• Description

MedStar's program offers round-the-clock access to a care team comprising a geriatrician, nurse practitioner, and social worker. The house calls reveal and address problems that are missed when care is poorly coordinated, enabling team members to identify social supports for patients that can improve quality of life, reduce the burden on caregivers, and head off problems that can lead to high-cost institutional care.

Based on the cost savings it achieved, the program became one of the models for the federal Center for Medicare and Medicaid Innovation's Independence at Home Demonstration, which is testing whether providing primary care at home to frail elderly patients with multiple chronic conditions or advanced illnesses improves outcomes and lowers health care spending. MedStar participates in the demonstration as part of a consortium that includes Virginia Commonwealth University and University of Pennsylvania Health System, both of which are implementing an approach similar to MedStar's. The consortium is one of nine participating groups to earn a share of the savings they produced for Medicare.