title: House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care.
abstract: In 2009 HealthCare Partners Affiliates Medical Group, based in Southern California, launched House Calls, an in-home program that provides, coordinates, and manages care primarily for recently discharged high-risk, frail, and psychosocially compromised patients. Its purpose is to reduce preventable emergency department visits and hospital readmissions. We present data over time from this well-established program to provide an example for other new programs that are being established across the United States to serve this population with complex needs. The findings show that the initial House Calls structure, staffing patterns, and processes differed across the geographic areas that it served, and that they also evolved over time in different ways. In the same time period, all areas experienced a reduction in operating costs per patient and showed substantial reductions in monthly per patient health care spending and hospital utilization after enrollment in the House Calls program, compared to the period before enrollment. Despite more than five years of experience, the program structure continues to evolve and adjust staffing and other features to accommodate the dynamic nature of this complex patient population.
authors.affiliation: Glenn A. Melnick (gmelnick@usc.edu) is a professor of health economics and financing and the Blue Cross Chair, both at the University of Southern California (USC), in Los Angeles, and a resident consultant at the RAND Corporation in Santa Monica, California.
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Melnick
authors.affiliation: Lois Green is an affiliated researcher in the USC Center for Health Financing, Policy, and Management.
authors.forename: Lois
authors.initials: L
authors.lastname: Green
authors.affiliation: Jeremy Rich is director of the HealthCare Partners Institute for Applied Research and Education, in El Segundo, California.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Rich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D017046:Cost Savings; D003695:Delivery of Health Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D017048:Health Care Costs; D018577:Homebound Persons / Q000706:statistics & numerical data*; D006792:House Calls / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D016730:Program Development
keywords: Chronic Care; Elderly; Organization and Delivery of Care