Every month, nurses visit Shirley Ehlers' home in Oceanside, Calif., to help care for her multiple chronic medical problems and keep her from having to make an avoidable trip to the hospital.
The nurses help Ehlers, a 73-year-old retired nurse with diabetes, asthma, heart problems and melanoma, manage her medications and coordinate care when needed. When Ehlers became depressed after a nursing home stay, a nurse set up a home visit from a mental health worker. After she fell and hit her head on a metal stool, a nurse came to her house to perform neurological follow-up checks during the next two days.
And when she suffered from atrial fibrillation one night, she called a designated number and spoke with a doctor who advised her to take a double dose of her medication and called back in an hour to check on her symptoms. The reassurance of having a physician to speak with while experiencing scary symptoms kept Ehlers from a premature and costly emergency room visit, she said.
Ehlers is enrolled in a home-based care program through her Medicare Advantage insurer, Blue Shield of California, which began a collaboration with home health provider Landmark Health this year to augment the role of primary-care physicians by sending an interdisciplinary care team to the home to aggressively manage patients' conditions and prevent complications.
Home healthcare programs similar to Blue Shield's are proliferating as health plans and at-risk providers look for ways to keep patients out of the hospital or from returning after being discharged. As healthcare costs squeeze patient wallets and company bottom lines, insurers have focused on the savings to be reaped by caring for patients at home. And by removing some benefit restrictions, Medicare is making it easier for those health plans to do so.
“The amount of services that are moving to the home is happening at the fastest pace I've seen,” said Bruce Greenstein, chief strategy and innovation officer at home healthcare provider LHC Group who previously served as HHS' chief technology officer. “The organizational alignment is occurring with the financial alignment and that's going to allow more innovation to happen in providing the right kind of care in the home,” he said.
Home healthcare companies experienced explosive growth and innovation over the past five years as they've zeroed in on caring for certain subsets of patients, from the chronically ill to those with advanced stages of disease who aren't likely to get better. They each promise to reduce admissions, ER visits and costly complications for the health plans they contract with.
Dr. Scott Mancuso, Landmark's chief clinical officer, said the company is bringing back the house call of the old days but “more advanced than a black bag and a stethoscope.” Its teams of physicians, nurse practitioners, nutritionists, pharmacists, psychiatrists and social workers provide resources at home or via telehealth around the clock for chronically ill patients. Health plan clients see a 30% reduction in hospitalizations within the first six months among patients who engage in the program, Mancuso said.