• House Calls Program Puts Patients First, Saves Money

    Joseph Milano, MD Jul 24, 2017

    Joseph MilanoAs we age, our ailments can grow more frequent and consequential. For many Americans, this means regular hospital visits that are both costly and potentially dangerous, needlessly exposing patients to infections. Faced with this challenge, Northwell Health, the largest healthcare provider in New York State, asked a simple question: Could we possibly offer older patients high-quality care in the comfort of their own home?

    Northwell is not the only one experimenting with the idea. Over the next 40 years, according to U.S. Department of Health and Human Services, the number of Americans aged 65 and older will double to 98 million. That trend demands that health systems rethink the way they care for their neediest patients.

    Home-based primary care is one solution. In less than seven years, the number of at-home care programs nationwide has mushroomed from zero to more than 260, an expansion that Northwell Health is proud to have helped lead.

    Northwell’s House Calls program helps hundreds of older New Yorkers annually by offering patients the same high-quality care they would receive in a hospital, but without requiring them to leave their living room. This care model includes access to ultrasound, radiology, electrocardiogram, sleep studies, lab work, physical exams, occupational and speech therapy, social work services, intravenous fluid, and prescription refills. A recent evaluation of the program’s efficiency found that 78 percent of patients participating in the program received treatment at home with no need for hospitalization.1

    These results should hardly come as a surprise. There’s a vast difference between having to rush to the hospital to be treated in an unfamiliar and sterile exam room and welcoming a caregiver into the safety and warmth of your own home. As a 57-year-old patient who is coping with several chronic conditions told me recently, the program gives him more than just care when he needs it; it gives him the chance to live a normal life without the disruption of repeated trips to the emergency department or the doctor’s office.

    “I don’t know where I would be at this point right now without this program,” the patient said. “I do feel confident that tomorrow I know what’s going to happen with my life. They’re saving my life.”

    The program saves money, too. In 2016, the Centers for Medicare & Medicaid Services reported that the House Calls program—part of the federal Independence at Home pilot initiative—reduced costs by $6,816 per patient per year for a total of $1,641,825 in Medicare savings, the second-highest savings rate of all at-home care programs surveyed.

    Given that Medicare currently covers 55 million Americans who are 65 or older, with the number expected to grow to 72.1 million by 2030, interest in similar programs is on the rise. The secret to success is simple: When clinicians, patients, and family members meet beyond the hospital’s confines, they become partners, communicating and collaborating to provide the best possible care.

    In doing so, they are proving medicine’s oldest and truest adage—that to care for a patient, you should first care about the patient. There’s no better place to do so than in the patient’s own home.

    Joseph Milano, MD, is medical director, Northwell Health House Calls, Northwell Health, New Hyde Park, N.Y.


    1. Abrashkin, K.A., Washko, J., Zhang, J., et al., “Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program—Preliminary Data,” The Journal of the American Geriatrics Society, December 2016.