Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website
HSRD Conference Logo



2017 HSR&D/QUERI National Conference Abstract

Printable View

1037 — A Case for VA Home Based Primary Care Expansion: HBPC Reduces Costs and Improves Community Survival

Lead/Presenter: Ciaran Phibbs
All Authors: Kinosian B (GEC-DAC, CMC VAMC, Philadelphia, PA) Makineni R (GECDAC, Providence VAMC, Providence, RI) Dally S (GECDAC Palo Alto VAMC, Menlo Park, CA) Phibbs CS (GECDAC Palo Alto VAMC, Menlo Park, CA) Edes T (Department of Veterans Affairs, Washington, DC) Davis D (Department of Veterans Affairs, Washington, DC) Intrator O (GECDAC, Canandaigua VAMC, Rochester, NY)

Objectives:
VA Home Based Primary Care (HBPC) provides longitudinal primary care to medically complex veterans, using a broad interdisciplinary team (IDT). The scope and cost of the IDT have raised questions about VA net savings. We sought to clarify if HBPC produces net savings to VHA.

Methods:
Three-year cohort study using calibrated projected costs for veterans enrolled in HBPC, compared to actual costs of veterans enrolled in VA-HBPC. VA utilization, cost and fee files, linked with Medicare claims; Residential History File for community survival. We identified 202,775 Independence at Home Qualified (IAH-Q) veterans in VA at the start of FY2013. IAH-Q veterans were those who had a hospitalization and post acute care in the past 12 months, 2+ chronic conditions, and 2+ functional deficits, using a JEN frailty index > = 6. We used the concurrent Nosos, augmented with calibration factors for each Nosos decile among the IAH-Q population, to project costs for the 12,131 IAH-Q HBPC patients and standard Nosos for 18,151 non-IAH-Q HBPC patients. We used a Residential History File to compute the share of days each veteran was in the community.

Results:
In 2013 the 12,131 IAH-Q Veterans had per-capita annual costs of $52,515 with expected costs of $64,457, while the 18,150 non-IAH-Q had costs of $33,955 with expected costs of $33,962. From 2013-2015, the prevalent HBPC population grew from 30,281 to 34,422; the mean observed costs grew from $41,390 to $44,243 while the mean expected costs grew from $45,716 to $52,450, resulting in savings of $4,326 to $8,207, with savings of 9.5% (2013 $135M), 12.2% (2014 $192M), and 15.6% (2015 $281M). Compared to a stratified sample of IAH-Q patients in PACT (N = 9,992) 85% of HBPC days were non-institutional (vs 81% for PACT), with 25% of HBPC patients, vs 5% of PACT patients, having 99% of days in community. Of 127 HBPC programs, 104 produced savings > 5%.

Implications:
VA HBPC produced substantial savings of 10-15% among high need, high cost Veterans.

Impacts:
Expansion of HBPC targeted to high need, high cost Veterans can produce substantial savings for VA.