Technology startup Heal is teaming up with insurance giant Aetna — now a CVS Health Corporation (NYSE: CVS) company — to bring doctor house calls to one of the United States’ largest markets.
Already available throughout California, parts of Virginia and Washington, D.C., Los Angeles-based Heal announced Tuesday that it is expanding to the Atlanta metropolitan area. As a result of the expansion, Aetna’s commercial members in the Atlanta market will now be able to schedule house calls with Heal’s pool of board-certified pediatricians, internists and family practice physicians — all at the same co-pay as their regular doctor’s office visit.
“Aetna — together with CVS — has a very strong commitment and interest to meeting patients where they are, making services and health care more accessible and simple,” Frank Ulibarri, Aetna market president for Georgia, Louisiana, Alabama and Mississippi, told Home Health Care News. “We want to be in the community, either in people’s neighborhood on the corner or, as in this case, actually in their homes.”
CVS first laid out its plans to buy Aetna for $69 billion in cash and stock in December 2017, with Aetna operating as a standalone unit within CVS. Despite pushback from some health economists and consumer groups, the merger was approved by the U.S. Department of Justice (DOJ) in October 2018.
Federal officials approved the deal on the condition CVS ultimately divest Aetna’s Medicare Part D prescription drug plan business to WellCare Health Plans Inc. The companies closed the merger on Nov. 28, though legal and antitrust concerns remain.
We want to be in the community, either in people’s neighborhood on the corner or, as in this case, actually in their homes.Frank Ulibarri, Aetna market presidentAdvertisement
For Heal, the move adds further momentum to what has already been an exciting eight or so months.
In May, the startup announced it had raised roughly $20 million in Series C funding, bringing its overall fundraising mark to over $71 million since 2014.
“The value of Heal for patients is that we remove all of the friction and barriers to getting timely access to high-quality primary, preventative, urgent and chronic care by sending a doctor into the home through an app or our website,” Nick Desai, co-founder and CEO of Heal, told HHCN. “We’ve removed the friction and barriers that go into people making suboptimal choices for when they seek health care — like running to the emergency room or just ignoring the issue.”
The shift home
Heal’s robust financial backing and steady expansion is emblematic of the U.S. health care system’s shift to home, often seen as the lowest cost, safest and consumer-preferred setting. In the past, Medicare-certified home health providers and personal care services companies have largely dominated the space.
Today, however, they’re routinely joined by an array of newcomers, including Heal, hospital-at-home programs, on-demand services and others. Expanded Medicare Advantage (MA) opportunities are partially driving health care’s march into the home.
Aetna is currently only offering Heal to its commercial members, but it, too, is exploring the MA avenue, Ulibarri said.
“We serve a very significant [commercial] population in the Atlanta market, from large and very notable employers to those that are mid-sized and smaller — local mom-and-pop shops, gas stations, grocery stores,” he said. “We continue to evaluate the potential for a Medicare Advantage application. We haven’t arrived at that quite yet, but those evaluations continue.”
Heal’s services are available to patients between 8 a.m. and 8 p.m., 365 days a year. Atlanta residents not covered by Aetna can book a Heal house call for a flat rate of about $149.
So far, Heal has provided roughly 100,000 house calls across its markets, helping to reduce emergency room and urgent care visits by up to 71%, according to the company. The generated health care savings associated with that decreased utilization: an estimated $62 million.
Heal expects to deliver about 250,000 house calls in 2019, while simultaneously launching in three more major cities in addition to Atlanta. That growth, changing demographics and a spike in chronic disease prevalence were among the factors that IRA Capital considered when it invested in Heal during the May fundraising round, Samir Patel, principal and co-founder of the real estate private equity firm, told HHCN.
“At IRA Capital, we look for companies that are winning within an industry and creating entirely new categories,” Patel said. “That’s what attracted us to Heal. Heal is doing that for health care by transforming patient and doctor expectations of what primary care can and should be.”
Besides doctor house calls, Heal also can track health data in the home through its WellBe platform, which uses a plug-in device to track blood pressure, weight, glucose levels and similar biometrics. Aetna will use the remote patient monitoring tool in Atlanta to help care for individuals with multiple chronic conditions in a program called Heal Together.
Atlanta, in particular, is the ideal market to roll out Heal Together with Aetna, Desai said, because of the generally high obesity rates and lack of health care educational awareness in the Southeast.
“We know from all kinds of market and demographic data that there’s a greater rate of obesity in the southeastern parts of the country,” he said. “You do tend to have patients with multiple co-morbidities — two or more chronic conditions — who are also overweight. We kind of say colloquially that we come for the cold and catch the cholesterol.”
More than 190 million Americans — about 59% of the U.S. population — are affected by more or more chronic diseases, according to the Partnership to Fight Chronic Disease. Following current trends, the number of people with three or more chronic diseases is expected to increase to 83 million by 2030 — with health care costs acclimating to more than $42 trillion.
“We’re keenly aware of market needs and having the potential to get into the home to see all of the things happening there that might affect health, whether that’s medication management, fall risks or general environment,” Ulibarri said. “You get to a certain age — chronic illnesses begin to show up and health care needs increase.”
Among its benefits, Heal has also been shown to prevent physician burnout, a growing problem nationally as paperwork burdens rise and time-per-patient plunges. In 2013, only 13% of family doctors did a house call in any given week, with only 3% doing two house calls a week, statistics from the American Academy of Family Physicians show.
There are signs home-based primary care could become more common in the years ahead — not only through collaborations like the one between Aetna and Heal, but also through health care policy. There are, for instance, 14 sites actively participating in the Independence at Home Demonstration from the Centers for Medicare & Medicaid Services (CMS).
The Independence at Home Demonstration began in 2012 to test a service delivery and payment incentive model that uses home-based primary care teams designed to improve health outcomes and reduce expenditures for Medicare beneficiaries with multiple chronic conditions. The demonstration is scheduled to end on Dec. 31, 2020.
“Doctors coming into the home in concert with home health staff, social workers, nurses, remote patient monitoring is where things are headed,” Desai said. “The home health space is going to explode and be an important solution for how we take care of the aging population in this country.”