Home-Based Primary Care: Independence at Home and the VA

Patients who are homebound or have serious chronic disabling conditions often have difficulties with timely access to medical care, leading to a variety of problems with care continuity, timely response to worsening conditions, adverse clinical outcomes, and higher costs. Those who have the greatest need for the most frequent care often face the steepest challenges with access to care; their jeopardy aligns with population health framing. Based on Medicare claims data from the early 2000s, the top 5% of Medicare beneficiaries incurred about half of the expenses of the program, averaging about $63,000 per person per year. The least expensive 50% of beneficiaries accounted for only 4% of Medicare spending. Those with the highest costs generally are older, physically frail, and more likely to utilize hospitals or skilled nursing facilities; many suffer from recurrent chronic conditions rather than one-time catastrophic illnesses. These patients often receive care that is fragmented and poorly coordinated [1]. In the USA, these individuals number around two or three million, some of them younger than Medicare age, but are heavily skewed to the geriatric population segment.