A home-based primary care program led to reduced medical costs for frail elderly patients, primarily due to lower spending at end-of-life.
Many home-based primary care (HBPC) programs aim to support frail elders in living at home as long as possible by providing medical care in the home. Many programs are designed to deliver cost-effective care for populations with complex medical needs and functional limitations. This study evaluated an HBPC program based at Spectrum Health/Priority Health, an integrated health care/health insurance system. HBPC participant medical costs for 12- and 24-months post-enrollment, as well as mortality rates, were compared with a matched control group.
The cost analysis of the study projects that the lifetime medical costs for HBPC participants were on average over $14,000 less than matched controls. Costs for participants in HBPC were approximately $2,900 higher at 12 months, but $8,620 lower at 24 months. The higher costs at 12 months reflect the short-term increased costs of program enrollment, but then program enrollees experience significantly reduced relative costs at end-of-life – approximately $37,000 less than controls. There was no statistically significant difference in mortality rates.
Home-based primary care programs serving frail older adults may potentially realize cost savings by balancing higher short-term costs upon program enrollment with reduced long-term costs due to advanced care planning.