One health plan’s perspective on in-home assessments
A statewide health plan, one of the largest in its market, recognized that primary care provider records were not always as complete as they could be in documenting Medicare Advantage patients’ chronic conditions. The health plan sought a partner to conduct comprehensive in-home visits to complete health risk assessments and help close gaps in care.
After reviewing multiple vendors, the health plan ultimately chose what is now the Optum® HouseCalls program. Since that decision in 2011, the Optum leadership team has continued to work with the health plan to understand its objectives and ensure the HouseCalls program delivers on them.
The HouseCalls program provides an annual in-home visit by Optum advanced practice clinicians. The visit meets Centers for Medicare & Medicaid Services (CMS) best practices for in-home visits.
In 2017, the program achieved a gross value of:
$3,094 per visit
7.69:1 return on investment
The program is on track to perform even greater value in the future.
How Optum HouseCalls works
The annual in-home visits are conducted by on-staff Optum advanced practice clinicians.
The visits typically last 45 to 60 minutes and include:
- Health history evaluation
- Comprehensive medication review
- Physical examination and review of systems
- Depression and cognitive screening
- Environmental assessment
- Nutritional assessment
- Health risks and gaps in care identification
- Member education materials
- Referral identification and coordination
- Labs and screenings
The HouseCalls program goes beyond assessments to educate patients about their conditions and alert the members’ providers for timely follow-up.– Health plan director of enrollment and premium services
HouseCalls promotes the primary care physician (PCP) relationship and the care continuum
At the end of the visit, a member summary is created.
Member’s PCP is sent the assessment results to address health risks and gaps in care.
Member receives a summary with topics to bring to member’s next PCP appointment.
A tiered strategy helps ensure return on investment
Since all health plans are unique with different goals and membership, the Optum HouseCalls team consults with each plan to develop specific strategies. This health plan has a two-tier approach prioritizing specific members. The Optum HouseCalls program creates two communication strategies to make the most of each outreach opportunity based on its tier.
Snapshot of the 2017 Optum HouseCalls program tiered approach to member outreach
Tier 1 — Members stratified as higher-priority targets
Tier 2 — Members prioritized lower, but still appropriate for outreach
We appreciate that the HouseCalls clinicians are on staff with Optum, not contracted through another company. They work as a true extension of our team. We can trust them to be consistently professional and caring with our members.– Health plan director of enrollment and premium services
Demonstrating value to members, helping the plan receive accurate payments
Optum HouseCalls is an integral part of the health plan’s multi-part strategy to improve member quality of life, ensure CMS compliance and help the plan receive accurate payments. The health plan also conducts chart reviews and has other internal programs through its value-based contracts with PCPs.
Looking ahead to the future of home assessments
Based on HouseCalls’ ability to complete member records, the health plan intends to continue using the program as an effective, efficient way to complete health risk assessments and help close gaps in care for their members.
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