‘Eyes in The Home’: ACOs Use Home Visits to Improve Care Management, Identify Needs, And Reduce Hospital Use

Journal Article
June 2019

This resource used national survey data from physician practices and ACOs, paired with qualitative interviews, to learn about home visiting programs.

  • ACO practices were more likely to report using care transitions home visits than non-ACO practices were.
  • Interviewed ACOs reported using home visits as part of care management and care transitions programs as well as to evaluate patients’ home environments and identify needs.
  • ACOs most often used nonphysician staff to conduct home visits.
  • Home visit implementation for some types of patients can be challenging because of barriers related to reimbursement, staffing, and resources.
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Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • How are home visits used in physician practices and accountable care organizations (ACOs)?
  • Who conducts these visits?
  • What are some challenges associated with home visits?