Characteristics of Home-Based Care Provided by Accountable Care Organizations
May 12, 2022
Home-based care is emerging as a critical approach to managing high-need, high-cost (HNHC) patients with multiple chronic conditions and complex social needs. This population accounts for a large share of Medicare spending, much of which is potentially preventable. Home-based care models, such as home-based primary care (HBPC), hospital at home (HAH), and care transition services, offer promising alternatives to facility-based care by improving access and patient experience. However, challenges such as low reimbursement rates, travel time, and limited availability of providers hinder the widespread adoption of these services.
A study analyzing 151 accountable care organizations (ACOs) found that 25% had formal home-based care programs, 25% conducted occasional home visits, and 17% were developing new initiatives. The most common program was HBPC, typically involving multidisciplinary teams of physicians, nurses, and social workers. Despite their benefits, these programs often conducted fewer than 500 visits annually, and many struggled to secure funding. Sources of financial support included direct billing, health system subsidies, and shared savings, but demonstrating a return on investment (ROI) remained a significant barrier to program expansion.
To ensure the sustainability of home-based care, the study recommends policy changes, including expanding Medicare waivers to cover home visits for all risk-bearing ACOs and integrating telehealth services. By addressing these financial and logistical challenges, home-based care programs can play a pivotal role in reducing hospital admissions and improving care coordination for HNHC patients, ultimately lowering overall healthcare costs and enhancing patient outcomes.