Insurers Push Hard to Keep Seniors at Home

Private insurance companies continue to concentrate on in-home services as a way to prevent hospitalizations and reduce overall costs of care, growing these efforts despite pushback from the federal government.

One such program, Humana at Home, is enrolling about 1,500 members daily and has reached nearly 1 million people nationwide, the Tampa Bay Times reported Sunday.

Humana at Home dispatches care managers to its beneficiaries’ homes. The social workers and nurses who take on the care management role do not provide medical treatment, but assess the beneficiary’s condition and provide assistance with health management.

For instance, Humana at Home participant Betty Herz has gotten help with her medications. One of Herz’s medications is expensive, so her care manager has taken steps to try to get the pills at a reduced cost, reported Tampa Bay Times Staff Writer Kathleen McGrory. Thanks to interventions like this, participants have had 45% fewer hospitalizations than anticipated, according to one internal analysis.

Insurers typically offer these type of programs through their Medicare Advantage plans. Another example is the HouseCalls program from OptumCare, which has made more than 1 million home visits to beneficiaries of UnitedHealthcare Medicare Advantage.

However, these initiatives have stirred controversy. Some insurers have utilized the in-home assessments to improperly inflate the risk scores used by the government to set Medicare Advantage payments, according to the Centers for Medicare & Medicaid Services (CMS).

But when CMS proposed getting stricter on how risk-score calculations would be tied to these home visits, the insurers protested, and the agency has backed off, noted McGrory.

Despite continued scrutiny from federal officials, programs like Humana at Home appear to be popular with beneficiaries and may be just another way in which in-home care is becoming the heart of the U.S. health care system.

Written by Tim Mullaney