Medical Care at Home Comes of Age

Christine Ritchie, MD, MSPH, Massachusetts General Hospital and Harvard Medical School
Bruce Leff, MD, Johns Hopkins University School of Medicine
Naomi Gallopyn, MS, Massachusetts General Hospital
Charles Pu, MD, Mass General Brigham Population Health and Harvard Medical School
Orla Sheehan, MD, PhD, Johns Hopkins University School of Medicine


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What Is Home-Based Medical Care?

Home-based medical care encompasses a variety of care models that often serve the most medically complex and socially vulnerable people. Medical management, comanagement, and oversight by nurse practitioners, physician assistants, and especially physicians — often in collaboration with an interprofessional care team — and the execution of a medical care plan are core components in the care of these patients. Essential care also requires addressing issues related to patients’ functional status, cognitive and behavioral concerns, and social determinants of health.

Over the last 30 years, a variety of home-based medical care models have been developed to address gaps in health care delivery, especially for people with multiple chronic conditions and functional impairments. These models are becoming increasingly important as patients seek care that is person-centered and meets their complex needs. This is especially true in the context of the ongoing COVID-19 crisis, which has drawn into sharp focus the need for care models that go beyond the traditional “bricks and mortar” of physician offices and hospitals.

While increasing use of home-based medical models could improve outcomes and lower costs for different types of high-need, high-cost patients, the burgeoning landscape of these models can be difficult to make sense of. This report aims to make it easier for policymakers, health plans, and health systems to understand the why, what, and how of home-based medical care models. It examines how this field has developed, details current home-based medical care models and the patient populations they serve, and describes real-world applications through case studies. Health care stakeholders can use this information to support purposeful program planning and creative implementation, and to identify opportunities to form a full-fledged home- and community-based service delivery ecosystem.