Last week, UnitedHealth Group (NYSE: UNH) defended its utilization of in-home health assessments, which are visits used widely by Medicare Advantage (MA) plans looking to fill gaps in patient care. Detractors of this type in-home visit have suggested that plans use them to up risk scores for MA members, which helps maximize reimbursement.
In July, a study published in Health Affairs argued that these in-home health risk assessments increase coding intensity in MA, which, in turn, leads to higher payments from the Centers for Medicare & Medicaid Services (CMS).
Then, earlier this month, the Wall Street Journal published a story criticizing the financial gains UnitedHealth Group specifically has derived from these in-home visits.
UnitedHealth Group responded, arguing that these in-home risk assessments help members access the care they need, and help plans gain greater insight into a patient’s whole health picture.
“It’s a critical touchpoint in the care continuum, supplementing annual physician visits — not replacing them — and ensuring people have access to needed services, including housing, food and social support,” UnitedHealth Group wrote. “The professionally licensed and highly trained HouseCalls clinicians — many of whom have been dedicated to visiting Medicare Advantage seniors for years as part of this program — perform health, home and environmental assessments and offer preventive services, but they do not prescribe or order treatments. They may refer members to other services or providers, but they always direct members back to their chosen, treating physician for treatment.”
UnitedHealth Group is one of the largest health care companies in the country. It is one of the largest payers via its UnitedHealthcare arm, and is also one of the largest health care services providers via its Optum arm.
The company’s HouseCalls program, specifically, is what the company defended in its release last week.
The Health Affairs study specifically broke down the financial impact that in-home risk assessments and “chart reviews” have. The author of the study wrote that encounter-based risk scores for MA enrollees were 7.4% higher when in-home health risk assessments or chart reviews were used.
UnitedHealth Group refuted the idea that the “HouseCalls program is simply a way to add codes and increase payment,” and said that the majority of its in-home visits do not result in elevated risk adjustments.
“HouseCalls provides one-on-one, in-home clinical assessments to more than 2.7 million patients each year,” the company wrote. “It allows advanced practice clinicians to identify and address gaps in care, ensuring patients receive important health screenings and connecting them with needed care. Within 90 days of a HouseCalls visit, 75% of patients receive additional primary care in a clinic. Last year, the program closed more than 3 million gaps in care by addressing medical, behavioral and social needs.”
UnitedHealth Group is not alone in this matter, either. CVS Health (NYSE: CVS), for instance, leverages Signify Health’s in-home visits to close gaps in care for Aetna members.
Health plans see these visits as a way to ensure members are getting all of their health needs fulfilled. Skeptics see the visits as a way to extract more money from CMS.
“Medicare Advantage is more affordable for patients and reduces costs for the broader health system,” UnitedHealth Group wrote. “Seniors in MA save 45% on premiums and out-of-pocket costs each year, which translates to an average savings of $2,800 annually compared to those in fee-for-service (FFS) Medicare. In 2023, 73% of MA enrollees, including those in UnitedHealthcare plans, pay no monthly premium.”
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