Northwell, federal medical program improves care, reduces cost of treating frail elderly patients at home

Dr. Atika Turkistani, a physician with Northwell Health’s House Calls, makes a home visit to one of her patients. (Photo courtesy of Northwell Health)

For the fifth consecutive year, Northwell Health’s House Calls program has been recognized by the US Centers for Medicare & Medicaid Services (CMS) for its success in in caring for chronically ill, frail seniors through home-based primary care as part of a federal demonstration project. In addition to improving health outcomes in older patients with complex health needs, Northwell’s clinicians reduced costs during the program’s fifth year by $14,051 per patient per year, representing 30.2 percent total cost of care reduction, for an overall saving to Medicare of more than $4.1 million.

Northwell had the highest savings performance among the 14 demonstration sites nationwide. After accounting for Medicare withholds, Northwell earned more than $1.8 million in incentive payments – the only such program in New York State to receive CMS incentive payments.

Northwell’s House Call practice is part of the demonstration project known as Independence at Home (IAH), which was established in 2012 as part of the Affordable Care Act (ACA). CMS analyzed program performance data between October 1, 2016-September 30, 2017, the most recent period for which information is available. CMS awarded a total of $6.86 million in incentive payments to eight of the 14 participating practices nationwide that succeeded in reducing Medicare costs and met quality goals.

During the fifth year of the demonstration project, Northwell’s House Calls practice provided care through its IAH program to 446 patients in Manhattan, Nassau, Suffolk and Queens counties. Through a highly responsive clinical model that includes 24/7 access, same day appointments and a community paramedic program, House Calls reduced cost of care to $2,703 per month compared to an expected spend of $3,874, a cost savings of 30.2 percent.

“We know our older, chronically ill patients want to remain at home as long as safely possible,” said Karen Abrashkin, MD, medical director of Northwell Health House Calls. “Programs like Independence at Home involve a large multidisciplinary team working together to deliver high-quality care, which gives patients access to health care providers when they need it. Feedback from CMS shows that we are allowing older adults to age safely in place.”

Patients enrolled in the House Calls program receive coordinated care, similar to treatment and referrals they would receive from a primary care physician, such as ultrasounds, radiology, electrocardiogram (EKG), sleep studies, lab work, physical exams, occupational and speech therapy, social work services, as well as intravenous fluids and prescription refills. Physicians, nurse practitioners and other clinicians are available for urgent, same-day visits during the week. The team also is accessible 24/7 to answer clinical questions from patients and caregivers, or arrange urgent services. In addition, House Calls with Northwell’s Center for Emergency Medical Services, developed a nationally-recognized community paramedic program capable of bringing highly trained clinicians to assess and treat patients in the home in under 30 minutes.

“The biggest cost saving comes from providing high-quality primary care and urgent care at home to either prevent hospitalizations by catching and treating problems early or providing acute care treatment in the home,” Dr. Abrashkin said. “We are focused on delivering patient-centered care that improves outcomes, reduces costs, and alleviates pain and suffering for patients by preventing unnecessary emergency department visits or hospitalizations.”

Cost savings achieved in the federal project will be reinvested to expand House Calls’ services to more patients in need, including recruiting additional physicians, increasing telehealth services and rolling out the program to patients in Staten Island and Westchester in 2020. Independence at Home is now completing its sixth year, and legislation has been proposed to extend the demonstration an additional three years.

Dr. Abrashkin noted that House Calls’ top performance in the demonstration project was achieved through collaboration with other programs across Northwell, including partnerships with the system’s nurse Clinical Call Center, Center for Emergency Medical Services, Home Health Care Agency, and Hospice.

Under the Independence at Home Demonstration project, participating practices must meet the performance measures for at least three of the six quality measures in order to qualify for the incentive payment. They are:

  • Follow up contact within 48 hours of a hospital admission, hospital discharge or emergency department visit;
  • Medication reconciliation in the home within 48 hours of a hospital discharge or emergency department visit;
  • Annual documentation of patient preferences;
  • Hospital readmissions within 30 days;
  • Hospital admissions for ambulatory care sensitive conditions;
  • Emergency department visits for ambulatory care sensitive conditions.

Submitted by Northwell Health.

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