Medicare Advantage insurer Clover Health bets on home care

In-home care also allows patients to avoid hospital-acquired infections, and gives providers insight into a patient's home life and other social determinants of health, which can affect care outcomes. Medicare Advantage giant Humana is another plan investing heavily in home-based healthcare with its recent deal to acquire provider Kindred Healthcare.

Clover is offering in-home care to its most vulnerable patients—those who have multiple or severe chronic conditions, difficulty getting out of the house or who end up in the hospital frequently. The insurer is pairing these members with a physician-led team of nurses, social workers and other clinicians who will "deliver care to the members rather than expecting these members to access care on their own," Dr. Kumar Dharmarajan, Clover's chief scientific officer, explained.

Clover said the care teams' small panels of 200 patients each will spend an hour with plan members and visit the home multiple times a month, if necessary. Lab testing, chest x-rays and ultrasounds will all be provided in the patient's house, and patients will have round-the-clock access to their clinicians. Clover is partnering with home-based primary care provider Principium Health to deliver the services.

Clover will also use genetic testing to make sure members are using the most effective prescription drugs for their conditions and avoid combinations that could cause adverse effects.

"Higher touch, in-home primary care that's really well coordinated should improve members' health outcomes, reduce emergency room visits and hospitalizations and we do expect it will improve outcomes and reduce costs as well," Dharmarajan said.

Clover initially launched the home care program last year in New Jersey, where 500 members are participating, and is now rolling across its entire business. Dharmarajan declined to share results from the pilot program, saying it's too early. Clover expects about 5% of its 30,000 members to be eligible. Beyond New Jersey, Clover serves patients in Savannah, Ga., San Antonio, Texas, and Bucks County, Penn.