Bruce Leff MD Professor of Medicine CoDirector Elder House Call Program Johns Hopkins University School of Medicine Campaign for Better Care Webinar June 30 2010 Lets Start with Leo ID: 544108
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The Importance of Home-based Primary Care: Why Older Adults Need It
Bruce Leff, MDProfessor of MedicineCo-Director, Elder House Call ProgramJohns Hopkins University School of Medicine
Campaign for Better Care Webinar
June 30, 2010Slide2
Let’s Start with Leo
Frail, homebound, 89 years oldLimited mobility; walks with walkerNeeds help with activities of daily livingHeart failure, lung disease, arthritis, diabetes, hypertension, etcAdmitted 4 times to the hospital last year for heart failure
Many medicines prescribed by physicians who have not seen him in yearsLives with frail wife who is his caregiverSlide3
The Population is Aging and Increasingly Frail
% of Older Adults Who Need Daily Personal CareThere are ~ 2-3 million older adults with high grade functional impairmentWill double in about 15 yearsSlide4
Our Current System Doesn’t Meet Leo’s Needs
He can’t get to the officeUses 911 as primary care, goes to the emergency department and is admitted to the hospital repeatedlyTreated as a basket of chronic conditions rather than a person with chronic conditionsNo continuity of careNo attention to his quality of lifeSlide5
Our Health Care System is Fiscally Unwell and UnsustainableSlide6
Chronic Conditions and Medicare Expenditures
Number of Chronic Conditions
Percent of
Beneficiaries 65+
Percent Medicare
Expenditures
0
18
1
1
19
4
2
21
11
3
18
184122157186313 7+214
22%
66%Slide7
Home-Based Primary CareSlide8
Compassionate, mobile primary care team providing primary and acute care
Target the most ill older adults, focus on providing high quality geriatric care and preventing hospitalizationsState-of-the-art diagnosis and treatment in the home
Coordinate
ALL
medical and social services
Financially viable for providers and for society
Key Principles of Effective Home-Based
Primary Care PracticesSlide9
Key Elements of the Home-Based Primary Care Model
Subspecialists
Radiology
Acute, ER, Ambulance
Aides, Food, Environment, Legal Counsel, Housing
Rehab, HHA, Hospice
Pharmacy, Durable Medical Equipment, IV, Oxygen
Transportation, Labs
Patient
MD/NP/SW
24/7 Team
Portable HERSlide10
Additional Advantages of Home-based Primary Care
Provides access to health care and focuses on unique needs of older adults“High touch, high tech” - portable technology expands clinical repertoire of home based physician compared to clinic
Seeing the patient in his / her own environment - builds trust, improves diagnosis, develop better care plans
House call physicians coordinate services and care better
Better integration of caregivers into care plansSlide11
Outcomes of Home-Based Primary Care
ProgramOutcomeVeterans Affairs Home-Based Primary Care↓ Total health care costs 24%
Highest pt satisfaction any VA program -83%Virginia Commonwealth University
↓ Hospital costs 60%
Urban Medical
Housecalls
,
Boston
↓
Hospital admissions
29%
↓
Hospital days
3
4%
University of Pennsylvania↓ Total health care costs 50% ↓ Hospitalizations 64%Philadelphia House Call Program for post-hospital patients↓ Hospital readmissions 50%↓ Total health care costs $3,000 to $4,845 per ptElder Partnership for All Inclusive Care (ElderPAC) at Penn↓ Medicare hospital days 59%↓ Medicare care costs 50% Office Without Walls, Nevada↓ Hospitalizations 27%↓ Costs by $760 per patientIndianapolis House Call program↓ Hospitalization 44% for high risk patients with multiple chronic diseasesSlide12
Summary
Population is aging and increasingly frailThe current health care delivery system doesn’t meet the needs of older, frail patients and is very expensiveHome-based primary care can deliver high quality care and reduce health service utilization and costs