Years ago, before brick-and-mortar offices were needed to house the complex medical equipment used by health care professionals, the majority of doctor-patient interactions took place in the home.
The combination of value-based care initiatives, Medicare Advantage (MA) growth and the COVID-19 emergency has now created a perfect storm for making home-based primary care mainstream again. Home Health Care News caught up with two of the most innovative house call models — Heal and Clover Health — on Wednesday during the 2020 FUTURE conference.
Los Angeles-based Heal’s doctors-on-demand model allows patients to book physician house calls through its technology platform in California, Virginia, Washington, D.C., Atlanta and New York.
The idea that the home is the best place to deliver primary care has picked up steam because of the public health emergency, but Heal CEO Nick Desai believes this setting has always had its advantages.
“People are talking about it more now because of COVID,” Desai said during a FUTURE panel discussion. “People don’t want to get exposed to other people’s COVID, so they want to stay in their house. But you should never want to get exposed to other people’s germs.”
Additionally, the home is the only place where a doctor can “truly assess” a person’s social determinants of health, which affect up to 80% of health outcomes, Desai noted.
When speaking about the social determinants of health, Desai used the scenario of a patient not following a doctor’s orders due to economic barriers.
For example, a patient may be told to take a certain medication with milk, but consistently fails to do so. The reason? He or she may not be able to afford milk, but too embarrassed to tell a doctor in an office setting. These are social factors that reveal themselves when care takes place in the home, Desai said.
“When we go into the home, we’re seeing factors that may seem completely trivial or even cartoonish to people who know health care, but are huge factors in a person’s ability to actually get better,” he said.
Having this fuller picture, ultimately, closes care gaps and leads to lower costs, lower readmission rates and higher medication adherence.
In July, Heal announced a strategic partnership with Humana Inc. (NYSE: HUM). The partnership involved Humana investing $100 million into Heal and plans to expand to new markets, such as Chicago, Charlotte, Houston and others.
Desai called the partnership a great validation of Heal’s strategy and approach.
“We really checked a lot of boxes for them, in terms of their focus on shifting primary care into the home,” Desai said. “With their volume of patients, their capital and strategic understanding, and our ability to deliver this kind of care, we can really accelerate our growth and success.”
Another company that delivers home-based primary care is Clover Health, a San Francisco-based Medicare Advantage insurer. Since its launch in 2013, Clover Health has raised more than $900 million.
The company’s in-home care model utilizes technology, including data analytics and machine learning to identify its highest-risk members. It then finds solutions to lower their risk of adverse health events.
In New Jersey, Clover Health’s in-home primary care practice touches just 3% of the company’s total population in that state. Yet it plays a huge role in Clover Health’s ability to lower total cost of care.
“That 3% that we address represents somewhere between 30% and 40% of the total cost of care for our members in New Jersey,” Kevin Murphy, Clover Health executive vice president of complex care, said at FUTURE.
Expanding care in the home
Despite challenges, Clover Health has grown during the public health emergency. The company, which primarily operates in New Jersey, was forced to pause home visits for everyone except the organization’s most high-risk members.
To compensate, Clover Health embedded telehealth in its point-of-care platform.
“As a result of that, we were able to … expand beyond that in-home care population we serve and see frequently on a monthly basis,” Murphy said. “We were also able to start reaching out to a lot of our Medicare Advantage members who didn’t have access to any care at that point in time. We’ve been able to grow our population by about 25%.”
While the home-based primary care model and in-home care may overlap in some ways, the two are not the same. This leaves plenty of room for collaborations and partnerships between home-based primary care and home health, home care and other in-home care providers.
“I don’t think there are any better partners than anyone that comes into the home, but specifically home health, palliative care [and] hospice,” Murphy said. “I’ve been fortunate to be part of the pioneering ACOs, part of Independence at Home, part of the MSSP programs. And in every one of those instances, one of our primary pillars was our relationship with home health.”
When it comes to contracting with Clover Health, there are a number of factors that are important to consider, according to Murphy.
“Quality certainly is important,” he said. “We typically start within our market. We have over 3,000 participating providers that are in our direct contracting entity.”
Providers looking to work with Clover Health also need to have a strong technology infrastructure.
“Data is very important to Clover,” Murphy said. “Having access to OASIS information, as well as clinical data in the EMR and then claims data. By putting those three pieces of data together, it gives us a good understanding of the patient from an informatics perspective.”
Partnering with in-home care agencies
When it can’t deliver in-home primary care itself, Clover Heal actually works with different partners, including Heal.
On its end, Heal has collaborated with in-home care providers such as Kindred at Home, 24 Hour Home Care and Girling Home Health, among others.
Desai echoed Murphy’s sentiments on the importance of a strong technology infrastructure and data. He added that in-home care providers that specialize in caring for certain communities also bring something important to the table.
“There are these two brothers in Orange County, California, where there’s a big Vietnamese community. They built a home health care agency serving literally just [this population],” he said. “You’d be surprised how big they are and how many people they’re serving.”
As it continues to build its in-home primary care business, Clover Health plans to work within the Primary Care First Model, specifically in the direct-contracting pathway.
“We’ve enrolled in the direct-contracting program,” Murphy said. “We are taking total cost of care risk.”
Murphy described the Primary Care First initiative and direct contracting as “the next evolution of the ACO model.”
Heal is also moving “a couple thousand” patients in New York to the Primary Care First Model, according to Desai.
“The big push for Heal is that we want to move every single patient … into a value-based contracting model. [This] allows us to focus on value over volume, aligns the incentives the right way, the patient gets the best care, the payer saves money, and we can let our doctors focus on quality value-oriented care.”