Bringing Primary Care Home: The Medical House Call Program at MedStar Washington Hospital Center

Authors
Martha Hostetter
Sarah Klein
Douglas McCarthy
Case Study
July 2016

This resource is a case study of MedStar Washington Hospital Center’s Medical House Call Program, which offers home-based primary care to patients who are too sick, frail, or disabled to come to a doctor’s office.

  • The program serves about 600 frail elderly patients in the Washington, D.C. area. Many suffer from Alzheimer’s disease and/or multiple chronic conditions, as well as functional limitations.
  • After an in-home assessment, an interdisciplinary care team that includes a geriatrician, a nurse practitioner, and a social worker arranges for diagnostic tests and treatment, medications, and equipment. They also provide education and support to patients and caregivers, with an emphasis on shared decision-making around end-of-life care.
  • A study of the program found costs of care declined along with the use of hospitals, emergency departments, and skilled nursing facilities, while spending on hospice and home care services increased. The benefits were greatest for high-risk patients — spending for that group declined nearly 30 percent.
  • The program bills Medicare and Medicaid on a per-service basis, amounting to roughly $100 per visit. It also participates in the Center for Medicare and Medicaid Innovation’s Independence at Home Demonstration. In the first year of the demonstration, MedStar and its partners reduced Medicare spending by 20 percent relative to what was expected for the population they served.
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Population Addressed
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What are the features of a successful program that serves the highest-need patients?
  • What results has it achieved?
Level of Evidence
Promising
What does this mean?