title: Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.
abstract: While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population.
authors.affiliation: Sarah Ruiz (sarah.ruiz@acl.hhs.gov) is a senior scientist at the National Institute on Disability, Independent Living, and Rehabilitation Research, in Washington, DC. This work was completed while she was a senior research scientist at NORC at the University of Chicago, in Bethesda, Maryland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ruiz
authors.affiliation: Lynne Page Snyder is a senior research scientist at NORC at the University of Chicago.
authors.forename: Lynne Page
authors.initials: LP
authors.lastname: Snyder
authors.affiliation: Christina Rotondo is a research analyst at NORC at the University of Chicago.
authors.forename: Christina
authors.initials: C
authors.lastname: Rotondo
authors.affiliation: Caitlin Cross-Barnet is a social science research analyst at the Center for Medicare and Medicaid Innovation, in Baltimore, Maryland.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Cross-Barnet
authors.affiliation: Erin Murphy Colligan is a social science research analyst at the Center for Medicare and Medicaid Innovation.
authors.forename: Erin Murphy
authors.initials: EM
authors.lastname: Colligan
authors.affiliation: Katherine Giuriceo is a social science research analyst at the Center for Medicare and Medicaid Innovation.
authors.forename: Katherine
authors.initials: K
authors.lastname: Giuriceo
mesh_terms: D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization; D006792:House Calls / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000191:economics; D011320:Primary Health Care / Q000706:statistics & numerical data; D014481:United States
keywords: Cost of Health Care; Home Visits; Multicomponent Interventions; Non-clinical care; Special Populations