Opportunity Knocks at Home: How Home-Based Primary Care Offers a Win-Win for U.S. Health Care

For far too many Americans, growing old and frail today means confronting repeated cycles of crisis, hospitalization, and expensive but ineffective or even counterproductive treatment—leading to still more of the same. Instead of reliably providing high-value treatment aiming to maximize quality of life in our declining years, the health-care system often provides high-cost treatment that seemingly aims to maximize treatment itself. The result is bad for the federal budget and in many cases, alas, even worse for patients. “There’s a lot of spending, but also a lot of suffering,” as Dr. Steven Landers, the president and CEO of the Visiting Nurse Association Group of New Jersey, said in a recent discussion with the author.

At a time when so many of the country’s health-care and fiscal problems seem intractable, this paper surfaces some good news. A win-win alternative, one that can reduce both cost and suffering, is at hand. With some nudging, it could move fairly rapidly into the mainstream of health care. Home-based primary care, as this alternative approach is called, is “one of the big opportunities in health care,” Landers said. Specifically:

  • Medicare beneficiaries who are in their declining years and have multiple chronic conditions can be provided with better care at lower cost, thanks to the use of multidisciplinary teams that treat them primarily at home.
  • Because this population is the most expensive group of patients in the medical system, even fractional savings can make a significant dent in health-care costs. More important, the result is likely to be more humane and effective from the patient’s point of view.
  • The multidisciplinary, home-based approach is not “vaporware,” an untried concept. To the contrary, it has a distinguished pedigree and has shown during more than a decade of clinical use and development that it can work in a variety of contexts.
  • To bring home-based care to a national market, much will need to happen. Demonstrations will need to show that home-based care can scale affordably; Medicare payment structures will need to change; medical culture will need to adjust. But many of those changes are under way already, and all are within reach.

In short, multidisciplinary, home-based primary care is low-hanging fruit in the search for a higher-value health-care system.


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