Project Sandbox

Project Sandbox is an experiment in building an engagement with models and instances of care delivery that have shown promise towards helping reduce costs while concurrently improving patient-centric outcomes to the healthcare system. The engagement is undertaken with the intent of catalyzing the healthcare delivery model towards improved sustainability and scalability. Our first project partner under Project Sandbox is the Medical House Call program, a home-based primary care model that is focused on providing care to the frail elderly.

Project Sandbox

An Overview

There are several innovative ideas in care delivery that exist today that have demonstrated the potential of lowering costs within the U.S. healthcare system, while concurrently improving outcomes and patient engagement.

Project Sandbox, which is aligned with the West Health Institute’s mission to pioneer new and smarter technologies, policies and practices, to make high-quality healthcare more accessible at a lower cost to all Americans, is an endeavor to research and analyze the factors that will enable the growth of these innovative care delivery ideas. It seeks to pose and find solutions to the following questions:

  • What headwinds might such models face with regards to sustainability and with regards to scalability?
  • How might we channel the innovation effort towards addressing and overcoming these barriers?
  • How might we catalyze a national movement towards the rapid adoption of these ideas?

The project hopes to engage and work with on the ground providers and pioneers in these instances of care delivery to achieve these goals.

Our first focus area: Home-based primary care of the frail elderly.

The problem and underserved need

There are 3-4 million seniors now living with multiple chronic illnesses such as diabetes, lung and heart disease who are too ill or disabled to easily visit their physician when they need care. These seniors, representing approximately 10% of Medicare beneficiaries, account for two thirds of Medicare’s expenditures.

Barriers to primary care

These seniors are typically unable to access a primary care physician’s office for needed care, and instead end up going to the ER, the most costly site of care. These patients place the largest burden on Medicare, and the number of people with multiple chronic illnesses is projected to grow to 6-8 million by 2025.[1]

Frail elders living in the community face numerous barriers such as mobility limitations, and often have difficulty obtaining primary care and social services. As a result, these elders are at risk of developing acute problems requiring hospitalization and/or institutionalization.

Complex problems of frail elders pose challenges to primary care physicians, as they typically can only spend an average of eight minutes per patient a day.[2]Even if frail elders do seek office care, primary care physicians lack the time needed to deal with multiple complex problems such as dementia, congestive heart failure, diabetes, functional impairment, and end-of-life care.[3]

The House Call model – A potential solution & key outcomes

The quickest way to control health costs is by addressing these highest cost patients first. House calls are a solution to the rising costs of helping home-bound patients with multiple chronic conditions. House calls are clinical visits to a patients’  home made by a team of care providers including physicians, nurse practitioners and social workers.

Home-based primary care programs have the potential to significantly save costs for the healthcare system’s most expensive patients by bringing them care in their homes. They provide for care coordination across all care settings. Through this program, providers are also accountable for good care and reduced cost. Overall this could result in significant savings for patients, their families, and the healthcare system.

However, these models, as with all innovation, face several barriers that they need to overcome before they can scale to a point where the impact created is substantial. Through the Sandbox project, we hope to study the factors that might be inhibiting sustainability and scalability of these models, and research innovative solutions to address the same.


[2] “For New Doctors, 8 Minutes Per Patient,” Pauline W. Chen, M.D., The New York Times (May 30, 2013)


 Additional Resources


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