Medicare ACOs need financial support to promote home care, study finds

A quarter of responsible care organizations offer home care programs, but financial risks hold back others, according to a study published Thursday in the American Journal of Managed Care.

Surveys of ACOs participating in the Medicare Shared Savings program reveal that 25% have home care programs, an additional 25% conduct home visits, and 17% are working to incorporate home care into their offerings.

According to the study, health care costs for high-need, high-cost patients are almost four times that of the average adult and account for a significant portion of “potentially avoidable” Medicare spending. It’s the 5% of people who account for half of the nation’s health spending, which is expected to top $4 trillion this year.

According to the study, home care could better serve these patients while generating cost savings.

But financial concerns stand in the way, the study concludes.

Providers cannot bill Medicare for many of these home services, and it is difficult to prove that the interventions improve health and save money, the researchers wrote. Three-quarters of CCOs surveyed identified the challenge of showing return on investment as a barrier to delivering home care.

Although 40% of ACOs said they intended to expand home-based programs, 38% would only expand them if they could demonstrate a positive return on investment.

The study includes recommendations for policy changes that would promote greater availability of home care for Medicare enrollees, including extending waivers to Shared Savings Program ACOs that accept downside risk and l extension of the Medicare waiver to the hospital at home.

“Expanding home visit waivers to all at-risk Medicare ACOs and telehealth coverage for patients receiving primary care at home would improve the financial sustainability of these programs,” said the study said. Continued telehealth coverage after the COVID-19 pandemic could be a game-changer for patients, the researchers wrote.

Participation in the shared savings program increased this year: more than 11 million Medicare enrollees are supported by one of the 483 ACOs in the shared savings program.

The study assessed data from 151 ACOs and focused on the 25% with formal home visiting programs.

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