• Parag Bharadwaj, Nathan Dyjack, Gagandeep Gill, Adam Solomon, Mark Schafer, Elizabeth Simpson, Roseann DeVito, Gwyn Merz, Lysa Switzer, Marshall Gillette, Lindsay Fahnestock, Chintan K Somaiya, and Manjit Randhawa.
• MemorialCare Medical Group, Long Beach, California, USA.
• J Palliat Med. 2023 Oct 1; 26 (10): 139513971395-1397.

AbstractBackground: MemorialCare Medical Group (MCMG) designed and implemented an advanced health care practitioner (AHP)-led home-visit primary care program to address the needs of a frail older adult population, who struggled with arriving for in-office care. We sought to perform a preliminary analysis to determine the program's efficacy. Methods: We conducted a retrospective review of patients enrolled in the program through tabulation of total costs of care, inpatient visits (IPVs), emergency department visits (EDVs), and 30-day readmissions (30DRs) 1-year pre-enrollment and postenrollment. Results: For the prior year and postyear windows, per-member per-month total cost of care decreased 21.4% ($5,883.44-$4,622.31), reflecting a gross savings of $2,693,480.32. Mean IPVs (2.42-1.56), EDVs (1.53-0.93), and 30DRs (0.27-0.13) were reduced. Conclusions: Initial analysis of an AHP-led in-home primary care program for frail seniors shows promise for improved outcomes with a clear decrease in the total cost of care.

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