Housecalls Program Overview › content › dam › uhccp › ...(ACV) received preventive care and other key screenings at higher rates than those who completed only one of the visits.*

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

PCA-1-001371-03222016-04182016 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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

• 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

HouseCalls Objectives


4

HouseCalls by the Numbers

HouseCalls Visits Completed HouseCalls Clinician Network

Referrals Generated to PCPs and Care Providers States Where HouseCalls Is Available


5

6

24

38 37 39 40

- 5

10 15 20 25 30 35 40 45

2011 2012 2013 2014 2015 2016 Est

105,000 262,000

672,000 753,000

1,019,180 1,185,604

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

2011 2012 2013 2014 2015 2016 Est

305

1,030 1,190 1,200

1,500 1,500

- 200 400 600 800

1,000 1,200 1,400 1,600

2011 2012 2013 2014 2015 2016 Est

40,000 155,000

372,000 350,000

810,000

950,000

-

200,000

400,000

600,000

800,000

1,000,000

2011 2012 2013 2014 2015 2016 Est

RAND Study Results

6 PCA-1-001371-03222016-04182016 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Study: Clinical Home Visit Program Reduces Costly Hospital and Nursing Home Admissions, Increases Physician Office Visits Among Medicare Beneficiaries

• A RAND Corporation study1 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].

1RAND Study, Published December 2015, Health Affairs, December 2015, Vol. 34, No.12, 2138-2146.

http://content.healthaffairs.org/cgi/content/full/34/12/2138?ijkey=uLYknWGvBkZWU&keytype=ref&siteid=healthaff

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

*Medicare and Retirement Informatics Study, April 8, 2015 , completed claims.

Table 1: HEDIS Close Rate, by Annual Care Visit/HouseCalls EngagementMedicare Advantage Members associated with a New York Medical Group1

No ACV or HCn=359

HouseCall Only

n=145ACV Only

n=159HC & ACV

n=100Engagement 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 ReviewSNP - Functional AssessmentSNP - Pain ScreeningDiabetes Care - Eye Exam 40% 40% 52% 65%Diabetes Care - Kidney Disease 73% 80% 71% 82%Diabetes - Blood Sugar 30% 20% 24% 35%Controlling Blood PressureRheumatoid Arthritis 67% 100% 100% 100%

45% 68% 63% 80%

Analysis Notes:

No members with Eligible measures

Removed from Analysis 2

2 Control l ing Blood pressure was removed from analys is . The measure i s typica l ly understated when Annual Care Vis i t occurs because this va lue can only be va l idated by CPT I i code or chart review.

1 This analys is i s representative of the 2014 Annual Care Vis i t and HouseCal l s actvi ty for members associated with a New York Medica l Group. Annual Care Vis i ts and HEDIS measure close rates are based on cla ims data . This data reflects adjudicated cla ims processed through 12/30/2014 and pre-adjudicated cla ims received through 2/02/2015


7

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 post-visit summary letter in the mail


Provider of Record Experience Prior to the

HouseCalls Visit During the

HouseCalls Visit After 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

• 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 post-visit 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

• 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


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

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.

HouseCalls visits may help improve CMS Star Ratings and support efforts to address care opportunities.


14

HouseCalls Stars/HEDIS Impact

Stars/HEDIS Measure Specification

Diabetes Kidney Disease • Percent of plan members (ages 18-75) with diabetes who had kidney

function test during the year, or have documented evidence of nephropathy

Annual Medication Review (SNP only) • Percentage of adult plan members (ages 66 and older) who had medication review during measurement year

Pain Screening (SNP only)

• Percentage of adult plan (ages 66 and older) who had a pain assessment during the measurement year

Functional Assessment (SNP only)

• Percentage of adult plan members (ages 66 and older) who had a functional assessment during the measurement year

Body Mass Index (BMI) • Percentage of plan members (ages age 18-74) who had a BMI

documented during measurement year or year prior to measurement year

Colorectal Cancer Screening • 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

Diabetes Blood Sugar (A1C control) • Percentage of plan members with diabetes who had an A1C lab test during the year showing average blood sugar is under control

Diabetes Care Eye Exam • 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


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) • Percentage of plan members who are diagnosed with Rheumatoid Arthritis

and are dispensed at least one prescription for disease modifying anti-rheumatic drugs (DMARD)

Breast Cancer Screening • Percentage of female plan members (ages 50-74) who had a mammogram during past 2 years

Medication Therapy Management (MTM) / Comprehensive Medication Review (CMR)

• Number of beneficiaries ages 18 or older who were enrolled in an MTM program for at least 60 days during the reporting period

Medication Reconciliation Post-Discharge (MRP)

• 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).

Statin Therapy for Patients With Cardiovascular Disease (SPC)

• 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

17

x

Reducing hospitalizations and long-term admissions

Detecting undiagnosed

conditions

Increasing physician engagement

Educating and empowering consumers

Closing care opportunities

Increasing member satisfaction

Improving access

Improved care, better outcomes lower cost


Thank You!


Questions?

18

Documents

Housecalls Program Overview › content › dam › uhccp › ...(ACV) received preventive care and other key screenings at higher rates than those who completed only one of the visits.*