A group of 17 Illinois health care organizations is collaborating to expand access to home-based primary care, including a number of hospice and palliative care providers.
The providers are participating in the Illinois House Call Project, an initiative by the Home Centered Care Institute (HCCI). The project follows up on a similar HCCI program conducted in Florida in which providers saw a collective 25% increase in home-based primary care patient volume, as well as reductions in facility utilization and readmissions.
“Home-based primary care was already on the rise, then the pandemic hit, which further reinforced the need for high-quality care delivered safely in the home,” said Julie Sacks, president and COO of HCCI. “With the critical need in Illinois for this type of care and with Illinois also being the ‘home state’ of HCCI, this initiative is one of our key priorities.”
Among the program’s goals is to enroll at least 3,000 new Illinois patients into home-based primary care by 2024.
About 12% of the 2.1 million seniors who reside in Illinois are 85 or older, and 40% of Medicare beneficiaries in the state have four or more chronic conditions, according to HCCI. Close to 260,000 of those seniors are homebound, with only 26% receiving home-based primary care.
Among the participants is Lightways Hospice and Serious Illness Care. Through the project, the nonprofit will explore the prospect of launching a home-based primary care business line in the long term, according to Sara Dado, senior director of clinical programs for Lightways.
“We oftentimes come in on the palliative care side for patients who maybe haven’t seen a physician for the last 10 years, because they’re not able to get out of their home, and there’s no resources available to them for home-based primary care,” Dado told Hospice News. “I just think it’s the next natural step for hospice care providers to really look at if we truly want to get upstream and get to people sooner.”
A home-based primary care service can also help hospices comply with program requirements in some alternative payment models, Dado said.
Lightways is a founding member of Advanced Illness Partners (AIP), a collaborative of nonprofit hospices that came together to form a direct contracting entity. Next year AIP will transition from direct contracting to the ACO Realizing Equity, Access, and Community Health (REACH) program.
Starting in 2023, the U.S. Centers for Medicare & Medicaid Services (CMS) is replacing the Global and Professional Direct Contracting (GPDC) model with ACO REACH. The agency says the new program reflects its “refreshed” priorities for payment system demonstrations.
Though hospices are eligible to participate, direct contracting and ACO REACH are fundamentally oriented around primary care. To maximize their opportunity, hospices have to adapt to taking on that role.
“One of our challenges has been extremely low claims alignment because we’re not a primary care provider. Those that are providing primary care and getting more patients’ claims aligned,” Dado said. “Then with taking on the risk of the management or the care in the home, we really have to be able to take on that primary care role.”
The gradual move of reimbursement systems to value-based care models is partly fueling a resurgence in home-based primary care, according to a 2018 study in the journal Geriatrics.
Patients in the United States received more than 2.2 million home-based primary care visits during 2016, up from less than 1 million in 1996, the study found. Patients in assisted living facilities, group homes, and other facilities received 3.2 million primary care visits in 2016.
For hospice provider Transitions Care, the Illinois House Calls Project presents an opportunity to expand their primary care footprint as well as to increase access to care for seniors in need.
A multi-state provider, the company’s service area in Illinois is concentrated in the northern portions of the state. Through the HCCI program, Transitions will be able to expand its home-based primary care program to the south and the west, according to COO Rick Cantrell.
“We as an agency within the State of Illinois that provides those types of care want to make sure that we’re providing the right care for people,” Cantrell told Hospice News. “The benefit for us is being able to expand our footprint to new geographical regions and areas.”
