Health care practices participating in accountable care organizations (ACOs) are more likely than non-ACO practices to use home visits to manage patients who need complex care, according to a new study from the Agency for Healthcare Research and Quality (ARHQ).
Published in Health Affairs, the study examines the use of home visits to enhance care quality, improve outcomes, and reduce health care spending by easing transitions after hospital discharge.
Using data from the National Survey of Healthcare Organizations and Systems, AHRQ identified practices that used home visits to facilitate care transitions for patients with complex health needs. Sixty-nine percent of surveyed practices reported participation in a Medicare, Medicaid, or a commercial ACO, and 80 percent of ACOs reported conducting home visits. AHRQ researchers used the National Survey of ACOs to compare the characteristics, and, for Medicare ACOs, performance of ACOs that used home visits and interviewed 39 ACO leaders to learn why and how they administer home visits.
The patients who receive home visits often are socially complex. Sometimes noncompliant and nonresponsive, these patients would have a hard time contacting their care manager on their own. Providers also use home visits when there is concern for a patient’s safety and when the patient is at high risk when left alone. Home visit activities are used to evaluate the patient’s home environment, review medications with the patient, and identify barriers to effective care.
Researchers found home visit implementation can be challenging for some practices, due to reimbursement barriers in fee-for-service models, inadequate staffing, and lack of resources. Because many home visits are conducted by providers other than physicians, such as social workers and care managers, the visits cannot always qualify for reimbursement from the Centers for Medicare & Medicaid Services. AHRQ urges policymakers to align reimbursement with home visits and other evidence-based practices.