The Impact of In-Home Chronic Disease Management on Spending

Employing personalized, in-home chronic disease management services can have a significant impact on spending for seniors with chronic conditions, a study from Avalere found.

“Demonstrating a positive impact on clinical and economic outcomes has been a long-standing challenge for the home care industry due to fragmented care standards across states, the lack of standardized measures in personal care, and limited access to claims data that would enable home health agencies that support patients with activities of daily living (e.g., medication management, meal preparation, patient education) to track and measure the impact of service delivery on patient utilization and outcomes,” the Avalere researchers began.

In order to shed light on the subject, the study analyzed a group of fee-for-service Medicare beneficiaries who received personalized care and compared them to another group of fee-for-service Medicare beneficiaries who did not receive personalized care. The participants all required chronic disease management for at least one of thirty conditions and were statistically similar.

Avalere used in-house medical and pharmacy claims data of more than 3,000 patients from 2007 through 2021. These patients received home healthcare support for their chronic conditions from 2012 through 2017. 

The researchers compared healthcare spending before the patients began receiving personalized home healthcare to healthcare spending after implementing these solutions. Then they compared these results to the results for a similar cohort of patients who had not received the home healthcare intervention at all.

Total cost of care was better for the group that received targeted home healthcare chronic disease management compared to the group that did not.

The top ten chronic conditions that saw the biggest decrease in healthcare spending with in-home chronic disease management were: quadriplegia, traumatic amputations and complications, multiple sclerosis, atherosclerosis of the extremities with ulceration or gangrene, lung and other severe cancers, reactive and unspecified psychosis, artificial openings for feeding or elimination, bone or joint or muscle infections or necrosis, seizure disorders and convulsions, and intestinal obstruction or perforation.

Patients with quadriplegia saw the highest healthcare spending difference in total cost of care after receiving home healthcare. The group that received the home healthcare solution spent $12,807. In contrast, the group that did not receive in-home chronic disease management support spent nearly $30,000 more, with average spending of $42,709.

The condition that ranked lowest in the top ten chronic conditions was intestinal obstruction or perforation. But even for this condition, patients with the intervention spent on average $17,738 less than their counterparts.

Despite the major differences in total cost of care between the two groups, the group that received the targeted home healthcare intervention did not display drastic differences between healthcare spending levels before and after implementing the intervention.

Based on these outcomes, home healthcare could positively influence healthcare spending for chronic disease management, the study concluded. 

“However, additional research will be required to better understand how patients should be prioritized relative to clinical and social factors that influence responsiveness to service delivery in the home and to identify which interventions drive lower utilization and spending,” the researchers qualified.

The potential positive impact of home healthcare has been broadly accepted. Since the coronavirus pandemic forced most care into the home, payers—particularly Medicare Advantage plans—have been working to build on those COVID-19 home healthcare strategies. 

For example, Humana took strides toward home healthcare with its acquisition of Kindred at Home as well as its acquisition of value-based home healthcare provider One Homecare Solutions.

But Humana was not alone. Other payers expanded their programs and, although the number of Medicare Advantage plans that have adopted home healthcare benefits is still small, it has experienced a surge in recent years.

Payers may not need much more convincing that home healthcare can have an impact on healthcare spending. However, this report provides more context for the influence that this strategy can have across many different disease types.