VA Home Based Primary Care

The American Action Forum recently released a paper entitled, “VA Home Based Primary Care Program: A Primer and Lessons for Medicare.” The primer highlights the Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) and how Medicare can take notes from a long-standing and highly successful program in home healthcare.

 Brief background on the HBPC program

  • Program began in 1972 with 6 demonstration sites
  • Serves veterans with chronic and disabling conditions who need more care than periodic doctor visits
  • Veterans have a care team consisting of physician medical directors, nurses, social workers, dietitians, psychologists, pharmacists and rehabilitative therapists who provide integrated and coordinated care for the patient
  •  No requirement that a patient be “homebound” or require skilled rehabilitative care

 What has the HBPC program accomplished?

  • Participants in the HBPC program saw a drop in hospital days by 62 percent
  • Nursing home care days dropped by 88 percent
  • Overall healthcare costs were reduced by 24 percent
  • A study concluded that participants in the HBPC program had higher scores for “health related quality of life” when compared with a control group

Medicare’s home health benefit serves nearly 3.5 million Americans, but differs drastically from the VA’s HBPC program on several key points, including providing care to patients who are homebound as opposed to a larger population of chronically ill patients. Medicare home health visits center around 60 day episodes whereas HBPC provides care to a patient for any amount of time as long as it’s appropriate. HBPC also focuses on coordination between a team of healthcare providers whereas Medicare home health is mostly medical, and often rehabilitative, in nature.

Furthermore, the Clinically Appropriate and Cost-Effective Placement (CACEP) report, recently released by the Alliance for Home Health Quality and Innovation details how placing patients in the most clinically appropriate setting achieves huge savings in the Medicare program. Home healthcare is often the most appropriate setting and significantly reduces hospital admission and readmission rates. Improving the Medicare home health benefit would only add to these already impressive statistics.

Bottom Line

Policy makers should look to the HBPC model to improve the Medicare home health care benefit due to successful outcomes and patient satisfaction, care coordination and significant cost savings.

Home Health Proves Resilient After Hurricane Sandy

Hurricane Sandy’s landfall last week challenged patients and providers across New York, Pennsylvania, Connecticut and New Jersey.  While many continue to wait for restored power, gas and supplies to arrive in their communities, the storm has also brought with it an overwhelming outpouring of care and compassion from family, friends, and neighbors.  The home health care workforce in the Mid-Atlantic and Northeast regions have joined in the critical relief efforts by assisting patients affected by Hurricane Sandy.

Home health patients and their caregivers face additional challenges in the wake of a super storm like Hurricane Sandy and last year’s Tropical Storm Irene. Many homebound patients rely on care from their aides, nurses and other home care professionals to administer medications and deliver critical health care services. Many patients in affected areas were left completely isolated in dark, cold apartments with no access to the outside world.  Yet while many businesses closed down operations, home health aides and nurses continued to care for their patients despite dangerous conditions at the height of the storm.

The Alliance is proud of the hard working, caring home health professionals who continue to put their patients first in the wake of natural disaster.

Recent news coverage on home health care following the storm

Enduring the Storm for Homebound Patients
The New York Times
http://www.nytimes.com/2012/11/02/nyregion/enduring-the-storm-for-homebound-patients.html?ref=health

The Healthcare Workers Who Saved Seniors from Sandy
Newsweek
http://www.thedailybeast.com/newsweek/2012/11/04/the-healthcare-workers-who-saved-seniors-from-sandy.html

Home Health Care Proves Resilient in the Face of Sandy Destruction
Minnesota Public Radio
http://minnesota.publicradio.org/features/npr.php?id=164207669

The Alliance thanks all the dedicated caregiving staff for their efforts during the recent storm.