Insurers turn to house calls to improve care and reduce costs

Get your black bag ready. House calls could be in your future.

While Medicare prepares to roll out the Independence at Home (IAH) pilot program on Jan. 1, 2012, commercial insurers have been testing variations on the concept for some time.

Blue Cross Blue Shield of Florida began providing home-based services in south Florida more than a year ago. Designed to provide care for the “sickest of the sick,” the program ensures that “members who can’t go to their physician to get care can have the care come to them,” says Uday Deshmukh, MD, senior medical director with Blue Cross Blue Shield of Florida.

For patients recently discharged from the hospital, in particular, “we understand that if the needed care is not provided, there may be an unchecked deterioration in their condition, which may result in an admission to the hospital and an extended stay. The program allows us to manage the cost while getting the best care to the patient,” notes Deshmukh.

Premera Blue Cross’s Home Visit Program targets a different set of patients. The Washington-based insurer began offering home visits on a limited basis in February to members who have “an immediate but not life-threatening need for care.”

Members call into a nurse line and then are walked through several options from self-care to urgent care center or house call. The house call program and nurse line provide alternatives to the hospital emergency room, especially over weekends or after hours when a primary care physician is unavailable, according to Roki Chauhan, MD, chief medical officer and senior vice president of Integrated Health Management at Premera Blue Cross.

The Patient Protection and Affordable Care Act included a provision asking the Centers for Medicare and Medicaid Services to test a payment incentive and service delivery model that improves health outcomes and reduces costs by providing home-based primary care to beneficiaries. The IAH program targets patients with two or more chronic diseases who have been admitted to the hospital and have used rehabilitative services in the last year.

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