The triple aim of healthcare – improving outcomes, reducing costs, and improving client and provider satisfaction – is the foundational goal of value-based care. Value-based payment models engaged by ACOs, MA plans, and other CMMI value-based models succeed by reducing costs, utilizing facility-based care only when necessary, and proactively meeting the needs of the highest-risk individuals within their patient population. MemorialCare Medical Group based in California has developed a care model that has proven quite successful in achieving all these outcomes.
MemorialCare Medical Group put together an advanced health care practitioner led home-visit primary care program aimed at meeting the needs of frail and elderly patients who encountered barriers to attending in-office visits. Preliminary results showed that per-member per-month total cost of care declined by 21.4% or over $1,200 per patient, with a gross savings of over $2.6 million. This was partially due to a reduction in inpatient visits, emergency department visits, and 30-day readmissions over the 1-year pre-enrollment and 1-year post-enrollment periods. Again, this was seen within the neediest and highest risk segment of the patient population who had previously been disengaged with primary care.
This is yet one more example of the power of primary care delivered with the aim of increasing access and proactive engagement within the highest-risk segment of patient populations. While home-visit models can be resource-intensive and are not yet properly reimbursed through fee-for-service Medicare, value-based contracts that allow patient success to translate into provider success and incentives make such models not only viable but vital. This model from MemorialCare Medical Group can act as a strong example to emulate.
“Preliminary Analysis of an Advanced Health Care Practitioner-Led Home-Visit Primary Care Program for High-Risk Patients Reduced Health Care Costs and Utilization” by Parag Bharadwaj, Nathan Dyjack, Gagandeep Gill, Adam Solomon, Mark Shafer, Elizabeth Simpson, Roseann DeVito, Gwyn Merz, Lysa Switzer, Marshall Gillette, Lindsay Fahnestock, Chintan K Somaiya, and Manjit Randhawa, published on July , 20223 by Journal of Palliative Medicine and available at https://pubmed.ncbi.nlm.nih.gov/37459163/