Moving and Scaling Home-Based Primary Care Phase III: Leveraging Policy Reforms to Scale Home-Based Primary Care

Moving and Scaling Home-Based Primary Care Phase III: Leveraging Policy Reforms to Scale Home-Based Primary Care


Over the past two decades, there has been a substantial shift to move care to home and community settings for people with complex health and social needs, particularly older adults and those with functional limitations. The COVID-19 pandemic accelerated this shift, as providers rapidly pivoted to delivering care outside of traditional clinical and institutional settings. However, the home setting remains unevenly used and underutilized. As we exit the acute phase of the COVID-19 public health emergency, there is significant opportunity to address the need for Age-Friendly Health Systems by shaping the policy and provider landscape to support home-based primary care.

Project Overview

This project serves to amplify evidence-based policy recommendations to health leaders and thereby strengthen policy efforts to scale home-based primary care. In particular, we plan to translate policy considerations to providers and provide practical guidance to policymakers to make payment and delivery models amendable to home-based primary care. This project builds upon previous home-based care work to address the ongoing need for home-based primary care to improve the health of older adults with complex needs.

For this project, the Center is collaborating with the National Home-Based Primary Care Learning Network, the Home Centered Care Institute (HCCI), and the American Academy of Home Care Medicine (AAHCM) to advance home-based primary care and age-friendly health systems as part of a broader grant, Moving and Scaling Home-Based Primary Care, Phase III: Quality, Training, Advocacy and Policy. The project is supported by The John A. Hartford Foundation, a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, The John A. Hartford Foundation has three priority areas: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care. Learn more at

Project Co-Grantee Principle Investigators


Creating a Culture of High-Quality Care: The National Home-based Primary Care Learning Network

Bruce Leff, MD
Director, The Center for Transformative Geriatric Research 
Professor of Medicine
Johns Hopkins University School of Medicine

Christine Ritchie, MD, MSPH
Geriatrician and Palliative Care Specialist
Massachusetts General Hospital and Harvard Medical School, 
Mongan Institute Center for Aging and Serious Illness 


Building the Home-Based Primary Care Workforce: Achieving Scale through Education & Technical Assistance

Thomas Cornwell, MD
Executive Chairman
Home Centered Care Institute
Julie Sacks, LCSW
President and Chief Operating Officer
Home Centered Care Institute


Making the Connections to Bring Home-Based Primary Care into the Mainstream - Building a National Provider Directory

Eric DeJonge, MD
Chief of Geriatrics for Capital Caring Health
American Academy of Home Care Medicine
Marc Arenas, MD 
Founder, NABR 
American Academy of Home Care Medicine
Sheridan Reiger
Regional Associate Medical Director - Washington State
American Academy of Home Care Medicine
Shada Biabani
American Academy of Home Care Medicine


Moving and Scaling Home-based Primary Care: Leveraging Policy Reforms to Scale Home-Based Primary Care

Robert Saunders, PhD
Senior Research Director
Duke-Margolis Center for Health Policy

Publications and Events

To stay up to date on project-related activities and research, sign up for our Home-Based Primary Care Newsletter.

Research Team

Montgomery Smith Headshot

Montgomery Smith, MPH

Senior Policy Analyst

Jonathan Gonzalez-Smith

Jonathan Gonzalez-Smith, MPAff

Assistant Research Director

Robert Saunders

Robert Saunders, PhD

Senior Research Director, Health Care Transformation
Adjunct Associate Professor
Senior Team Member
Margolis Core Faculty

Pic of Ginny

Ginny Rogers, MBA '23

Margolis Scholar