Health systems have been shouldering the cost of mobile integrated healthcare programs for at-risk patients, but some insurers may be ready to start picking up the tab as providers prove they can save money.
UMass Memorial Health, Geisinger, Prisma Health and others that operate these at-home care programs say the service saves millions of dollars by preventing emergency room visits and rehospitalizations of chronically ill patients. Government and private insurers have been covering little to none of the cost, but that could be changing as systems get information to prove the programs are effective.
Related: Hospital-at-home, emergency medical systems vie for paramedics
Mobile integrated healthcare is a 30-year-old model designed to provide on-demand and preventive care to patients who may not have a physician or reliable access to healthcare — especially those with chronic conditions such as diabetes and chronic obstructive pulmonary disease. It brings coordinated care where people live, including to those who are homeless. Patients receive examinations, medication and sometimes diagnostic services, mostly from paramedics.
The concept has take off over the last decade, especially during the COVID-19 pandemic as providers tried to stem the tidal wave of patients flooding hospital emergency rooms, said Victoria Reinhartz, executive director of the National Association of Mobile Integrated Healthcare Providers.
Systems that looked at program results have found mobile integrated healthcare keeps high-risk patients out of the hospital and lowers overall costs.
For example, nearly 1,100 Florida Medicare Advantage members who received care for three months from a mobile integrated healthcare service operated by Nashville, Tennessee-based Envision Healthcare experienced a 21% decrease in emergency department visits and a 40% decrease in hospital utilization, according to a 2017 study.
Worcester, Massachusetts-based UMass Memorial Health released a study earlier this year that found 76% of patients who received care through its mobile integrated healthcare program from 2022 through 2024 avoided going to the emergency room within 30 days of an in-home visit.
Researchers from Worcester Polytechnic Institute this month estimated the program saved up to $1.8 million dollars in avoidable emergency service costs for the 550 unique patients who received approximately 1,000 home visits through the program during that time.
Savings generated by the program could be even greater, said Dr. Laurel O’Connor, director of Mobile Integrated Health at UMass Memorial Health.
“It does not take into account other costs that are associated with those acute encounters that end up in the ER, like hospitalization, because many of the patients that end up in the ER are hospitalized and that is extremely expensive,” O’Connor said. "They could also get COVID in the waiting room. So, there are a lot of potential downstream costs that patients will not suffer from if they are at home.”
While mobile integrated healthcare programs may help control the cost of delivering care to at-risk patients, most providers are not fully reimbursed for the service because Medicare, Medicaid and private insurance don’t typically cover care provided by paramedics that does not involve an ambulance trip to the hospital.
UMass Memorial Health supports its mobile integrated healthcare program mostly through grants, O’Connor said. She said Medicare and Medicaid cover telehealth visits that physicians provide and the health system’s hospital-at-home program — which is reimbursed by Medicare and Medicaid — pays for paramedics’ salaries.
Greenville, South Carolina-based Prisma Health also uses grant funding to support its mobile integrated healthcare program, which is expected to provide in-home care to more than 7,000 patients this year, said Aaron Dix, Prisma Health vice president of mobile health.
Dix could not estimate how much the six-year-old program has saved the health system. He estimates the cost savings are significant because many of the patients who receive care have severe chronic conditions that can escalate and lead to hospitalizations without the program's preventive care.
“You just have to take a small leap of faith that financially there is cost avoidance. It’s the uninsured and the underinsured population groups that the hospital systems are footing the bill for to control their health,” he said.
Some health systems pay third-party vendors out of pocket to provide mobile integrated healthcare to patients because it's less expensive than incurring penalties from Medicare when those patients bounce back to the hospital.
Hyannis, Massachusetts-based Estella Health provides the service to hospitals in New Hampshire and Massachusetts, including Beth Israel Deaconess-Plymouth in Massachusetts and Cape Cod Hospital in Hyannis, Massachusetts, said Estella Health Chief Operating Officer Brendan Hayden.
“They see the value because the visit decreases the overall cost of care for that patient, so it is money well spent to them,” he said.
Some health insurers are also beginning to see the value of paying for the home-based service, according to Hayden. He said he has received inquiries from a few insurers interested in piloting mobile integrated healthcare reimbursement.
“Insurance companies are at risk for every life they have covered and they are looking for strategies that will better manage patients in a more proactive way instead of reactive, which is very expensive,” Hayden said.
Blue Cross Blue Shield of New Mexico is one step ahead. The insurer piloted a mobile integrated healthcare program for some patients in Albuquerque in 2017 that resulted in a 61% reduction in emergency room visits, a spokesperson said in an email. She said the insurer has since expanded coverage to members living in three other New Mexico communities who are enrolled in Turquoise Care, a Medicaid managed care plan.
Some states are also considering Medicaid coverage of the service.
A bill before the Illinois General Assembly would require insurers to pay for all services provided under mobile integrated healthcare. Legislation introduced earlier this year in the Oregon House of Representatives would set up a registry for mobile integrated healthcare providers to participate in a state medical assistance program and establish billing codes for reimbursement under the state's Medicaid program.
Congress is considering Medicare coverage, as well. Legislation introduced in both the House and Senate would allow Medicare to reimburse for care emergency service providers offer in the home without requiring patients to be transported to the hospital.
O'Connor hopes the positive results from UMass Memorial Health can help move those coverage conversations forward and encourage insurers to begin reimbursing for mobile integrated health, as well as encourage other health systems to launch or expand similar programs.
“This is one program in one hospital in one state. We really wanted to say in this analysis that we saved a substantial amount of money in a very small, conservative way. Imagine if you took into account all of the things that we are preventing and scaled it up. It could be really impactful," O'Connor said.
