This is the research project we have all been waiting for.
For years, healthcare at home lobbyists and advocacy organizations have been trying to get through to public and private payers the principle that both skilled medical and personal care services provided to people in their homes save more than they cost. The response of CMS and insurance companies has been, "show me." Anecdotes and heart-wrenching personal stories have not been sufficient to convert the hearts and minds of number crunchers hungry for hard evidence.
Within the next 12 months, this will change
The Journal of the American Geriatric Society will publish an article later today (8/12/16) describing the first phase of Harvard Medical School's new research into the impact of in-home care on overall healthcare costs. The article will be titled, "Preliminary Data on a Care Coordination Program for Home Care Recipients."
For a preview of the preliminary data, we interviewed Mr. Geoff Nudd, CEO of ClearCare, a Harvard research partner, in advance of the article's release. ClearCare is a non-medical home care software vendor based in San Francisco.
"This is a study with foundational, fundamental research for the whole industry," Nudd told us, "quantifying the impact of home care on overall costs. This is a $20 billion industry but patients with functional disabilities cost the system $200 billion a year. Amazingly, research like this on this massive, high-cost patient population, this huge industry, has never been done before."
Harvard engaged ClearCare customer Right at Home to participate in the study at 22 of its 310 franchises. "They developed a rigorous study structure," Nudd added, "to compare patients in a control group to those under carefully designed care protocols."
Right at Home caregivers using the Harvard protocols complete a brief questionnaire at the end of every shacidift or visit. They respond to questions such as, "Does the client seem different than usual? Has there been a change in mobility, eating or drinking, toileting, skin condition or increase in swelling?" and "Does client show any reduced talking or alertness?"
In the pilot, caregivers reported a change in patient condition after 2 percent of all shifts, representing an average of 1.9 changes per care recipient in a 6-month period. Changes in behavior and skin condition were the most frequently recorded domains.
In those 2 percent of cases, a case manager is alerted via the ClearCare software and a triage sequence begins. The patient may be sent to a doctor visit, to the hospital, or be scheduled for a home RN visit. Sometimes the response is to alert the family.
The test: Medicare claims data
"The evidence is good but anecdotal so far," Nudd explained, "but during the first six months of next year the Harvard researchers will begin to cross-reference Medicare claims data between clients under the triage protocols and the control group. By the middle of next year, we will have quantified the impact of in-home care on overall healthcare costs."
He is quick to add that, although this particular trial uses ClearCare software, the Harvard Medical School protocols are not vendor specific. "Any agency can be equipped to execute these protocols," he said. "Be assured, you do not have to be a ClearCare customer to use these publicly available protocols."
Behind the Data: People
One of the stories from the early days of the Harvard Medical School study that ClearCare CEO Geoff Nudd found most gratifying was the one he said demonstrated the remarkable effect of catching problems early. A diabetic patient had developed a foot ulcer. Her non-medical caregiver noticed it and reported it electronically to her case manager, who passed it along to the skilled medical home health agency on the patient's care team, which had a nurse visit on the schedule for the following week. Instead, the HHA sent a nurse immediately. The RN treated the ulcer, it began to heal, and the patient did not have to go to the hospital. "It could have been much more serious," Nudd opined. "One week later and it might have been too late to successfully treat that ulcer and avoid a trip to the hospital."