Home Centered Care Institute
Advancing Home-Based Primary Care
The Home Centered Care Institute is a collaborative non-profit founded in 2012 by house call physician Dr. Tom Cornwell at the urging of a generous philanthropist who recognized home-based primary care as a way to change the way the US healthcare system cares for chronically ill, medically complex patients. Those patients, who too often rely on the emergency response system as their source of primary care present a tremendous challenge for an already taxed healthcare system. Just 1% of Medicare patients account for an astonishing 23% of Medicare spending. HCCI believes that a workforce of highly trained home-based primary care providers is a solution – a means of providing extraordinary care in a financially sustainable manner – for transforming healthcare in the US.
Currently, only a small fraction – 14% – of the patients who genuinely need this care receive it. It isn’t because they don’t want it. It isn’t because physicians don’t believe in its effectiveness. Limited access to home-based primary care is due to a critical shortage of home-based primary workers. In 2014, 2,153,050 patients received a house call, for a total of 5,367,730 visits. The bulk of these visits, however, were made by only 1,000 clinicians. To reach just 50% of patients who could benefit most from HBPC, it will take an additional 1,000 new clinicians every year for the next five years, in addition to an equal number of practice management personnel.
The HCCI Solution
To meet this need, HCCI collaborated with a dedicated group of national HBPC experts and, led by Dr. Marta Twaddle, developed the nation’s first comprehensive HBPC curriculum. The curriculum is multi-faceted, comprised of interactive classroom education, mentorship, field-based experience, and online training that includes video, webinars, podcasts, and shared learning opportunities.
HCCI has partnered with eight of the nation’s most respected institutions of higher medical learning to deliver the classroom portion of this training. These Centers of Excellece will be the site of 12 hours of intense, highly interactive learning, focusing on clinical and practice management topics, consistent with the AAHCM clinical competencies in HBPC and the AGS guidelines for patients with multimorbidities. The classroom training includes topics such as infection control in the home, patient and personal safety, medication management, and the economics of HBPC. In addition to the Centers of Excellence, HCCI has identified Practice Excellence Partners, high-performing house call practices throughout the US where learners accompany house call clinicians and practice managers on patient visits and in the office.
To build a body of knowledge related to HBPC, and eventual evidence-based standards of care, HCCI will partner with house call practices, Centers of Excellence, and Practice Excellence Partners to compile a home-based primary care data registry, the first data registry of its kind in the nation. The registry will allow practices of various types and affiliations to compare operating and clinical categories among peer groups. While long available for other medical specialties, house call medicine has not had the benefit of such peer group comparisons. Staffing levels, clinical quality indicators, compensation and marketing expenses are among the categories envisioned, along with clinical practices. It is HCCI’s goal that comprehensive HBPC research will eventually form the basis for a certification in the field.