How Does the Shift to Home-Based Care Affect Quality and Cost?

Many health systems are seeking to move care into the home as an alternative to hospitals and skilled nursing facilities. A panel convened by the Leonard Davis Institute (LDI) at the University of Pennsylvania last week discussed how this shift could affect the quality and cost of care. “The widespread use of home-based care is uncharted territory, and there are many questions about how to achieve the goal of shifting more care out of institutions and into people's homes and potential barriers to successfully doing so,” said Rachel Werner, M.D., Ph.D., executive director of Penn LDI. “These include our continued reliance on fee-for-service hospital-centric payment arrangements in most cases, and unequal access to the technologies needed to successfully transition to care at home to name just a few.”

With acute hospital-at-home programs, there is a lot of evidence to suggest that there's better patient, family and caregiver experience and that home care is high quality by pretty much any quality metric, said Bruce Leff, M.D., director of the Center for Transformative Geriatric Research and a professor at Johns Hopkins University School of Medicine. For instance, he said, a national demonstration study involving Medicare Advantage plans in the early 2000s saw a 75 percent reduction in incident delirium acute confusional states which can contribute to long-term cognitive decline in older adults.