February 2020

In This Issue: Advancements in VA Primary Care
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Does VA Home-based Primary Care Reduce Costs?

Feature Article

Takeaway: This project uses VA and Medicare data to examine whether home-based primary care (HBPC) improves outcomes, keeps Veterans out of nursing homes, and reduces total VA spending. Investigators also are developing a tool that program managers could use to identify Veterans who might benefit from HBPC to allow effective targeting of program resources.

The Medicare Independence-at-Home (IAH) demonstration which provides frail elderly patients with provider-managed integrated care and supportive services at home has shown reduced rates of hospitalizations, 30-day rehospitalizations, emergency department care, and an average $3,070 annual costs savings per patient. This ongoing HSR&D study (October 2017 – September 2020) will determine whether VA’s Home Based Primary Care (HBPC) program—the inceptor of IAH—produces similar outcomes as Medicare IAH qualifying beneficiaries receiving Medicare Home-based Primary Care . Investigators also will:

• Determine effectiveness of VA HBPC in groups that do and do not meet IAH qualifying criteria;
• Develop criteria equivalent to qualifying for IAH in order to appropriately identify Veterans for VA HBPC enrollment; and
• Assess how HBPC affects utilization and costs.

Study investigators will use Medicare, Medicaid, and VA data to capture all relevant utilization and diagnoses – and will identify all Veterans who were potentially eligible for HBPC in 2011. The intervention cohort will be all Veterans who received HBPC in 2012. The control group will be determined from those potentially eligible Veterans who did not use HBPC in 2012.Follow up data will be analyzed for both groups through 2015, comparing functional status, use of services, and costs.

Preliminary Findings

None to report as yet.  

Impact

Even though a Medicare demonstration has shown that a program like VA Home-based Primary Care is an effective and cost-saving intervention, HBPC has been limited in size and currently serves a fraction of the Veterans who could benefit from this innovative program. This project will provide VA’s Office of Geriatrics and Extended Care Policy and Operations leadership with information needed to make informed decisions about effective expansion of the HBPC program. In addition, study investigators will develop a tool that program managers can use to identify Veterans who could benefit from HBPC to allow effective targeting of program resources.

Principal Investigator: Ciaran Phibbs, PhD, is part of HSR&D’s Center for Innovation to Implementation (Ci2i) in Palo Alto, CA.

Publications

None to report at this time.

View study abstract