OUTCOMES OF HBPC--Veterans are enrolled into HBPC for chronic, progressively debilitating conditions that are not expected to improve.
Not surprisingly, the annual mortality rate among veterans enrolled in HBPC is 24 percent, with more than three-quarters of those deaths occurring at home.
VA conducted a national evaluation of the impact of HBPC in 2002.
Enrollment in HBPC was associated with a 62 percent reduction in hospital bed days of care (BDOC), an 88 percent reduction in nursing home BDOC, and a 264 percent increase in homecare visits.
In a subsequent analysis of all veterans newly enrolled in HBPC during fiscal year 2008, (5) enrollment in HBPC was associated with a 56 percent reduction in hospital BDOC, an 84 percent reduction in nursing home BDOC, and a 78 percent reduction in total inpatient BDOC, results similar to the 2002 analysis.
A more recent analysis (5) assessed the impact of HBPC on combined VA and Medicare utilization and costs, since many veterans are dually eligible and receive care in both systems.
For example, the average duration of enrollment in HBPC is approximately 315 days versus an average of 65 days for an episode of Medicare homecare.
HBPC does not require a need for skilled care, does not require strict homebound status, and accepts progressive decline in function as an expected outcome.
HBPC programs have geographic restrictions (generally limited to less than 60 miles from the home VA facility) and cannot provide multiple daily or even weekly visits; the average frequency of HBPC visits is 3.1 per month.
Very importantly, HBPC is strongly associated with reductions in BDOC, total costs of care and high levels of patient satisfaction, whereas Medicare homecare has not shown any significant impact on BDOC or total cost of care.
Also importantly, HBPC and Medicare homecare can be complementary, as when an HBPC patient with chronic illness suffers an acute illness or injury and requires skilled nursing or rehabilitation in addition to chronic care after discharge from the hospital.
--The success of the HBPC model and of similar programs in several smaller private sector health care systems prompted Congress to pass the Independence at Home Act in 2010.