Home-based primary care in the VA setting, with a focus on Birmingham, Alabama.

The Veterans Administration Hospital-Based Home Care Program provides comprehensive primary care to homebound veterans. Unlike Medicare-funded home care, it is not oriented to episodic provision of skilled nursing care, but rather to long-term primary care in the home. The interdisciplinary composition of HBPC teams allows for innovative approaches to care and coordinated implementation of treatment plans. Outcomes assessment of care provided through HBPC has been positive, suggesting an overall improvement in function and decrease in health care costs among those using the HBPC Program. The HBPC Program offers a tested model of primary home care within a "managed care" model. Its positive features should be considered by those initiating managed primary home care within the private sector.