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September/October Publisher’s Message
How is Home-Based Primary Care Disrupting Traditional Models?
Many agree the future of care is in the home. During COVID-19, home-based care created a new sense of urgency which will continue beyond the pandemic. Payers and providers are looking at home-based care as a less expensive option to the rising cost of healthcare and the preference of consumers.
Home-based care becomes a greater solution as the healthcare industry experiences the rising number of uninsured people and greater enrollment in Medicaid. The silver lining of COVID-19 is it expanded telehealth capabilities in the home and aligned physicians to be paid for oversight.
Primary Care Models Disrupting Traditional Models
Home-based medical care models are shaking-up the $260 billion primary care market. Primary care practices are getting hit hard by the loss of revenue during the COVID-19 pandemic and the impact of the health crisis is forcing organizations to rethink how they operate.
A RAND study found that 81% of people 65+ had multiple chronic conditions (MCC) and Medicare enrollment is expected to grow to nearly 80 million by 2030.
The models shaking-up the healthcare industry are:
- Home-based primary care (HBPC) programs that provide appropriate care (primary, urgent, or palliative) to high-risk, medically vulnerable patients, often suffering multiple chronic conditions, when and where they need it.
- Integrated primary care delivery models that address chronic care management in the home. Most partner with payers in shared savings arrangements. These are interdisciplinary team-based models.
- Primary care physician groups partnering-up with insurers adding the support of telehealth and pharmacies to deliver care in the home.
Technology Key to the Disruption
CMS recently released proposed policy changes for 2021 Medicare payments rates under its annual Physician Fee Schedule. It includes an expanded Medicare list of services. Services added include more complex visits that allow offices to bill for more advanced office/outpatient evaluation and management codes, prolonged services, group psychotherapy, neurobehavioral status exam, care planning for patients with cognitive impairment and home visits. The expansion of telehealth billing codes provides for physician care oversight in the home.
In this issue of The Remington Report, we take a deep dive into primary care models disrupting traditional models. The acceleration of home care that occurred during the pandemic kindled the transition to a patient-centric care model.
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