Overview and Statement of Need
The practice of health care today is in a state of tremendous transition. Changing demographics, rising costs, a strain on resources, and ever-changing policies and fee structures have left health care providers struggling to provide cost-effective, quality care for patients. The aging and chronically ill population is particularly at risk for being underserved, and this population is growing faster than ever. These realities are especially true in Florida, which together with 16 other states in the southern region of the U.S., contains the greatest number of people over age 65 and over age 85 years,1 and more than the national average of Medicare beneficiaries with four or more chronic conditions.2 We know that nationally, 5% of Medicare beneficiaries account for 50% of Medicare spending3 and that much of this expense can be attributed to repeated, costly hospitalizations for chronically ill, medically complex patients.
Yet, from research studies and such real-world trials as the CMS Independence at Home demonstration, we also know that innovative home-centered care models effectively address both patient and provider needs in the current health care environment.
Home-based primary care (HBPC) offers an alternative model of care for the frail, complex, chronically ill and disabled aging population: 1) improved patient outcomes; 2) improved patient satisfaction; 3) reduced costs; and 4) improved experience for physicians and other practitioners.
Florida has been identified as an area of significant need in terms of a large Medicare population with multiple chronic illnesses as well as prevalence of HBPC providers. In addition, the new CMS Primary Cares First Initiative became available in 26 states, including Florida, in January 2020. This important demonstration project will open some doors for new and existing HBPC providers, featuring new Alternative Payment Models (APMs) for primary care services, including HBPC, for high need and seriously ill Medicare beneficiaries.
Home Centered Care Institute (HCCI) has analyzed the HBPC supply and demand (PDF) in Florida and is implementing The Florida House Call Project, with support from the RRF Foundation for Aging. As part of this work, HCCI has launched an in-depth provider survey to better understand the prevalence of house call providers and practices across the state, any obstacles or burdens they are facing, current utilization of HBPC in Florida and identification of areas of unmet need, and the overall perceptions and impact of home-centered care on Florida’s medical culture.
The Florida House Call Project has identified, equipped, and motivated a new network of HBPC providers to spread awareness of home-centered care and relevant HCCI resources, tools, and training, to collaborate with HCCI in marketing and communication of the benefits of HBPC, and to lead local training and in-service activities. HCCI’s on-going goals include:
- Expand the national footprint of home-centered care to a high need area not currently served by HCCI’s Centers of Excellence for Home Based Primary Care™.
- Grow the workforce of trained and qualified house call providers (physicians, nurse practitioners, and physician assistants) and practice staff (e.g., nurses/care navigators, practice managers) serving aging, medically complex patients in Florida.
- Develop a foundation for statewide research in Florida and for future national research aimed at strengthening the field and practice of home-centered care.
- Increase demand, momentum, and capacity for home-centered care in Florida through enhanced professional and public awareness and dissemination of project outcomes.
Home-Centered Care Champions
A key strategy for meeting these objectives was to identify a cohort of Home-Centered Care Champions who are geographically dispersed across the state of Florida. These providers and practice professionals have been prepared to serve as leaders and champions of home-based care through specialized training designed to prepare them to spread awareness of HBPC within their communities and to lead local education of other providers, practice/operations staff, and the public, using HCCI resources, tools, and curriculum.
- The Older Population: 2010. In: U.S. Census Bureau, ed. Washington, D.C.2011.
- Ornstein KA, Leff B, Covinsky KE. Epidemiology of the homebound population in the United States. JAMA internal medicine. 2015;175.
- Cohen S. Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2012. Statistical Brief (Medical Expenditure Panel Survey (US). Rockville, MD: Agency for Healthcare Research and Quality; 2012.
HCCI is grateful to the RRF Foundation for Aging for its philanthropic support of The Florida House Call Project.