Nursing care moving to outpatient model

The number of skilled nursing facilities and nursing homes is on the decline with the introduction of in-home care, which is aimed at cutting costs, according to The New York Times.

Despite the aging population, the number of nursing homes--which have relied heavily on Medicare and Medicaid dollars--has shrunk by almost 350 during the past six years. Meanwhile, the number of in-home nursing programs nationwide has doubled since 2007, from 42 programs in 22 states in 2007 to 84 programs in 29 states today, the article noted.

"It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care," Jason A. Helgerson, who directs New York's Medicaid program, told the Times. "That meant we were institutionalizing service for people, many of whom didn't need 24-hour nursing care. If a person can get a service like home healthcare or Meals on Wheels, they can stay in an apartment and thrive in that environment."

The move from institutionalized care, as Helgerson called it, to managed care is one that stems from nationwide initiatives to cut costs while improving care.

In the newer model of care, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for patients in the comfort of their own home or at adult day-care centers. Studies indicate that the managed care model can not only save money over the traditional nursing home approach but also improves patient outcomes.

With fixed monthly fees for each participant, center operators of the Program of All-Inclusive Care for the Elderly--better known as PACE--are incentivized to offer preventative care rather than fee-for-service care that have traditionally relied on hospitalizations for payments. The idea is simple: keep patients out of the hospital and save some money and keep the patients happy.

As Gene Lindsey, president and CEO of Atrius Health, noted, managed care with global payments is a "big experiment." As the nation's healthcare system tests out at-home care, adult day center programs and Pioneer Accountable Care Organizations, like Atrius Health, only time will tell if the experiment with work.

For more information:
- read the New York Times special report
- check out the FierceHealthcare interview with Atrius Health

Karen M. Cheung contributed to this article.