New intervention study examines health outcomes among private-pay home care recipients

Researchers from Harvard Medical School's Department of Health Care Policy have launched a joint partnership with ClearCare, a company that provides a software platform for home care agencies, and Right at Home, senior home care franchise. The program, titled "The Intervention in-Home Care to Improve Outcomes," or simply "In-Home," will test a brand new, large scale randomized intervention aimed at preventing hospitalizations, improving health outcomes, and lowering Medicare spending among private-pay home care recipients.

"To date, almost no one has looked on a large-scale basis at how the private-pay home care population utilizes health care," said Dr. David Grabowski, Professor of Health Care Policy at Harvard Medical School. "In this program, we will have access to a large population of private-paying home care recipients via our partnership with Right at Home. We will also have the ability to identify detailed changes in care-recipient condition and hospitalizations over time via our partnership with ClearCare." Grabowski will manage the project.

The study is one of the inaugural projects under the newly established Healthcare Markets and Regulation Lab at Harvard Medical School, supported in part by The Laura and John Arnold Foundation.

The program consists of two components: 1) early identification of patient changes in condition, and 2) monitoring (or helping to manage) these changes in the home.

If these changes remain undetected and unmanaged, they frequently escalate into costly hospitalizations. Under this new program, acute changes in a patient's physical or cognitive status are observed and reported via a caregiver checklist. Any changes in status are communicated in real-time to a care manager who reviews the reported change in condition and decides on the appropriate course of action. By identifying avoidable conditions in their early stages, determining the appropriate escalation, and then helping to manage the condition in the home, the In-Home program can achieve the "win-win" of improving outcomes while lowering health care spending for the home care population.

"Through these partnerships, for the first time ever, we will be able to determine whether home care technology coupled with a simple intervention strategy can reduce hospitalizations, improve overall health, and reduce costs," said Grabowski.

"We are experiencing a massive demographic shift, with more older people than younger for the first time in human history," said Geoff Nudd, CEO of ClearCare. "This fact, in combination with expensive treatments driving the healthcare cost crisis, is prompting a general examination of how preventative, non-medical care might be the answer to the problem. This program will provide us with invaluable insight into how the power of home care can improve lives."

"According to the U.S. Department of Health, roughly 28 percent – or 11.8 million – American seniors now live alone," stated Allen Hager, Founder of Right at Home. "While this fact illustrates that there is, indeed, a real need for home help for seniors, what's even more critical is that it prompts us to gain a deeper understanding, and validation, of how this help can support a better quality of life."

The In-Home Program should be of particular interest to provider groups and health plans. These groups are increasingly working together to decrease hospitalizations, reduce the overall expense to health networks, and ultimately lower costs for the care recipient. Until now, these providers and plans have not typically reimbursed for home care services, which are mostly paid for privately by the care recipient, because the impact of these services has not been formally examined at scale. The findings of the In-Home Program could further reinforce aging at home as not only the choice of most seniors, but also as a model of aging that simultaneously lowers health care spending while maximizing quality of life.