In-home Visits and Subsequent Health Outcomes in Medicare Advantage Beneficiaries With Coronary Artery Disease, Diabetes, Hypertension, and Depression

Abstract

Background: 

Coronary artery disease, diabetes, hypertension, and depression are common burdensome conditions.

Objectives: 

To examine whether multidimensional preventive in-home visits were associated with fewer emergency and inpatient care episodes and higher quality of care.

Research Design: 

An observational, retrospective data analysis.

Subjects: 

A nationwide Medicare Advantage population from the Optum Labs Data Warehouse.

Measures: 

We compared beneficiaries with 1 or more of the conditions with an in-home visit in 2018 (“Exposure”) with those without a visit in 2018 but with a future visit in 2019 (“Wait List Control”) using a difference-in-differences analysis. Primary outcomes were 1-year all-cause inpatient care and emergency visit counts. Secondary outcomes included primary care visits, major adverse cardiovascular events, and select quality-of-care metrics. An exploratory outcome was the time-to-first primary care visit after the index date.

Results: 

Among those eligible to receive an in-home visit, a total of 48,566 patients had an in-home visit in 2018 (the “Exposure” group), and 36,549 beneficiaries constituted the “Wait List” control group. Receiving an in-home visit early was associated with a greater decrease in inpatient stays for all 4 conditions (change score range for any stay: −5.22% to −2.47%) (P<0.001, depression <0.05); decrease in emergency visits (change score range for any stay: −4.39% to −3.67%) (P<0.0.001, depression <0.05); and fewer major adverse cardiovascular events for coronary artery disease and depression (P<0.001 and <0.025, respectively) 1 year later. Minimal differences were noted for change in ambulatory and primary care visits, with no consistent increase in quality-of-care metrics. Time-to-first primary care visit was shorter for the “Exposure” versus the Wait List control group in all conditions (difference between 2.45 and 4.95 d).

Conclusions: 

The feasibility and impact of a nationwide multidimensional preventive in-home visit were demonstrated, targeting common and high morbidity conditions. Benefits were observed against a Wait List control group, resulting in less resource-intense care.