Overview
Agenda Overview Objectives Background Case studies Member Experience Primary Care Provider Experience Referrals and Follow-up Influence on Centers for Medicare & Medicaid Services (CMS) Star Ratings Post-Visit Reports Questions 2
HouseCalls Overview HouseCalls provides in-home clinical visits at no additional cost for qualified UnitedHealthcare Medicare Advantage members. The 45-60 minute visits are performed by licensed HouseCalls clinicians and may include: Review of health history and medication Wellness evaluation Review of home environment Education about chronic conditions Lab tests for: glycated hemoglobin (HgA1c) by finger stick and diabetes kidney disease monitoring by urine dipstick Fecal occult blood test (ifobt) kit for the member to complete and mail to a lab which sends results to the member s primary care provider (PCP) Discussion topics and questions to bring to the member s next PCP appointment HouseCalls visits are not meant to replace the care a member receives from their PCP. HouseCalls clinicians encourage members to follow up and stay connected with their PCP. 3
HouseCalls Objectives Increase access to care Improve health outcomes Increase patient satisfaction Empower members with information to make educated health choices Connect members to care management programs Reinforce patient/care provider relationships Reduce hospital admissions Improve Health Effectiveness and Data Information Set (HEDIS) scores, CMS Star Ratings and other health plan quality measures and help close 14 specific care opportunities Help PCPs update medical records 4
HouseCalls by the Numbers HouseCalls Visits Completed HouseCalls Clinician Network 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 105,000 262,000 672,000 753,000 1,185,604 1,019,180 1,600 1,400 1,200 1,000 800 600 400 200 305 1,030 1,190 1,200 1,500 1,500-2011 2012 2013 2014 2015 2016 Est - 2011 2012 2013 2014 2015 2016 Est Referrals Generated to PCPs and Care Providers States Where HouseCalls Is Available 1,000,000 800,000 600,000 400,000 200,000-950,000 810,000 372,000 350,000 155,000 40,000 2011 2012 2013 2014 2015 2016 Est 45 40 35 30 25 20 15 10 5-38 37 39 40 24 6 2011 2012 2013 2014 2015 2016 Est 5
RAND Study Results Study: Clinical Home Visit Program Reduces Costly Hospital and Nursing Home Admissions, Increases Physician Office Visits Among Medicare Beneficiaries A RAND Corporation study 1 published in Health Affairs evaluated the effectiveness of Optum s HouseCalls program for UnitedHealthcare Medicare Advantage plan beneficiaries Results show HouseCalls program participants had up to 14 percent fewer hospital admissions, lower risk of admission to nursing homes, and a 2-6 percent increase in physician office visits You may access the Health Affairs article, which will be publicly accessible until approximately [date]. 1 RAND Study, Published December 2015, Health Affairs, December 2015, Vol. 34, No.12, 2138-2146. 6
HouseCalls Case Study Members who completed a HouseCalls visit and an Annual Care Visit (ACV) received preventive care and other key screenings at higher rates than those who completed only one of the visits.* Of the 763 UnitedHealthcare Medicare Advantage members sampled: 67 percent had open care opportunities 13 percent completed both a HouseCalls visit and an ACV 56 percent of members had an ACV after completing their HouseCalls visit Table 1: HEDIS Close Rate, by Annual Care Visit/HouseCalls Engagement Medicare Advantage Members associated with a New York Medical Group 1 No ACV or HC n=359 HouseCall Only n=145 ACV Only n=159 HC & ACV n=100 Engagement Rates: 47% 19% 21% 13% Breast Cancer Screening 42% 45% 65% 89% Colorectal Cancer Screening 48% 63% 52% 79% Adult BMI Assessment 56% 100% 69% 100% SNP - Medication Review SNP - Functional Assessment No members with Eligible measures SNP - Pain Screening Diabetes Care - Eye Exam 40% 40% 52% 65% Diabetes Care - Kidney Disease 73% 80% 71% 82% Diabetes - Blood Sugar 30% 20% 24% 35% Controlling Blood Pressure Removed from Analysis 2 Rheumatoid Arthritis 67% 100% 100% 100% 45% 68% 63% 80% Analysis Notes: 1 This analysis is representative of the 2014 Annual Care Visit and HouseCalls actvity for members associated with a New York Medical Group. Annual Care Visits and HEDIS measure close rates are based on claims data. This data reflects adjudicated claims processed through 12/30/2014 and pre-adjudicated claims received through 2/02/2015 2 Controlling Blood pressure was removed from analysis. The measure is typically understated when Annual Care Visit occurs because this value can only be validated by CPT Ii code or chart review. 7 *Medicare and Retirement Informatics Study, April 8, 2015, completed claims.
Member Experience Prior to the HouseCalls Visit Day Before the HouseCalls Visit Day of the HouseCalls Visit After the HouseCalls Visit Member Receives: Introductory Letter describing program and opportunity to earn $15 gift card for completing a HouseCalls visit (eligibility based on plan offering) Scheduling call Appointment reminder postcard The licensed HouseCalls clinician contacts the member to confirm details and answer member questions Licensed HouseCalls clinician arrives at scheduled time, performs the HouseCalls visit Urgent needs receive immediate care follow-up Member receives an Ask Your PCP form to bring to their primary care provider If appropriate, member is referred to other care management programs Member may receive $15 gift card incentive for completing HouseCalls visit (eligibility based on plan offering) Member receives a postvisit summary letter in the mail 8
Provider of Record Experience Prior to the HouseCalls Visit Physician of record receives an introductory letter for their members who will receive a HouseCalls visit Letters are sent annually or upon new enrollment During the HouseCalls Visit HouseCalls is designed to support the care members receive from their physician HouseCalls is not intended to replace a member s regular physician visits or the care they receive through their primary physicians (including their annual wellness visit) Information collected during the HouseCalls visit is shared with the physician of record through a PCP postvisit report letter The post-visit report letter summarizes visit results and findings from the licensed HouseCalls clinician including: Findings/diagnoses Medications Physical exam results Lab results (if applicable) Program referrals Additional recommendations After the HouseCalls Visit A copy of the post-visit report letter (mailed to the PCP s office) contains valuable information and should be placed in the member s patient record The member will bring an Ask your PCP form with them to their next visit with their PCP 9
Provider Post-Visit Report Mailed to PCP s office on file within approximately four to six weeks Includes: Findings/diagnoses Medications Health screening Lab tests (if applicable) Referrals Recommendations PCPs may call HouseCalls Clinical with questions about the report: 888-591-1511 Lab results are sent separately, if applicable Please place in member s patient record 10
Member Post-Visit Report Mailed to member s home within approximately four to six weeks Includes: Vital signs Findings/diagnoses Medications Recommendations Education/information Members are encouraged to follow up with their PCP with questions Lab results are sent separately, if applicable 11
HouseCalls Referrals 12
HouseCalls and CMS Star Ratings HouseCalls partners with UnitedHealthcare teams to help improve HEDIS scores, CMS Star Ratings and other health plan quality measures through thoughtful member engagement Includes annual auditor meetings and detailed Section 5 documentation on data collected through the electronic medical record (EMR) as part of the clinical encounter The data collected by HouseCalls to support CMS Star Ratings efforts is considered supplemental data 13
HouseCalls Aims to Influence Star Ratings HouseCalls visits may help improve CMS Star Ratings and support efforts to address care opportunities. Direct impact Diabetes kidney disease monitoring (urine dipstick)* Annual medication review Pain screening Functional assessment Body mass index measurement Colorectal cancer screening (ifobt kit)* Diabetes blood sugar (A1C control)* Diabetes care eye exam Osteoporosis management Rheumatoid arthritis therapy (ART) Breast cancer screening Comprehensive medication therapy management and review Medication reconciliation post discharge (MRP) Statin therapy for patients with cardiovascular disease (SPC)** Indirect Impact Medication adherence and high risk medication Controlling blood pressure Annual flu vaccine Diabetes treatment Helping improve or maintaining mental health Monitoring physical health, and helping improve or maintain physical health Helping improve bladder control Helping reduce the risk of falling Helping to decrease unplanned readmissions for any diagnosis *Conducted through the HouseCalls lab program for members with open care opportunities. ** New measure for 2016. Rate 1 population only. 14
HouseCalls Stars/HEDIS Impact Stars/HEDIS Measure Diabetes Kidney Disease Annual Medication Review (SNP only) Pain Screening (SNP only) Functional Assessment (SNP only) Body Mass Index (BMI) Colorectal Cancer Screening Diabetes Blood Sugar (A1C control) Diabetes Care Eye Exam Specification Percent of plan members (ages 18-75) with diabetes who had kidney function test during the year, or have documented evidence of nephropathy Percentage of adult plan members (ages 66 and older) who had medication review during measurement year Percentage of adult plan (ages 66 and older) who had a pain assessment during the measurement year Percentage of adult plan members (ages 66 and older) who had a functional assessment during the measurement year Percentage of plan members (ages age 18-74) who had a BMI documented during measurement year or year prior to measurement year Percentage of plan members (ages 50-75) who had colonoscopy < 10 years ago, or sigmoidoscopy < 5 years ago, or fecal occult blood/guaiac testing during measurement year Percentage of plan members with diabetes who had an A1C lab test during the year showing average blood sugar is under control Percentage of plan members (ages 18-75) who had retinal eye exam by eye care professional in measurement year OR a negative/normal screening in prior year 15
HouseCalls Stars/HEDIS Impact Stars/HEDIS Measure Specification Osteoporosis Management Percentage of female plan members (ages 67 or older) who suffered a fracture and had either a bone mineral density test or prescription for a drug to treat or prevent osteoporosis in the 6 months following a fracture ART (Rheumatoid Arthritis) Breast Cancer Screening Medication Therapy Management (MTM) / Comprehensive Medication Review (CMR) Medication Reconciliation Post- Discharge (MRP) Statin Therapy for Patients With Cardiovascular Disease (SPC) Percentage of plan members who are diagnosed with Rheumatoid Arthritis and are dispensed at least one prescription for disease modifying antirheumatic drugs (DMARD) Percentage of female plan members (ages 50-74) who had a mammogram during past 2 years Number of beneficiaries ages 18 or older who were enrolled in an MTM program for at least 60 days during the reporting period The percentage of discharges from January 1 December 1 of the measurement year for members ages 18 or older for whom medications were reconciled the date of discharge through 30 days after discharge (31 total days). The percentage of males ages 21 75 and females ages 40 75 during the measurement year, who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria. The following rate is reported: Received Statin Therapy. Members who were dispensed at least one high or moderate-intensity statin medication during the measurement year 16
How HouseCalls Helps Improved care, better outcomes lower cost Improving access Increasing physician engagement Closing care opportunities x Reducing hospitalizations and long-term admissions Detecting undiagnosed conditions Educating and empowering consumers Increasing member satisfaction 17
Questions? Thank You! 18