Innovative Healthcare Teams Updates

Not a scam: Insurers send doctors to members’ homes

By HEATHER STAUFFER | Staff Writer, Lancaster Online

Since 2011, Highmark Inc. has arranged about 4,000 house calls for Lancaster County seniors enrolled in its Medicare Advantage plan.

Next month, the insurer is going to expand the program to younger people who bought plans offered on the Affordable Care Act marketplace.

“Members really, really appreciate it,” said Timothy Lightner, Highmark’s vice president of senior markets. And, he said, “I would be surprised if anyone with any significant amount of Medicare Advantage business is not doing these kinds of home visits.”

The free program, which Highmark doesn’t publicize, is by invitation only for those data analytics identify as likely to suffer from undocumented chronic conditions or disengaged from the health care system.

It’s administered by vendors Highmark contracts with: Matrix Medical Network, CenseoHealth and ComplexCare Solutions.

A similar program offered by Aetna is also administered by Matrix, according to a company spokeswoman. And Capital BlueCross has an equivalent program called CarePlus.

The visits take about an hour, with the physician or nurse practitioner assessing both the members’ physical health and living environment.

Medicare pays Highmark a set amount monthly for each Medicare Advantage enrollee, Lightner said.
The visits help Highmark’s bottom line two ways: By documenting health conditions that can bump up that reimbursement, and by enabling better care that keeps Highmark’s costs lower. Afterward, summaries go to both members and their primary care providers.

Dr. David Bowers, a family doctor who helped lead Lancaster General Medical Group for about 12 years starting in 1996 and recently started a health care consulting business in Manheim Township, said he has made hundreds of home visits and can attest to their value.

For example, he said, one patient came in from her porch smelling like cigarette smoke. When he asked why, “She replied that she still smoked ‘a few’ cigarettes daily.
“At her office visits, she always denied smoking!” Bowers said.

The biggest hurdle the program faces, Lightner said, is convincing members that an insurance company sending a doctor to their home for a free visit is not a scam. So Highmark is mounting an awareness campaign in advance of the program’s expansion.

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