A Los Angeles program that makes house calls to older patients shows promise as a national model for other health care companies to save money, USC researchers say.
The Affordable Care Act in 2010 offered incentives for companies to pilot programs that would save the system money, including home-centered programs to assist seniors with high-risk health conditions. HealthCare Partners Affiliates Medical Group launched House Calls in 2009 to serve Los Angeles area patients — making it one of the first and oldest such home-centered programs in the country.
In a new study published this month in the journal Health Affairs, USC Schaeffer Center for Health Policy and Economics and USC Price School of Public Policy researchers found that the House Calls program became more efficient as it reduced health care spending and hospitalization rates over the course of a few years. The patients were considered “high risk” — older and with multiple co-morbidities. A few of those include diabetes, hypertension, congestive heart failure, renal failure and cardiac arrhythmia.
The study was funded by the California HealthCare Foundation.
“Overall, we see a potential for substantial improved patient outcomes and potential savings in total health care costs from this home-based care program for high-risk Medicare beneficiaries,” said lead author Glenn Melnick, professor at the USC Price School and the USC Schaeffer Center.
According to data provided by House Calls to the researchers, the average monthly program cost for enrolling a patient in the House Calls program declined over time to less than $200 per patient — from a range of $187-$310 in 2010 to $147-$185 per patient per month in 2013.
Hospitalization rates drop
Researchers also found that hospitalization rates dropped from 159 per 1,000 patients in the six-month period before patients were enrolled in House Calls to 96 admissions per 1,000 patients during their enrollment in the program. Within the six-month period after patients left the program, House Calls program admissions stabilized at 100 admissions per 1,000 patients.
House Calls achieved savings primarily through better monitoring of high-risk patients.
The program evolved over time and gradually used fewer physicians for services while increasing its reliance on nurse practitioners. This money-saving move reduced the company’s salary overhead for physicians from 45 percent in 2010 to 24 percent in 2013.
“House Calls achieved savings primarily through better monitoring of high-risk patients and then by coordinating their care with multiple health professionals, which is complicated since these patients tend to have multiple conditions,” Melnick said. “Monitoring and coordination keeps them out of the emergency room and hospitals as inpatients.”
Melnick said the study did not assess costs incurred by family members or friends who serve as caregivers for these patients when they are at home. Researchers are investigating those undocumented costs for a later study, he said.