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Rowan and Berger: Model Programs After VA’s Home-Based System

For centuries, military conflicts and battlefield hospitals have been the birthplace of countless medical advances. Staples of today’s modern medicine — vaccines, infection-prevention techniques, blood transfusions and antibiotics — can be credited to the innovative thinking of our military men and women.

Given this history, it comes as no surprise that today’s military — specifically the Department of Veterans Affairs — is leading the way in revolutionizing the manner in which care is provided to a growing number of aging service members. While Medicare is struggling to remain solvent, the VA has implemented a program that is improving patient outcomes and saving money.

The VA’s home-based primary care program — developed in 1972 as a way to serve chronically ill veterans with comprehensive, interdisciplinary care in patients’ homes — has enabled the delivery of skilled, coordinated and cost-effective services in a challenging fiscal environment. This focus on providing clinically advanced care in the home setting has yielded unprecedented outcomes that should serve as a model for America’s health care system.

In addition to providing veterans with high-quality care in the setting most patients prefer, this system of encouraging home care for long-term chronic disease management saves money.

According to the VA’s estimates, the HBPC program has reduced hospital days by 62 percent and long-term care days by 88 percent, resulting in a 24 percent decrease in costs for participants. This level of savings is almost unheard of in today’s health care landscape.

Just as vaccines grew from the need to prevent infectious diseases from spreading among soldiers, the HBPC has grown from the need to control costs for millions of veterans without sacrificing the exceptional care they need and deserve. The HBPC program uses a longitudinal care model to produce positive patient outcomes, clearly demonstrating that it’s possible to reduce costs and improve quality of care at the same time. By focusing on routine and continuous service that monitors, assesses and coordinates care as well as prevention and early detection of chronic conditions, veterans are benefiting by staying healthier longer and avoiding inpatient stays in much costlier institutional settings.

The VA recently announced a rule that would eliminate the patient copayment for tele-health services at home. The VA recognizes that removing this burden will encourage more veterans to use home health services. By doing away with additional barriers to care, patients will have increased access to the HBPC program, which will in turn improve patient quality of life and reduce VA costs in the long run.

The VA should be commended for having the forethought more than 30 years ago to put into place a program that would meet the evolving needs of America’s veterans. While the VA is achieving the goals originally set for the HBPC, the department has also created a model that lawmakers and others should take note of as we look for ways to improve health care for all Americans.

John Rowan is president and Tom Berger is executive director of Vietnam Veterans of America’s Veterans Health Council.