A new study predicted accountable care organizations will scale back expansion into home care services if they don’t see a return on their investment.
The study, which appeared in the American Journal of Managed Care, found ACOs are delivering a diverse array of home services, but many of those services aren’t billable to Medicare. The services include primary care, acute medical care, palliative care, hospital-at-home and interventions addressing social determinants of health.
For the study, researchers surveyed 151 ACOs and found one quarter had formal home-based programs, one quarter offered occasional home visits and 17% were actively developing new home-based programs. Half of the programs were established over the past three years using multidisciplinary care teams. Funding sources included direct billing for services, health system subsidies and ACO shared savings. Although the majority of respondents expressed interest in offering more in-home services, they said demonstrating a return on investment from those services was a moderate to major challenge.
There has been growing interest in providing home-based care, especially to people living in underserved communities. A number of companies, including VillageMD, Heal, Dispatch Health and Doctor on Demand are pushing to move more primary care into the home. Although Medicare does pay for in-home primary care, home-based primary care providers see fewer patients due to travel time and that limits revenue for providers. Still, the study points out that home-based care can lower costs for medically complex patients because it can reduce rehospitalizations.
The researchers said ACOs could be encouraged to expand in-home care if the Centers for Medicare and Medicaid Services extended COVID-19 public health emergency waivers and paid for telehealth in conjunction with in-home primary care services. The combination of the two could lower rates of in-home care and encourage more patients to get care at home.