How One Primary Care Organization is Boosting Value-Based Care for Seniors

October 24, 2022 - Delivering high-quality, value-based care is a strategic goal for most US healthcare organizations, though the means to the end varies. For one senior-focused primary care provider, in-home care supplemented by telehealth and remote patient monitoring (RPM) has proved to be the answer.

Listen to the full podcast to hear more details. And don’t forget to subscribe on iTunes, Spotify, or Google Podcasts.

Called Heal, the organization aims to bring the primary care experience to seniors in their homes.

"[Heal] allows [seniors] to be independent and to be cared for at home as much as possible," said Justin Zaghi, MD, Heal's chief medical officer, in an interview with Healthcare Strategies. "It allows them to minimize being a burden on their family members and creating challenges for their family members in terms of getting access to care."

And seniors are craving this independence more than ever, Zaghi added. Increasingly, older adults are living and remaining active longer. This is driving the growing desire to age in place. Aging in place is the "ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level," according to the Centers for Disease Control and Prevention.

The rise in virtual care adoption and at-home care, largely driven by the COVID-19 pandemic, has supported value-based care models that leverage telemedicine and RPM modalities, like Heal's.  

Per the model, Heal's clinicians and advanced practice providers make house calls with all the necessary equipment for conducting a clinic visit. These house calls are supplemented by telehealth visits and RPM using Bluetooth-enabled devices, including blood pressure cuffs and glucometers.

Heal's model is based on at-home and virtual care, which tends to be more expensive than care provided in clinics, but the model supports value-based care by improving health outcomes and reducing costs in the long run, according to Zaghi.

"Sending a doctor to a patient's home can help reduce ER visits, it can reduce hospitalizations, it can lead to observations [on social determinants of health] that will prevent the patient from having their health worsen," he said.

For example, Heal providers have been able to remotely track patients with heart failure and extend care into their homes, significantly reducing ER visits among this population.

Further, the organization has been participating in a demonstration project with Medicare in New York called Independence At Home.

"We saved Medicare on average $10,000 per patient in one year… [By] providing regular visits at home with telemedicine [we were] able to significantly reduce hospital use, readmissions, admissions, and as a result, improve healthcare outcomes and save money," Zaghi said.

Heal currently operates in eight states, with plans to expand across the country.