Smarter health care, right at home


By Kristy Duffey, MS, APRN, GNP-BC, senior vice president, clinical operations for OptumCare 


Health care professional wearing a stethoscope speaking to a senior patient at home

Shouldn’t our health care system be as responsive to our needs as our technology is? After all, a phone is no longer just a phone. It’s also a calendar, a GPS and a computer, and you can even wear it on your wrist.

A refrigerator can show you what’s inside via wireless camera so you know what to pick up at the store. A smart thermostat adjusts automatically so it’s comfortable when you come home. These innovative products help us get what we need, when and where we need it.

Similarly, emerging health care companies are devising new innovations to deliver care. For example, by making the most of the specialized skills offered by advanced practice clinicians (APCs), trained as nurse practitioners (NPs) or physician assistants (PAs).

Supply, demand and couchside manner

Many of us are familiar with APCs in the physician’s office. You might see one on short notice when your doctor is unavailable, or an APC might be the preferred provider you turn to for annual exams. APCs have advanced degrees, certifications and specialized training, conduct examinations, prescribe medications and order diagnostic tests, in some states independently and in others along with physician collaboration.

Additionally, these skilled clinicians can be the best fit to bring care to more people, in the right place. That might be the doctor’s office, but it might be a nursing home or even an exam on your cozy living room sofa.

With special training in listening and observing, advanced clinicians offer attentive, personalized care. They also often spend more time at each visit than a physician typically can. So health care becomes more effective, appropriate and comfortable for more of us.

Bringing customized care to home or clinic

By law, the Affordable Care Act (ACA) makes health insurance available to more people and requires preventive services are free for those who are insured. This means making primary care services available to an additional 30 million people, according to Whitehouse.gov. Better preventive care is good for people’s health. The idea is that prevention will save money — and lives— in the long run by catching problems early.

But what if people can’t get that care? Increasingly, our nation doesn’t have enough primary-care physicians (PCPs) to meet these needs. Reports suggest the U.S. may face a shortage of up to 90,000 PCPs nationwide in the next 10 years. 

Physicians who use the help of APCs can care for nearly twice as many people and focus on more complex care. APCs form a vital strand in the fabric of health care, extending medical services into rural areas and the homes of seniors and people with chronic illness.

Helping people stay healthy

Last year, OptumCare APCs made more than 1 million home visits to Medicare Advantage patients —more than four times as many as in 2012. The APC spends up to an hour at a visit, checking health functions, educating about any concerns and helping develop a plan of care.

The service has grown so rapidly because it works. In fact, in addition to providing a medical exam, the clinician might notice an empty refrigerator and recommend nutrition support, or see the need for social services and make a referral to a social worker.

The outcomes are convincing, as well. A recent study by RAND Corporation found that Medicare members who received an OptumCare home visit had decreased hospital admission rates up to 14 percent and reduced long-term care stays up to 90 percent.

Of course, system innovations only matter because they enable health care providers to make a difference, one person at a time. Take the example of Paul, a Medicare member in Wisconsin, who hadn’t seen a doctor in years.

At a visit to Paul’s home, the ACP discovered a blood pressure problem that he needed to have checked out right away. “Jenny was very persuasive,” Paul says. “She said, ‘I’m not leaving until you make a doctor’s appointment.’”

That appointment may have saved Paul’s life. The doctor found indications of lung cancer, which, if undetected, would have worsened quickly. Instead, the cancer is being treated, and Paul is enjoying his woodworking hobby and his family at home, just the way he likes.

Paul’s story demonstrates how APCs can function as part of an effective, team-based model of care. The RAND Corporation study found that patients who received home visits had an increase (2–6 percent) in physician appointments after their home visit.

Clearly, being able to meet the needs of more people is good for all of us. Even better, when advanced practice clinicians are part of an integrated health system, people can get care where they are, and the physician is kept in the loop.

Now, that’s a smarter system — one that is, as it should be, even more practical and responsive than a Wi-Fi refrigerator.

About the author: Kristy Duffey, MS, APRN, GNP-BC, is senior vice president, clinical operations for OptumCare. She oversees more than 2,500 practitioners, clinical teams of pharmacists, care managers, social workers and dieticians. 


ACA Outcome: Source: Medical Economics

Physician shortage: Source: Association of American Medical Colleges

PCP leveraging of APCs: Source: Health Affairs, 2010; Annals of Family Medicine, 2012; from Primary Care Highlights position paper


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