One-quarter of accountable care organizations provide home-based care programs, but financial risks are holding others back, according to a study published in the American Journal of Managed Care Thursday.
Surveys of ACOs participating in the Medicare Shared Savings Program reveal that 25% have home care programs, another 25% provide some home visits and 17% are working to incorporate home care into their offerings.
High-need, high-cost patients' healthcare costs are nearly four times greater than the average adult's and make up a large share of "potentially preventable" Medicare spending, the study says. These are the 5% of people who account for half of the nation's healthcare spending, which is expected to exceed $4 trillion this year.
Home-based care could better serve these patients while also generating cost savings, according to the study.
But financial concerns stand in the way, the study concludes.
Providers can't bill Medicare for many of these at-home services and proving the interventions improve health and save money is difficult, the researchers wrote. Three-quarters of the ACOs surveyed identified the challenge of showing return on investment as an obstacle to offering home-based care.
Although 40% of ACOs reported plans to expand home-based programs, 38% would only expand if they could demonstrate a positive return on investment.
The study includes recommendations for policy changes that would promote greater availability of home-based care for Medicare enrollees, including extending waivers to Shared Savings Program ACOs that accept downside risk and expanding the Medicare hospital-at-home waiver.
"Expanding home-visit waivers to all risk-bearing Medicare ACOs and covering telehealth for patients receiving home-based primary care would improve these programs' financial viability," the study says. Continuing telehealth coverage after the COVID-19 pandemic could be a "game-changer" for patients, the researchers wrote.
Shared Savings Program participation grew this year: More than 11 million Medicare enrollees are supported by one of 483 Shared Savings Program ACOs.
The study assessed data from 151 ACOs and concentrated on the 25% with formal home-visit programs.