Health plans — and the entities that own them — continue to invest heavily around in-home care.
The latest example is GuideWell Mutual Holding Corporation, which announced a new “multi-year strategic investment” in subsidiary PopHealthCare on Wednesday. The company is not disclosing the exact size of the investment.
“At GuideWell, we are committed to transforming health care and finding new and better ways to provide quality, personalized and affordable health care to our members where they are,” Pat Geraghty, president and CEO of GuideWell, said in a press release.
Jacksonville, Florida-based GuideWell is the nonprofit parent company to a family of innovative health care organizations. In addition to PopHealthCare, its subsidiaries include the health plan Florida Blue, which serves more than 5 million members across the Sunshine State.
In November, the company also acquired a majority share in Kansas-based New Directions, a behavioral health business with more than 16 million members across its footprint. Financial figures for last year haven’t been reported, but GuideWell’s 2019 revenue checked in at about $19 billion, according to the Jacksonville Daily Record.
On its end, PopHealthCare offers risk-adjustment solutions, in-home assessments and home-based primary care, serving more than two dozen health plan clients in 15 states. Its home-based primary care segment, “CareSight,” serves about 11,000 patients in total.
PopHealthCare predominantly operates across the Medicare Advantage (MA), commercial, Affordable Care Act (ACA) and managed Medicaid markets.
“We provide a full wrapper of either collaborative or attributed in-home primary care,” CareSight COO Brandon Oliver told Home Health Care News. “Our collaborative model works with an individual’s primary care provider to provide additional services in the home, based on risk, based on acuity, based on chronic conditions and those types of things. We also have markets where we are the primary care provider of record.”
Above all, PopHealthCare and its different offerings are designed to keep people at home and out of the hospital. To do so, the CareSight team takes a longitudinal approach to care by both managing chronic conditions and addressing the social determinants of health.
Its patients — younger and older adults alike — typically account for “the top 5% to 12%” of a health plan’s vulnerable population, Oliver noted. CareSight normally averages about 18 visits per patient per year, collectively spending about 11 hours in the home for each individual.
“Once people experience health care in the home, they don’t want to go back to brick-and-mortar [facilities] anymore,” Oliver said.
GuideWell’s multi-year strategic investment in PopHealthCare will allow it to expand into new markets, according to the company. Ultimately, it believes, the expansion could help plans lower the total cost of care for the vulnerable populations they serve anywhere from 10% to 20%.
The investment will come over the course of three-plus years, a GuideWell spokesperson told HHCN.
Along with the funding, GuideWell is providing strategic clinical, financial and operational thought leadership and support, the spokesperson said.
“The COVID-19 pandemic has accelerated the recognition that home-based care maximizes patient engagement and experience, and is the key to delivering better health outcomes for vulnerable populations,” Kirk Stanley, president of PopHealthCare, said in the press release. “The investment from GuideWell will position us to become the market leader for in-home care and treatment from a dedicated primary care doctor and care team for vulnerable seniors and adult populations.”
While the COVID-19 crisis accelerated the recognition of in-home care, it also forced providers to shake up their traditional operating models.
For PopHealthCare, that partly meant leveraging virtual care for the first time, Oliver said. CareSight had used telephonic support prior to the pandemic, but within the course of six weeks it also stood up new synchronous video communication with telehealth, he added.
“It has been a year of firsts,” Oliver said. “But it has also been a year that has really reiterated where the strength of our company comes from.”
Technology has helped the PopHealthCare team extend care into the home, but its model will always take a person- and home-first approach. And that gives the in-home primary care provider an edge, Oliver said.
“While we will always use telehealth and telecare capabilities, our value is really driven in the home,” he said. “And I think it’s what our competitors are learning, too. This space is seemingly getting crowded very quickly. But it’s being done, I think, more from a technological side versus an in-home side.”
GuideWell’s investment in PopHealthCare wasn’t the only home-based care news involving health plans this week.
On Monday, Humana Inc. (NYSE: HUM) announced it had entered into an agreement to acquire onehome, a home-focused, post-acute care company.
“We’ve been historically saying that we believe that many members want to receive services in the home and that we see the home as a lower-cost environment,” Kirk Allen, Humana’s senior VP of home care, told HHCN at the time.
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