What's Happening at Home: A Claims-based Approach to Better Understand Home Clinical Care Received by Older Adults.

BackgroundHome clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC.ObjectiveTo describe HCC received by older adults using claims data within the OptumLabs Data Warehouse.Research designUsing administrative claims data for commercial and Medicare Advantage enrollees, we describe morbidity profiles, health service use, and care coordination (operationalized as care plan oversight [CPO]) for people receiving HCC and the subgroup receiving HBMC.ParticipantsThree million adults (3,027,247) age ≥65 with 12 months of continuous enrollment 2013-2014.MeasuresCPT or HCPCS codes delineated HCC, HBMC, and CPO recipients and care site, frequency, and provider type. Other measures included demographic characteristics, clinical characteristics, and health care utilization.ResultsOverall, 5% of the study population (n=161,801) received 2+ months of HCC visits; of these, 46% also received 2+ HBMC visits (n=73,638) while 54% received only skilled home health (n=88,163 HCC but no HBMC). HBMC-recipients had high comorbidity burden (Charlson score 4.3), dementia (35%), and ambulance trips (58%), but few nursing facility admissions (4.9%). Evidence of care coordination (CPO claims) occurred in 30% of the HCC population, 46% of HBMC, and 17% of the skilled home health care only.ConclusionsApproximately 1 of 20 older adults in this study received HCC; 30% or less have a claim for care coordination by their primary care provider.