A lot has been written lately about the return of the house call. Innovative health plans, entrepreneurs and forward-thinking health systems are recognizing that house calls are a compelling example of how we can build a more integrated and technology-enabled health system that treats patients at the right time in the optimal setting.
A recent Fast Company article highlighted that patients are subjected to 1.2 billion wasted hours each year in doctor’s waiting rooms and 71 percent of emergency room visits could have been handled by a primary care provider. For those Medicare beneficiaries who are frail and have difficulty getting to and from medical appointments, having a nurse practitioner or doctor come to their homes is an invaluable convenience. But these visits also close gaps in care, and help those beneficiaries who don’t generally go to the doctor re-engage in the health care system.
Medicare Advantage, a part of Medicare serving 17 million seniors, offers important lessons that can help inform decisions about investing in house calls. Seniors in Medicare Advantage are more likely to receive primary care and preventive services than those in Medicare fee-for-service. They need fewer emergency services, hip and knee replacements, and have fewer preventable hospital admissions and readmissions.
Home clinical visits are one tool that is adding value for Medicare Beneficiaries, especially those that do not actively seek primary care. The visits are used for care planning, clinical documentation and the accurate measurement of a patient’s acuity, and result in a fuller picture of the needs of the patient. At a typical in-home clinical visit, which lasts 45 to 60 minutes (longer than a typical office visit), a nurse practitioner or doctor works with the patient to assess their health, detect gaps in care, assess environmental and social factors impacting their health, establish a plan of care, and coordinate follow-up with the senior’s primary care provider.
Both seniors and their primary care doctors receive treatment or care plans resulting from the visit. These plans generally include recommendations for each diagnosis; a current medication list; screening results; and recommendations for follow-up care.
A recent RAND study found that an integrated home-based clinical program promotes follow up physician office visits, averts costly institutional care and supports aging in place.
Another recent analysis of home-based clinical visits by a large provider found that “low engagement” Medicare Advantage beneficiaries (defined as no PCP visit in 6 months) were twice as likely to visit their primary care doctor after a home visit than those who did not receive a home visit. The analysis also found that patients who received visits in their homes were significantly more likely to fill their prescriptions. For example, patients with hypertension were 38 percent more likely to obtain their medications while patients with diabetes were 25 percent more likely and patients with depression were 26 percent more likely to fill their prescriptions. Without obtaining their medications, these patients’ conditions would likely have worsened and required more expensive and invasive interventions later.
So, if we improve quality, engage patients more effectively and see the whole picture of a patients’ health by visiting their home—while also saving money—why is the doctor’s office the most accepted mode of receiving primary care? Our office-based culture grew out of advancing technology in the 1950s and 60s that made equipment a necessary part of patient care. Now, as we work toward moving our health system into a more personalized, technology-driven, outcomes-based model, the house call is back.
As we look for innovative ways to connect the health system, improve patient care and promote affordability for beneficiaries, Medicare Advantage and its many successes – including in home clinical visits – is a good place to start.