Demonstrating a positive impact on clinical and economic outcomes has been a long-standing challenge for the home care industry due to fragmented care standards across states, the lack of standardized measures in personal care, and limited access to claims data that would enable home health agencies that support patients with activities of daily living (e.g., medication management, meal preparation, patient education) to track and measure the impact of service delivery on patient utilization and outcomes.

To address this knowledge gap, Avalere evaluated the impact of home care interventions on utilization of emergency department visits, skilled nursing facilities, and home health care, and on overall healthcare expenditures in a cohort of Medicare FFS beneficiaries who were enrolled between 2007 and 2021. The overall cohort was divided into 2 sub-groups: 1 that received targeted home care and a statistically similar control group that did not.

Medical and pharmacy claims were then pulled from Avalere’s in-house datasets, and utilization and spend were tracked during the 12 months prior to (baseline) and after (follow-up) home care service delivery had been initiated. For each outcome of interest, the difference between the baseline and follow-up periods was estimated, and the differences were compared between the intervention and control groups.

As illustrated by Table 1, a key finding of the analysis was that, although the change (baseline vs. follow-up) in overall spend favored the non-intervention group, the total cost of care was significantly lower for patients who received targeted home-based care and were previously diagnosed with 1 or more chronic conditions of interest.

Note: The population without home care services did not have any home care claims in the data accessed by Avalere, but they may have received services not captured in the database. Only the top-10 chronic conditions are listed.

For example, the cost increase experienced by quadriplegia patients who received home-based care was, on average, $29,902 lower than the increase observed for quadriplegia patients who did not receive home-based care. A similar trend was observed for other chronic conditions that may benefit from home-based support, including multiple sclerosis, traumatic amputations, lung cancer, and seizure disorders.

The results point toward a potential positive impact of types or components of home-based care on the management of specific chronic conditions. However, additional research will be required to better understand how patients should be prioritized relative to clinical and social factors that influence responsiveness to service delivery in the home and to identify which interventions drive lower utilization and spending.

Funding for this analysis was provided by BrightStar Care. Avalere retained editorial control.

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Methodology

Avalere conducted a retrospective cohort study using Medicare FFS data (100% sample; Parts A, B, and D) from 2007–2021 that were accessed under a research-focused data use agreement with the Centers for Medicare & Medicaid Services. As noted above, Avalere pulled the enrollment and claims data of approximately 3,603 patients (intervention group) who received targeted home care services between 2012 and 2017 and a large, random sample of beneficiaries who were enrolled in Medicare during the same timeframe and had no history of being exposed to the vendor’s service offerings.

Next, a regression-based matching algorithm was used to identify a subset of non-intervention beneficiaries who were, on average, statistically comparable to the intervention group with respect to baseline demographic and clinical characteristics, including age, gender, frailty status, dual eligibility status, low income status, clinical risk, and recent home health utilization. Upon finalization of the research cohort, Avalere derived utilization and cost metrics from the claims data and conducted a between-group difference-in-differences analysis to quantify the impact of targeted home-based care.