NEW YORK – A patient-centered, medical-home approach to care for patients with multiple chronic diseases when they are discharged from the hospital and back in their own residences substantially cut their rate of hospital readmissions, suggesting that this new model of home-based medical care pays for itself by avoiding hospitalization costs.
"We think it’s very important for the U.S. health care system to move its focus from hospital to home, with care management that prevents unnecessary emergency department visits and hospital admissions," Dr. Eric C. Rackow said at the course.
Dr. Eric C. Rackow
"You can alter the outcomes at home [of patients with diabetes and other chronic diseases] if you keep patients healthier and more functional at home and out of the hospital," said Dr. Rackow, professor of medicine at New York University, and president and CEO of SeniorBridge, a company that provides medical services to patients when they are in their homes.
"We have health plan contracts where we have shown a 50% reduction in hospitalization and readmissions rates, producing a 50% drop in the cost per member per month," Dr. Rackow said in an interview. Although SeniorBridge is relatively unique in offering the services from a variety of health care professionals for in-home services to patients, the model is amenable to scale up, he said. "Doctors are the captains, but it’s the nurses, social workers, nutritionists, and pharmacists who actually are in the patients’ homes. Physicians can manage a large number of patients. It’s a cost-effective way to extend the physician’s reach."
To document the impact that home-based intervention can have, he presented data collected by SeniorBridge from 503 patients aged 65 years or older that the company managed during 2008-2010. Eighty-eight of these patients who had diabetes and multiple other chronic conditions had a hospital readmission rate of 21% during their first 30 days at home following discharge from their index hospitalization. The other 415 patients managed by SeniorBridge had multiple chronic conditions but no diabetes, and they had an 11% rehospitalization rate during their first 30 days at home. In contrast, a historic control of similar elderly Americans with multiple chronic conditions who did not receive comprehensive care at home following their hospital discharge had a 33% readmission rate, Dr. Rackow said.
Another data analysis showed that 230 elderly SeniorBridge–treated patients with diabetes and multiple chronic diseases averaged 0.37 hospitalizations/year, and 1,486 elderly SeniorBridge-treated patients with multiple chronic diseases but no diabetes averaged 0.28 hospitalizations/year. By comparison, Medicare data showed a rate of 1.3 hospitalizations/year among similar patients receiving conventional care following a hospital discharge.
Multiple chronic illnesses are a hallmark of elderly patients with diabetes, affecting three-quarters of Americans 65 years or older with diabetes, Dr. Rackow said. The combination of diabetes, chronic obstructive pulmonary disease, and heart failure forms a common comorbidity constellation among elderly patients with diabetes, he noted.
Patients with several simultaneous chronic illnesses face special physical and cognitive challenges that pose problems for their self-directed care, he said. "The functional limitations [triggered by multiple chronic diseases] and the inability to self-manage tips patients and causes frequent hospitalizations." That’s why home medical services that aid a patient’s self management can have such a significant impact on rehospitalization rates.
Payment for SeniorBridge’s services has come from Medicaid, private insurers, and from long-term insurance policies. Medicare does not currently pay for these services, Dr. Rackow said.
Dr. Rackow is an employee, stockholder, and board member of SeniorBridge.
Here is a related video on "How Patients View Chronic Disease."