Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. They are among the most costly patients in the U.S. health care system, not because of a specific disease but because of a powerful combination of multiple chronic conditions, functional impairment, frailty, and social stressors.
- The full scope of their needs is not met by any of the existing formal health services – ambulatory, hospital, emergency department (ED), hospice, or skilled home health care.
- Their needs and their limited ability to access primary care commonly result in unnecessary ED visits, hospitalizations, and downstream health care expenditures.
- These patients account for approximately half of the costliest 5 percent of patients.