Better Access, Quality, and Cost for Clinically Complex Veterans with Home-Based Primary Care

Thomas Edes
Bruce Kinosian
Nancy H. Vuckovic
Linda Olivia Nichols
Margaret Mary Becker
Monir Hossain
Peer-Reviewed Article
October 2014


The Department of Veterans Affairs (VA) home-based primary care (HBPC) program reduced total costs of care for VA and Medicare and earned high satisfaction ratings from patients and their caregivers.


The VA’s HBPC program, which serves individuals with complex conditions who are often homebound, has reduced costs for the VA. It was not clear, however, if those costs just shifted to Medicare and whether patient goals were met. This cost projection study was conducted to determine if HBPC reduced both VA and Medicare costs without restricting services. The researchers also qualitatively studied veteran and family caregiver perspectives on quality of care.


For nearly 9,500 new HBPC enrollees, Medicare costs were 10.8 percent lower than projected, VA plus Medicare costs were 11.7 lower than projected, and hospitalizations for VA and Medicare were over 25 percent lower than during the period without HBPC. Patients and their family caregivers reported greater access to care, better quality of care, stronger relationships with staff, and enhanced quality of life under HBPC than before they were enrolled in the program. They did not perceive any restriction of services from HBPC.


The VA HBPC program successfully reduced costs and maintained high patient and caregiver satisfaction levels without shifting costs to Medicare or restricting services. HBPC programs show promise at reducing costs and unnecessary acute care utilization and providing better quality care to patients.

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