Home Based Primary Care for Frail, Homebound Veterans as a Model for Independence at Home 5.10.10

Home Based Primary Care for frail, homebound Veterans as a model for Independence at Home B. Kinosian 1, 3 , T. Edes 2 1. University of Pennsylvania, Philadelphia, PA, 2. Department of Veterans Affairs, Washington DC 3. CHERP, Philadelphia VAMC, Philadelphia, PA Average Observed, Predicted & Post Admission Annualized Costs by Risk Adjustment Decile: HBPC Annualization Adjusted for 1-yr Mortality of 24% Mean Observed $45,980 +/- $34,383 Mean Predicted $45,948 +/- 3692 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Background ,[object Object],Objectives Background: Home Based Primary Care (HBPC) provides interdisciplinary team managed, all-inclusive longitudinal care to frail, clinically complex veterans. The Independence at Home bill (IAH) establishes, in effect, a public Special Needs Plan focused on frail, homebound Medicare beneficiaries. We project HBPC’s experience onto the IAH population to estimate public savings from expansion of home-based, all inclusive care. Methods: We merged cost records from Medicare Part A and VA for the 9425 veterans enrolled in HBPC in FY06. We computed the annualized 6-month costs, admissions, and inpatient days/1000 for the 6 months before and for the 6 months after enrollment into HBPC. We compared the total costs of this cohort before and after HBPC to the projected Fee for Service (FFS) costs using the mean Hierarchical Condition Category (HCC) score computed from both VA and Medicare diagnoses, valued by the cost/HCC for both VA and Medicare factors. Results Total costs for these veterans (mean age=76.1; mean ADL count=2.1; %male= 96%) was $45,980/yr before, and $30,680 after introduction of HBPC (33% reduction). Inpatient costs declined from $929 per patient per month (pppm) to $389 pppm. Inpatient days/1000 declined from 14,694 before to 4,935 after (66%). Total care was $433,361,500 before HBPC, and $375,077,000 after HBPC, a savings of $58,200,000 ($6,180/patient/yr) after accounting for the cost of HBPC. The mean risk score for these HBPC veterans was 2.74; similar to FFS, community dwelling males with 2+ ADL dependencies (2.46) , with the projected annual cost of $45, 948 (99% of observed). Assuming adequate risk adjustment to cover observed costs, using savings factors specified in IAH as a public Special Needs Plan operated by the Center for Medicare and Medicaid Services, the Plan would recoup initial savings of $42,035,000 or $4660 pmpy. Applied to the estimated 160,000 frail, homebound elderly receiving home based primary care (10% of those with 2+ ADL dependencies), this would result in savings of $745 million/yr, or $7.5 billion over the Congressional Budget Office 10-year projection frame. Conclusion: Frail, home bound veterans with complex chronic diseases require significant resources. The use of interdisciplinary team-led, all-inclusive home care as envisaged under IAH can result in substantial savings to the public. *Data updated Abstract* ,[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],Results ,[object Object],Conclusions ,[object Object],[object Object],[object Object],[object Object],Policy Implications

Home Based Primary Care for Frail, Homebound Veterans as a Model for Independence at Home 5.10.10

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Home Based Primary Care for Frail, Homebound Veterans as a Model for Independence at Home 5.10.10