MA Plan Uses Home Healthcare to Manage Multiple Chronic Diseases

CVS Health’s Aetna is using home healthcare to address chronic disease management for those with multiple chronic diseases, the payer announced.

Aetna will partner with Landmark Health (Landmark) in New York to serve members on Aetna’s individual Medicare Advantage plan. This partnership will target eligible members in New York City and Long Island as well as three other major urban centers in New York—Albany, Rochester, and Buffalo.

Qualifying members will have multiple chronic conditions that they are managing. They will also be living at home, not in a skilled nursing facility or another long-term care institution.

“This new approach identifies members with multiple chronic conditions and provides stronger in-home physician support in addition to their current primary care physician relationship,” said Lauren Casalveri, Aetna vice president and chief Medicare officer in New York.

“This collaboration allows members to remain safely in their homes and provides optimal treatment for their conditions.”

Landmark providers will be able to offer a broad range of at-home services, including acute and urgent care services, health screenings, home safety checks, and more.

Members will have access to a healthcare professional all day, every day with personalized service.

“We recognize that members with multiple chronic conditions, you know, are particularly vulnerable to needing care urgently and personally,” Casalveri explained to HealthPayerIntelligence.

As a result of more personalized care, higher quality of care, and greater provider accessibility, Casalveri expected to see improvements in healthcare spending as well as other benefits for seniors.

Transportation can be a social determinants of health barrier for seniors, leading to lower access to care and higher costs overall. But with this new partnership, patients would not have to leave their homes, which may make them more likely to access lower cost, appropriate care.

By receiving treatment at home, patients will not be driven to a local higher-cost, urgent care site to obtain treatment.

The payer will be watching a couple of different quality measures to assess the program’s success.

“First and foremost, we'll be looking for feedback from the members who are seeing the Landmark providers and their caregivers, so there's very consistent surveying and checking in with them,” shared Casalveri. “I think that's the most important measure of quality.”

In addition to collecting data on member experience, the payer will also emphasize preventive care through this program. The quality measures will evaluate whether members receive the proper health screenings, lab tests, flu shots, and other relevant preventive care techniques. The payer will also watch for emergency department visits to decrease.

Timeliness will be key to coordinating care strategies between the Landmark providers, the member’s primary care provider, and Aetna, Casalveri explained. It is essential to identify the most timely way to deliver care to members in the moment that they need it and to communicate with the appropriate parties in a timely fashion.

Casalveri said that the payer has been evaluating Landmark Health for the purposes of this partnership for years, underscoring the prolonged need for this type of service.

In fact, in 2019 Aetna partnered with CareLinx to deliver at-home caregiver services to better support seniors living at home. At the time, studies showed that seniors would prefer to live at home but are pessimistic about their ability to do so.

However, the coronavirus pandemic amplified the immediate need for in-home healthcare options nationwide as patients stayed home due to paused elective care. The pandemic shed light on the fact that the healthcare system is angled toward caring for seniors in facilities and institutions, not in their own homes.

“The pandemic is certainly having an interesting impact on how care is being provided. From my perspective, as I focus on seniors, I worry most about members avoiding needed care and avoiding preventive care,” Casalveri shared.

She emphasized that the industry needs to work toward better financing for seniors to receive at-home care.

“If the pandemic provides more urgency around finding creative ways to support families, to help seniors live safely, individually at home, I think that will be a very positive outcome,” Casalveri said.