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How MA Plans Can Build on COVID-19 Home Healthcare Strategies

Medicare Advantage plans can build on coronavirus home healthcare strategies such as bundling social determinants of health services and leaning into remote patient monitoring.

Kelsey Waddill
By
Published: 26 May 2021

After a year of accelerating home healthcare services, payers can build on their coronavirus home healthcare strategies to bolster their home healthcare programs more permanently.

Hospital readmissions have been linked to worse healthcare outcomes. 

The Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP) analyzed 18 principal diagnoses—including respiratory diseases, mental health conditions, and childbirth—and compared their admission and readmission costs. 

The researchers found that, on average, the readmission cost for these 18 diagnoses was around $14,400. The 30-day readmission rate for Medicare specifically declined from 2010 through 2016, but remained the highest readmission rate of the four insurance types studied—Medicare, Medicaid, private payer, and uninsured.

In contrast, home healthcare has proven to be an effective tool for lowering costs in senior care and improving patient outcomes.

In a study of inpatient cost compared to home healthcare spending, patients who received follow-up care in an inpatient setting accrued costs over the 90 days following discharge that were more than $7,300 higher than those who used home healthcare. The readmission rate was also lower for the population that received follow-up care through a home healthcare program.

The coronavirus pandemic added a new layer of urgency to keeping seniors out of the hospital, both for payers and for seniors themselves. Seniors comprised one of the populations that was most vulnerable to the virus.

Around 80 percent of coronavirus-related deaths were reported to be seniors 65 years old and older and coronavirus-related hospitalization was 65 times as likely among adults ages 75 to 85 when compared to coronavirus patients between the ages of five and 17 years old, according to the CDC.

The effort to keep seniors out of hospitals where they could easily catch the virus pushed care into the home.

“COVID forced the issue a little bit in that it made the retirees willing to consider home healthcare a little bit more than they had in the past,” Craig Condon, chief executive officer of UnitedHealthcare Retiree Solutions, told HealthPayerIntelligence. “It hit a tipping point from which we expect it to grow going forward.”

As the coronavirus vaccination rate increases and the pandemic becomes more manageable, payers like UnitedHealthcare are looking to build on the momentum that they gathered around home healthcare during the pandemic.

Bundle services to support member engagement

The coronavirus pandemic pushed forward the rapid development and adoption of home healthcare strategies.

“What COVID may have done is accelerate everyone's thinking about: how do you provide that optimal set of services in the home?” explained Joe Agostini, MD, chief medical officer at UnitedHealthcare Retiree Solutions, explained to HealthPayerIntelligence. “We on the health plan side are thinking about moving more quickly and aggressively in terms of supporting those older adults in their own home. So, it has given us an opportunity to move faster on many of the ideas that we've been thinking about in recent years.”

As part of delivering these services more quickly and efficiently to members, UnitedHealthcare bundled certain home healthcare services.

The payer recently announced its new post-discharge home healthcare program, Healthy at Home, which offers a couple of key social determinants of health services as part of its home healthcare approach.

This bundled home healthcare services strategy can improve member engagement.

“Putting sets of services together makes it easier for retirees to reach out to us for assistance and for them to engage when we call them,” said Agostini.

The UnitedHealthcare team designed this program to provide three key social determinants of health services: transportation, meal delivery, and in-home personal care. However, Agostini noted that there is always an opportunity to expand on these offerings.

In the future, the payer may add prescription delivery and house call services to its bundle. For now, the Healthy at Home program coexists with other UnitedHealthcare solutions for seniors.

“Post-COVID, we're going to work through how to keep this evolving,” Condon shared. "The secret is just to engage the retiree in this case, and make sure we can meet them where they are and provide the services they need. That's an evolution and I think it'll happen across the board and we're part of that process.”

Lean into remote patient monitoring tech

The coronavirus pandemic forced the healthcare industry to leverage technologies in new ways to reach patients in their home and track their health outcomes. 

The telehealth boom challenged many underlying assumptions about seniors ability to adjust to new technologies: around three-quarters of seniors who used telehealth during the pandemic said that they would do so again and 90 percent reported positive experiences.

Moving forward, remote patient monitoring technologies will continue to play a significant role in advancing home healthcare services.

“In addition to this Healthy at Home program, we've also been offering more digital support tools and remote patient monitoring for older adults because they're more likely over time to engage in those new technologies,” Agostini explained. 

In particular, remote patient monitoring has been key to preventing hospital readmissions by alerting payers and providers to potential risks, even before the patient is aware that she could experience an adverse health event.

“Our strategic plan is to focus on people who are at very high risk for hospitalization or have a very high risk chronic condition,” said Agostini. 

“If we give them additional tools in their own homes to monitor their own health, to monitor their own vital signs, we may be able to detect much sooner whether they're going into decline or may be at risk for going into the hospital. These tools can assist both patients and providers in intervening early to help people maintain health and avoid hospitalizations."

UnitedHealthcare’s remote patient monitoring technology strategy goes hand-in-hand with its home healthcare program to bolster patient experiences and patient outcomes at home.

“The COVID-19 pandemic has accelerated the interest and acceptance of health care technologies and as a Medicare Advantage plan we have the opportunity to connect people to services that allow them to get the right level of care at the right time and in the right place,” Agostini added.

“Having flexibility to support care at home when it is safe and effective is important. Effective home care can address a person’s needs and support the caregiver to help people remain independent in their preferred setting.”

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