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.