by Evan Sweeney | May 11, 2018 11:24 am
Paul Engwall, above, says the HouseCalls program saved his life by
helping to identify an aortic aneurysm. (UnitedHealthcare)
The 72-year-old
Lyndon, Illinois, resident saw his primary care doctor regularly and considered
himself healthy, so he was reluctant to take a house call offered by his
Medicare Advantage insurer.
But after a friend
died of cancer, he and his wife, Lorna, reconsidered. In November 2016, they
scheduled a visit with Hesper Nowatzki, a nurse practitioner with
UnitedHealthcare’s HouseCalls program. After what seemed like an ordinary
assessment, Paul’s urine dipstick test revealed an “outrageously abnormal amount
of protein,” according to Nowatzki.
“That took me on a long strange trip,” Paul
Engwall told FierceHealthcare. “I’m one of four brothers and I always thought I
was the healthy one.”
The high protein
levels in Paul’s urine were signs of kidney disease, and Nowatzki quickly
referred him to a nephrologist. A kidney biopsy and further testing later
showed he had an aortic aneurysm that was on the brink of rupturing, prompting
immediate surgery.
Paul made a full
recovery, but the impact of that urine test—one that is often overlooked during
a primary care visit—wasn’t lost on his wife.
“Hesper saved Paul’s
life,” Lorna said. “If she hadn’t done that one little thing—if she had just
done everything else and not the dipstick, we still wouldn’t have known
anything was wrong with Paul.”
HouseCalls sees rapid growth since 2012
That level of
preventative care is a staple of UnitedHealthcare's HouseCalls program, which
recently surpassed 5 million visits. The program has grown significantly over
the last several years, staffing 350 advanced care practitioners in
2012 to 1,700 clinicians across 45 states and the District of Columbia.
The program was
solidified six years ago with the purchase of XLHealth, a Medicare Advantage
plan that focused on beneficiaries with chronic conditions that were also
eligible for Medicaid. At the time, UnitedHealth predicted it would add about
$2 billion in revenues.
During the company’s
earnings conference last fall, UnitedHealth Group Chief Financial Officer John
Rex highlighted the acquisition that appeared small on the surface but
provided “unique capabilities providing in-home health assessments, primarily
to seniors.”
The program has
surpassed 1 million visits in each of the last three years, and the company
expects to complete 1.4 million visits in 2018. That’s up from just 262,000
visits in 2012.
It’s difficult to
quantify the returns on the program, said Jennie Roberts, vice president of
clinical quality at UnitedHealthcare, but there’s value in the number of
hospitalizations and high-cost admissions the program prevents in the long
term.
“The benefit is during
these health assessments, really having members identify opportunities around
whether they need follow-up treatment or follow-up treatment plans,” Roberts
told FierceHealthcare. “Honestly, that will drive up some costs initially,
especially if members aren’t engaging with care.”
In the long term,
however, it translates to fewer hospitalizations and better outcomes. A 2015
study published by the Rand Corporation found
that those enrolled in UnitedHealth’s HouseCalls program had 14% fewer hospital
admissions and a lower risk of nursing home admission compared to Medicare
Advantage beneficiaries that weren’t enrolled in the program. Visits to
specialists increased as much as 6% in the year after a HouseCall visit.
The HouseCalls
assessments are intended to supplement primary care visits, but many members
end up feeling it was the most thorough exam they’ve had, Nowatzki says.
Practitioners typically spend 45 to 60 minutes with each member, often
addressing issues that a primary care physician can’t, such as access to food
and transportation that may be inhibiting access to care.
But Nowatzki says
she’s also surprised at the number of recommended tests and evaluations that
members say their doctors haven’t talked with them about.
“In the confines of an
office visit, it’s a time factor,” Nowatzki says. “The focus is not necessarily
on prevention like my job is.”
No comments:
Post a Comment