An aging population and an increase in chronic conditions among older adults are driving partnerships between Medicare Advantage plans and at-home care companies, though it could take time to see savings from such programs.
Insurers are seeking out these value-based care arrangements as the plans face rising medical care costs and a potential 0.16% rate cut in 2025 from the Centers for Medicare and Medicaid Services. WellBe Senior Medical, Harmony Cares and Patina Health are working with insurers including UnitedHealth Group, Aetna and BlueCross BlueShield to provide home-based primary care to vulnerable older adults.
Related: CVS invests in WellBe Senior Medical
It could take a few years for insurers to determine if arrangements with home-based providers are saving a significant amount of money, according to Rick Kes, a healthcare senior analyst at RSM. However, Kes said he thinks the potential for savings is there, especially if home-based providers can keep vulnerable adults out of the hospital.
“The cheapest place for these health insurers to have their members is living in their homes and many members would prefer that as their most desirable venue to be in,” Kes said.
Many of WellBe Senior Medical's patients have multiple chronic conditions, cognitive deficits and mobility issues which makes it hard for them to navigate the healthcare system, CEO Jeff Kang said.
“The system is set up to take care of a 45-year-old competent person who has a car and can get to a doctor’s appointment and get their prescriptions filled,” Kang said. “The system is not set up for these patients.”
Jerlean Nwokocha is one such older adult who has trouble accessing healthcare. Mobility issues make it hard for her to travel to doctors' appointments to get treatment for her diabetes, hypertension and asthma. So once a month, WellBe Senior Medical nurse practitioner Tabitha Washington visits Nwokocha in her Chicago home for wellness checks.
Washington recently visited Nwokocha two days after she returned home from the hospital following back surgery, much to the patient's delight.
"I thought about you the whole time I was in the hospital. I'm so happy to see you," Nwokocha told Washington moments after the nurse practitioner set up her laptop and medical equipment on a dining room table.
Washington checked Nwokocha’s incision, blood pressure, glucose levels and breathing. She also refilled several maintenance prescriptions, in addition to filling pain medication that had been prescribed during Nwokocha’s hospital stay.
“When patients get discharged from the hospital, sometimes not everything gets done properly,” Washington explained to Nwokocha as she sifted through the patient's prescriptions and other paperwork.
Normally, Washington's visits take about a half-hour. This visit stretched beyond 90 minutes as she helped Nwokocha arrange for transportation to an upcoming neurologist appointment, obtain a home care aide and access in-home meals or groceries for two weeks through her Aetna Medicare Advantage plan.
“We need to make sure that you get all of the benefits you qualify for,” Washington told Nwokocha. “It’s tough because you’re on a fixed income.”
Being in a patient’s home gives providers a better perspective on how social determinants of health, such as food, housing and isolation could be affecting their overall health, Kang said. He said WellBe Senior Medical’s holistic care model is reducing patient care costs by 20% for some individuals.
The company provides care to more than 100,000 patients in Illinois, Ohio, Utah, Georgia, West Virginia, Oregon and Pennsylvania. WellBe takes on the full risk of care costs for patients assigned by insurers and the company shares savings with those insurers if it can reduce overall healthcare costs.
Aetna CVS Health said in an email that WellBe Senior Medical shows how value-based care arrangements can benefit Medicare Advantage members. The insurer announced an investment in the provider in January, though the exact amount was not disclosed. WellBe said it is using the money to expand nationally.
