Home-Based Care as a New Medical Model: An Opportunity for Nurse Practitioners

Much attention has been given to the use of the emergency department (ED) by the uninsured patient, whereas the insured patient actually uses ED more frequently. The focus of this article is how to reduce costs for the geriatric insured chronically ill patient using nurse practitioners in a home-based program. Patients in this category are enrolled and offered scheduled and urgent visits. Patients are asked to contact the home-based company when considering an ED visit. Assuming the patient's needs can be served at home, nurse practitioners are dispatched to diagnose infections; administer breathing treatments: order medications: and administer oral, intramuscular, and intravenous medications. Home-based companies achieve revenue through a value-based system in which actual costs for each engaged patient is compared with unenrolled patients of the same acuity and with similar conditions. The company demonstrates the savings and receives a portion of the savings for each enrolled patient. Patients incur no costs except for the health plan premiums they are already paying. Patients wait for urgent care in the home, rather than risking exposure to other contagions in an ED waiting room. Many high-risk high-need patients have difficulty attending regular clinic appointments, so scheduled, home-based visits can identify changes in a patient's condition that patients and caregivers are unable to recognize. Mild illnesses in such patients may escalate to more serious problems in high-risk high-need patients, and the home-based concept offers a new career opportunity to nurse practitioners while decreasing health care costs among the sickest 5% of the population on whom more than 50% of health care costs are incurred annually.