most important responsibility is to provide “Vitamin L” – or “Love.” Love is what keeps people going, sometimes for years longer than anyone would expect, and that is particularly true, for example, with patients who have dementia.

So, I encourage the caregivers and cheer them on because it’s their love for the patients that’s making the difference.

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The Power of Three: Grant Recipients Continue to Advance Home-Based Primary Care

In the Fall of 2019, The John A. Hartford Foundation awarded a three-year, $1.6M grant entitled, Moving and Scaling Home-Based Primary Care Phase II: Quality, Training and Advocacy. The project aims to improve care for the more than two million older adults who are the “invisible homebound” with functional impairments and frailty. This phase builds on the success of the initial grant phase, with the same organizations leading three complementary grants.

While each organization has its own unique deliverables, they continue to work in close collaboration to achieve the overall goal ─ increasing access to high quality, home-based primary care that leads to improved outcomes for both patients and caregivers. Following is an overall look at the grant recipients and their respective projects:

  • The American Academy of Home Care Medicine (AAHCM) is charged with developing a home-based primary care (HBPC) national practice directory. “Our mission in phase two is to create an online Home-Based Primary Care National Practice Directory site to connect patients to practices and refer other providers to home-based primary care providers,” said Brent Feorene, executive director for AAHCM. “The site will also serve as a provider resource for timely information about HBPC, new payment policies and educational content on quality of care. Ultimately, this project will help expand services to populations with serious advanced illness.” The directory is being built using a human-centered design process to ensure it encompasses all the information its various users need and is slated to launch during the fourth quarter of this year.
  • The National Home-Based Primary Care Learning Network led by Dr. Christine Ritchie at Massachusetts General Hospital and Dr. Bruce Leff at Johns Hopkins University School of Medicine will work to expand and enhance a national quality improvement Learning Network among HBPC practices. “The Learning Network will be comprised of practices that identify new and ongoing quality and practice issues in HBPC, develop practice-guided strategies to address these issues, and use real-time, practice-based, data-driven initiatives to evaluate the effectiveness of these efforts,” said Naomi Gallopyn, program manager for Massachusetts General Hospital. The group recently completed a similar project with nine HBPC practices and is now seeking applications to grow their Learning Network with an additional 10 practices (deadline is April 24, 2020). For more information, please visit
  • The Home Centered Care Institute (HCCI) will build on its strong foundation and leverage the expertise of its staff, faculty and partners to develop and implement an enhanced multi-modal educational strategy. “HCCI is uniquely qualified to meet the current and growing demand for education and training of the home-based primary care workforce,” said Melissa Singleton, Chief Learning Officer for HCCI. “By further enhancing our offerings around clinical and practice management topics, we are equipping providers around the country with the knowledge and skills to be successful. Ultimately, this grant will help achieve HCCI’s goal of expanding the workforce, enhancing patient and caregiver satisfaction, lowering overall costs, and providing higher quality care for home-limited patients.”

“Increasing access to high-quality, home-based primary care is one profoundly important way that we can make health care more age-friendly and focused on what matters to older adults and their families,” said Scott Bane, JD, MPA, Program Officer at The John A. Hartford Foundation.  “The collaborative work of these three organizations will help more providers deliver the right kind of care in the right place for older adults with the most complex needs.”

About The John A. Hartford Foundation

The John A. Hartford Foundation, based in New York City, is a private, nonpartisan philanthropy dedicated to improving the care of older adults. Established in 1929, the Foundation has three priority areas: creating age-friendly health systems, supporting family caregiving, and improving serious illness and end-of-life care. For more information, visit and follow @johnahartford.

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Thomas Cornwell, MD, Transitions Roles at HCCI and Joins VillageMD

Founder of Home Centered Care Institute transitions from CEO to Executive Chairman and takes on new role with VillageMD

Schaumburg, IL, March 2, 2020

Thomas Cornwell, MD
Thomas Cornwell, MD

The Home Centered Care Institute (HCCI) announced today that its founder, Dr. Thomas Cornwell, will transition his role with the organization from Chief Executive Officer to Executive Chairman, effective March 9, 2020. At that time, he will also become the Senior Medical Director of Village Medical at Home, part of VillageMD.

Since founding HCCI, Dr. Cornwell has played a critical role in fulfilling the organization’s vision to spread home-based primary care (HBPC) to more patients by generating substantial awareness of HBPC and the need for expanding house call programs and the workforce.

HCCI has also played a role in the continuation of the Independence at Home Medicare Demonstration and the Centers for Medicare & Medicaid Services’ New Payment Models; educated over 500 unique learners and 260 HBPC practices; introduced a consulting practice focused on practice management and clinical care; created six HCCI Centers of Excellence for Home-Based Primary Care™; assembled a national faculty of HBPC leaders; and taught over 1,000 students and health system leaders at three medical universities in China along with partnering with Shandong University in Jinan to create an HCCI HBPC training center.

“I am incredibly proud of the team at HCCI and know it is in good hands and well-positioned for the future,” said Dr. Cornwell. “I am excited to be joining Village Medical at Home and combining their operational excellence with my twenty-five years of HBPC experience and clinical skills to further spread house calls nationally.”

Taking on his new role with Village Medical at Home means that Dr. Cornwell will no longer practice with Northwestern Medicine HomeCare Physicians. “I remain forever thankful for Northwestern Medicine’s support of HomeCare Physicians,” said Cornwell. “The numerous awards, media exposure, and national recognition we have received as a house calls practice – and, most importantly, the number of patient and caregiver lives we’ve been able to touch – are all a result of Northwestern’s incredible support.”

HCCI’s Board plans to review the existing leadership structure at their next meeting. In the interim, Julie Sacks, Chief Operating Officer, will continue to manage the daily operations of HCCI. Sacks shared her thoughts on the transition, saying, “Without Dr. Cornwell and our funders, there would be no HCCI. He had the incredible vision and passion to establish an organization that is transforming our health care system. I also consider it an honor to help steward HCCI through this important transition.”

Richard Maybury, Chairman of the Board for HCCI, also shared his perspective, adding, “Dr. Cornwell has been caring for patients in their homes for over 25 years, so his new role is a natural extension of that work. At the same time, HCCI is well-positioned for the future with a strong core of proprietary HBPC education delivered through multiple channels, a growing consulting practice, a key role in HBPC advocacy, a national network of leading academic healthcare institutions and HBPC faculty, and the right combination of experienced and tenured leaders and staff in place to take the organization forward.”

As Executive Chairman, Dr. Cornwell will be a member of the board; continue to act as a strategist; represent HCCI to the public, industry and media; and play a continued role in the organization’s ongoing growth and improvement, including fundraising.

Home Centered Care Institute

The Home Centered Care Institute (HCCI) is a national non-profit organization focused on advancing home-based primary care to ensure that medically complex and homebound or home-limited patients have access to high-quality care in their homes. HCCI works with leading academic medical centers, health systems, and industry experts to raise awareness of and advocate for expanding the model by growing the home-based primary care workforce through education and training and developing a research-based model for sustainable house call program implementation and growth. For more information, visit and follow @HCCInstitute.

Northwestern Medicine

Northwestern Medicine is the shared strategic vision of Northwestern Memorial HealthCare (NMHC) and Northwestern University Feinberg School of Medicine to transform the future of healthcare and become a premier integrated academic health system. Each day, 33,700 clinical and administrative staff, medical and science faculty, and medical students come together with a shared commitment to superior quality, academic excellence, scientific discovery and patient safety. For more information, visit


VillageMD is a leading provider of healthcare for organizations moving toward a primary care-led, high-value clinical model. The VillageMD solution provides the tools, technology, operations, and staffing support needed for physicians to drive the highest quality clinical results across a population. VillageMD works with physician groups, independent practice associations, and health systems to improve quality, deliver a first-rate patient experience, and lower costs in the communities they serve. VillageMD will continue to grow its Village Medical brand and scale its Village Medical at Home offering. VillageMD has grown to include more than 2,500 physicians across nine markets and is responsible for approximately 500,000 lives and $3 billion in total medical spend in value-based contracts. To learn more, please visit

Read the VillageMD press release here.

Read the HCCI Chairman of the Board letter here.

# # #

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Chairman of the Board Letter

March 2, 2020
Chairman of the Board Letter

Thomas Cornwell, MD, Transitions Roles at HCCI and Joins VillageMD

On behalf of the Board of Directors, leaders and staff at the Home Centered Care Institute (HCCI), I wanted to share some exciting news with you. Dr. Thomas Cornwell, the founder and Chief Executive Officer of HCCI, will begin a new role as Senior Medical Director of Village Medical at Home, part of VillageMD, effective March 9, 2020. In this position, he will bring his experience, skills and passion from making over 33,000 house calls to VillageMD’s extensive provider network that serves over 500,000 patients in nine markets. With this change, Dr. Cornwell will no longer be HCCI’s CEO, but he will maintain a strong connection to the organization in his new role as Executive Chairman.

Dr. Cornwell has been providing home-based primary care (HBPC) for over twenty-five years, starting at a time when house calls were relatively rare. Well, they are most assuredly not as rare now – in part due to his vision, HCCI’s efforts, and as also evidenced by VillageMD’s expansion into the field. His original vision, supported by our funders, led to establishing HCCI, where he and a similarly passionate team have made great strides towards increasing access to HBPC by:

  • Generating substantial public and provider awareness of the importance of HBPC and the need for expanding the workforce.
  • Playing a role in the continuation of the Independence at Home Medicare Demonstration and the Centers for Medicare & Medicaid Services’ two New Payment Models: Primary Care First and Direct Contracting.
  • Educating over 500 unique learners and 260 HBPC practices through live workshops, pre-conferences, online courses, webinars and additional events and resources.
  • Introducing a consulting practice that supports new and existing HBPC programs through a focus on practice management and clinical care.
  • Creating six HCCI Centers of Excellence for Home-Based Primary Care™ with prominent national academic healthcare institutions and assembling a national faculty of HBPC leaders.
  • Teaching over 1,000 students and health system leaders at three medical universities in China and partnering with Shandong University in Jinan to create an HCCI HBPC training center.

I am excited about this change for two main reasons First, this new role will allow Dr. Cornwell to leverage his clinical experience and skills to an even greater extent while continuing to support HCCI and its mission to spread HBPC nationally. Second, I know HCCI has the people, infrastructure and partners in place to continue its excellent training and consulting, advocacy work, research, and focus on increasing public awareness, now and into the future.

In terms of roles, as Executive Chairman, Dr. Cornwell will be a member of the board; continue to act as a strategist; represent HCCI to the public, industry and media; and play a continued role in the organization’s ongoing growth and improvement, including fundraising. Our board will also review the existing leadership structure at our next meeting in March. In the interim, Julie Sacks, Chief Operating Officer, will continue to manage the daily operations of the organization ─ to include overseeing the senior leadership team and creating and ensuring the execution of the organization’s high-level strategies, new initiatives, and partnerships.

Due to his new role, Dr. Cornwell will no longer practice at Northwestern Medicine HomeCare Physicians. Dr. Cornwell remains forever thankful for the role Northwestern Medicine played in supporting him and HomeCare Physicians. Dr. Paul Chiang will continue to lead HomeCare Physicians and remain Senior Medical and Practice Advisor at HCCI.

The entire board wishes to thank Dr. Cornwell for his tremendous contributions and leadership as the CEO and is pleased to be able to continue to work with him in his new Executive Chairman role.  Also, we want to congratulate him on joining VillageMD, a wonderful opportunity that further spotlights the increasing visibility of HBPC.

Finally, I personally want to thank Dr. Cornwell, or “Tom” as I call him, for his friendship and for everything he’s done to make house calls a valued and visible part of the healthcare landscape.  Because, in the end, it’s all about taking care of a patient in their home ─ something I’m sure we all hope is available when we, and our loved ones, need it.

Read the VillageMD press release here.

Read the HCCI Chairman of the Board letter here.

Richard Maybury
Chairman of the Board
Home Centered Care Institute



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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.

Read More

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International Workshop Shows How Small the World Really Is

GSA 2019 International Workshop on Home Care Medicine

On Friday, November 15, over 45 professionals in the field of gerontology attended the first-ever International Workshop on Home Care Medicine in Austin, Texas, as part of the Gerontological Society of America’s (GSA) Annual Scientific Meeting. The GSA describes itself as “the oldest and largest interdisciplinary scientific organization devoted to the advancement of gerontological research, learning, and practice.”

Recognizing the need to expand the “home care medicine conversation” globally, GSA invited the Home Centered Care Institute (HCCI) and American Academy of Home Care Medicine (AAHCM) to develop and co-lead the workshop. The session brought presenters together with participants from countries around the world, including Canada, China, France, Italy, Japan, the Netherlands, Spain, and the United States.

Aaron Yao, PhD, lead researcher for HCCI and Cheeloo Scholar Professor at Shandong University in China, played a key role in organizing the workshop. The program was designed to present recent trends and developments in home care medicine, facilitate the building of strategic partnerships to address global challenges, and provide an opportunity for peer networking.

The workshop was made up of four panel sessions featuring participants from different countries and allowed for extensive Q&A. The four panel themes were Service Delivery and Interprofessional Care, Technology (Mobile Diagnostics, EMR) in Home Care, Payments and Revenue Models, and Workforce Education and Training.

When asked what stood out most for him about the program, Yao answered, “The workshop’s message to me was simple but powerful – that aging has no borders and that great minds think alike.”

Melissa Singleton, Chief Learning Officer, HCCI, also found unique value in the event, “Having the chance to hear people from around the world talk about this growing and much-needed field of medicine reminded me of how very much alike we all are. Of course, each country has its own methodology, such as how they train providers, their payment models, and so on. But, even with that, finding our commonalities and sharing best practices make the world a little smaller, the challenges more manageable and the opportunities for collaboration even greater.”

The GSA workshop was not HCCI’s first appearance on an international stage. A little over a year ago, Yao facilitated an invitation for Dr. Thomas Cornwell, Chief Executive Officer of HCCI, to teach at the Shandong University School of Healthcare Management. Since then, much of HCCI’s curriculum has been translated into Chinese, and a total of 1,250 Chinese providers have been trained by HCCI faculty. The recent collaboration for GSA was an opportunity to bring Dr. Cornwell and HCCI back together with colleagues at Shandong University, as well as to meet new leaders in the field from around the world.

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Payment Reform Paves The Way For Expanding Home-Based Primary Care

house call doctor at door

May 2, 2019  |  Home Centered Care Institute

The field of home-based primary care (HBPC) received extraordinary news as the US Department of Health and Human Services (HHS), in collaboration with the Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI), announced its groundbreaking CMS Primary Cares initiative in Washington, D.C.

CMS Primary Cares aims to improve quality, improve patient experience of care, and reduce expenditures by increasing patient access to advanced primary care services. This revolutionary payment model includes several elements specifically designed to support practices caring for patients with complex chronic needs or serious illness, the patient population that can benefit so dramatically from home-based primary care.

About 4 million vulnerable adults in the United States have difficulty obtaining or are completely unable to access office-based primary care because they are frail, chronically-ill, functionally-limited and/or homebound. In desperation, these individuals often use the emergency room as their primary care physician. Since many of these patients have multiple comorbidities, ED visits frequently spiral into a lengthy hospital admissions.

“With 10,000 baby boomers turning 65 every day and our population living longer with more chronic diseases, home-based primary care provides the optimal solution for a growing number of patients as part of a value-based healthcare system,” notes Dr Thomas Cornwell, a practicing home-based primary care physician and Founder and CEO of HCCI. “Beginning in 2020, the CMS Primary Cares initiative will reduce barriers to entry and create a financially stable model for hospital systems and practices to bring quality care to the patients who need it most.”

“Since 2017, HCCI has partnered with leading academic centers and health systems to provide high-quality two-day training programs using the nation’s first comprehensive curriculum for home-based primary care,” shares Melissa Singleton, HCCI’s Vice President of Education & Research. “We train the entire team – physicians, nurse practitioners, physician assistants, social workers, practice managers, and others. And they come to us from a diverse range of specialties, including internal medicine, family practice, geriatrics, and more.”

Dr. Cornwell adds, “With the new CMS Primary Cares initiative, we stand a real chance of attracting more providers to the field – creating universal access to best practice house call programs, making home-based primary care the national standard for treating medically complex patients who are better cared for in the home.”

HHS Secretary Alex Azar lauded the CMS Primary Cares initiative as a historic first step toward a much bigger vision, even broader than value-based care. That vision is a healthcare system where every American patient feels she’s being treated like a person, not a number; where your doctor has one focus: not what procedures to order or how to bill you for them, but how to keep you healthy and well.

HCCI applauds and supports the diligent efforts of HHS Secretary Alex Azar, CMS Administrator Seema Verma, CMMI Senior Advisor to the Secretary Adam Boehler, AAHCM (who has led the charge on advocacy for our field), USMM, Centene, Aspire, Landmark, John A. Hartford Foundation, and all the provider organizations around the U.S. who have helped make this possible.

If you are interested in learning more about HCCI or supporting the future of HBPC, visit

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Video Link:
Eric De Jonge, MD., President of the American Academy of Home Care Medicine shares insight about the new payment models:

About HCCI

The Home Centered Care Institute (HCCI) is a national non-profit organization focused on advancing home-based primary care (HBPC) to ensure that chronically ill, medically complex and homebound patients have access to high-quality care in their home. HCCI works with leading academic medical centers, health systems and industry experts to raise awareness of and advocate for expanding the HBPC model by growing the HBPC workforce through education and training and developing a research-based model for sustainable house call program implementation and growth.

Find out more at

Media Contact:

Julie Sacks
Home Centered Care Institute (HCCI)
[email protected]

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HBPC in the News HCCI in the News Uncategorized

Researchers Make the Case for Home-based Medical Care

frail seniors

Dec 12, 2018, American Academy of Family Physicians

Frail Seniors Need Access to Care

Home-based medical care for frail older adults makes a lot of sense. Evidence demonstrating that physicians and other clinicians can deliver high-quality, cost-saving care to these patients is mounting, and use of these services is increasing nationwide.

For instance, research shows that in 2013, more than 7,000 clinicians made 2.5 million medical visits to private residences of fee-for-service Medicare beneficiaries.

But gaps in delivery of this care still exist. Authors of research published in the Journal of the American Geriatrics Society examined trends in use of home-based care as well as the characteristics of patients receiving this care. Read the full article

HBPC in the News HCCI in the News

Study Finds Frail Seniors Going Without Desperately Needed In-home Healthcare

Aaron YaoA research team consisting of Aaron Yao, PhD, of the University of Virginia School of Medicine, Christine Ritchie, MD, of the University of California, San Francisco; Bruce Leff, MD, of Johns Hopkins University and Thomas Cornwell, MD, of the Home Centered Care Institute (HCCI) have recently published a study in the Journal of the American Geriatrics Society that found frail seniors are going without desperately needed in-home healthcare.

Read excerpts from the study here:

HCCI in the News

HCCI CEO Honored by ESSE Adult Day Services and Congressman Peter Roskam

HCCI CEO Honored by ESSE Adult Day Services and Congressman Peter Roskam

Dr. Thomas Cornwell, CEO of the Home Centered Care Institute (HCCI), was honored by ESSE Adult Day Services and Congressman Peter Roskam (IL-06) for his significant contributions to the field of home-based primary care and commitment to caring for older, chronically ill Americans and other medically complex patients. On April 6, 2018, Dr. Cornwell was the guest of honor at ESSE Adult Day Services’ annual dinner, where Congressman Roskam spoke to Dr. Cornwell’s achievements.

Rep Peter Roskam and Tom CornwellHome-based primary care, or the modern-day house call, brings the expertise of physicians, nurse practitioners and physician assistants to patients in the comfort and convenience of the home. Dr. Cornwell has made over 33,000 house calls throughout his career. In addition to serving as CEO of HCCI, Dr. Cornwell is a family medicine physician at Northwestern Regional Medical Group. He is also the founder of HomeCare Physicians, serves as the physician representative on the State of Illinois’ Older Adult Services Advisory Committee, and is past president of the American Academy of Home Care Medicine.

Under Dr. Cornwell’s leadership, HCCI recently launched its HCCI Essential Elements of Home-Based Primary Care™ program, which offers an advanced training opportunity for nurse practitioners, physicians, and management and support staff to help them chart a clear path to establishing, expanding or joining a house call program. Additional HCCI educational offerings that provide on-the-job experience and online learning opportunities support the organization’s goal of educating the next generation of home-based primary care providers.

Read the complete article here