June, 2019 | HealthAffairs.org
Authors: Taressa K. Fraze, Laura B. Beidler, Adam D. M. Briggs, Carrie H. Colla
Home visits are used for a variety of services and patient populations. We used national survey data from physician practices and accountable care organizations (ACOs), paired with qualitative interviews, to learn about home visiting programs. ACO practices were more likely to report using care transitions home visits than non-ACO practices were. Eighty percent of ACOs reported using home visits for some of their patients, with larger ACOs more commonly using home visits. Interviewed ACOs reported using home visits as part of care management and care transitions programs as well as to evaluate patients’ home environments and identify needs. ACOs most often used nonphysician staff to conduct home visits. Home visit implementation for some types of patients can be challenging because of barriers related to reimbursement, staffing, and resources.
More than a half-century ago, it was not unusual for physicians to make house calls. Modern medicine, however, transitioned care from the patient’s home to the provider’s office in an effort to improve efficiency.1,2 Still, there are advantages to house calls: to offer the patient convenience and safety, help providers build more personal relationships with patients, comprehensively assess patients’ needs, and identify issues related to the home environment.3 Moreover, many patients benefit from more intensive, home-based care,4,5 and evidence suggests that care provided in patients’ homes can both reduce costs and improve quality.4–7 Medicare has created new reimbursement models to support home visits for patients who are functionally unable to attend office-based visits.8
Home visits can improve the quality of care by easing transitions between care settings, enhancing care management, and helping older patients successfully age at home.3,9 Home visits can be used for a variety of services and patient populations, such as care management for patients with chronic disease, home-based primary or acute care, postdischarge care transitions, and support for frail patients. Home visits have the potential to reduce spending by preventing readmissions or by helping people with complex needs manage their conditions in lower-acuity (and lower-cost) settings.7,10 Home visits are particularly useful for addressing unforeseen challenges after discharge, such as those related to obtaining support from caregivers, understanding a care plan, understanding the full spectrum of medications a patient has at home, and making necessary adjustments to the home environment.4,10