Economic implications of providing home based care in rural settings

Context: Home visits to older people can improve care, reduce utilization and cut costs under Medicare risk. However, providing home care visits is more costly than conducting appointments in a physician's office. Hudson Headwaters Health Network (HHHN), a federally qualified health center in rural, Upstate New York, began a new program to provide home based care to frail elderly living in the community, but the long term cost-effectiveness of this program is unknown.

Study Objectives: To determine the cost savings of providing preventive and interventional home care to rural frail elderly.

Study Design: Randomized case/control.

Setting: HHHN practices that are part of the Capital-Adirondack Practice Based Research Network.

Participants: 174 adults aged 64 or older who scored at-risk for functional decline as measured by the VES-13.

Study Intervention: Provision of home based primary care

Outcome Measures: Pre/post intervention measures of utilization and costs from a Medicare managed care insurer.

Results: The odds of inpatient admissions, outpatient admissions and pharmacy claims are significantly less for the intervention group than the control group. Males had lesser odds of having a pharmacy claim compared to females, but males in the intervention group were more likely to have a pharmacy claim. Patients over 80 years are less likely to have a pharmacy claim compared to people less than 80 years.

Conclusions: These results imply that the intervention is cost reducing, since utilization of many higher cost services are likely to be decreased for the home based care.