Additive Impact of Virtual Urgent and Emergency Department at Home Care on Value-Based Primary Care for Medicaid and Dual-Eligible Members

Abstract

Virtual urgent care (VUC) and emergency department at home (ED at home) are two emerging interventions that may help address avoidable health care costs driven by inadequate access to primary care. This study evaluates the integration of VUC and ED at home as a combined mobile integrated care program, into a value-based primary care model that serves Medicaid and dual-eligible populations. Use of embedded VUC and ED at home among individuals with claim-identified physical health needs was associated with a statistically significant 27% reduction in inpatient admissions (P = 0.05), a 61% reduction in readmission (P = 0.04), and a 240% increase in engagement with primary care and care coordination (P < 0.001). Use of these services was also associated with a total cost of care decrease of $550 per member per month (P = 0.07). Findings suggest that virtual and home-based acute care services may be a promising lever for value-based payment models to enhance engagement and realize goals of improved cost and outcomes among populations with complex medical and social needs.