“It’s a distinctive part of the culture of UnitedHealth Group that we continue to strive to deliver on our financial commitments to you through changing environments and unforeseen challenges,” UnitedHealth Group CEO Andrew Witty said during the company’s third-quarter earnings call on Tuesday. “As we look to 2025 … we remain in a dynamic period for the health care sector. Amid this, it’s important that we continue to invest in the durable value creating capabilities of this company that support our 13% to 16% long-term growth objectives.”

Despite this current operating environment, Witty expressed optimism about the company’s ability to grow in the years to come.

The company already owns the home health giant LHC Group, and is in the process of acquiring Amedisys Inc. (Nasdaq: AMED), another one of the largest home health providers in the country.

One of the elements laying the groundwork for growth is UnitedHealth Group’s commitment to the transition of the health system to value-based care, Witty noted.

“At UnitedHealth Group, we’re purposefully organized to support the transition to value-based care,” he said. “It requires deep engagement with patients, setting the foundation to move to more coordinated care, connecting patients to primary care earlier, driving clinically accurate diagnoses more effectively, recognizing and managing chronic conditions and slowing disease progression. We’re seeing the benefits of this work come to fruition.”

Specifically, individuals who receive care services under Optum’s value-based models are more likely to receive cancer screenings. Optum is UnitedHealth Group’s health care services arm.

These individuals are also better positioned to control their diabetes and hypertension, compared to those under fee-for-service Medicare. Plus, they are 10% less likely to visit the emergency room, or be readmitted to hospital.

UnitedHealth Group’s value-based care models incorporate home-based care services, such as house calls, home health care and other in-home visits.

For the third quarter of 2024, UnitedHealth Group brought in revenues of $100.8 billion, a $8.5 billion increase over the prior year period.

Optum’s Q3 revenue was $63.9 billion, a $7.2 billion increase over the prior year.

“This was driven by an increase in both the number and type of care services we offer and the patients we serve, especially in the home and among those with complex needs,” John Rex, president and CFO of UnitedHealth Group, said during the call.

UnitedHealthcare’s Q3 revenue was $74.9 billion, a $5 billion increase over the previous year.

“Indications are tracking favorably as we head into 2025, reflecting continued strong uptake of UnitedHealthcare’s innovative offerings,” Rex said. “Our Medicare Advantage plans, on offer this fall, balance providing as much benefit stability as possible for seniors, while contending with the CMS funding cuts, IRA changes and expected care patterns.”

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Enhabit Inc. (NYSE: EHAB) CEO Barb Jacobsmeyer said Wednesday that the company would terminate its contract with the country’s largest Medicare Advantage (MA) payer, UnitedHealth Group’s (NYSE UNH) UnitedHealthcare.

UnitedHealthcare accounts for 9.4 million MA beneficiaries, or 29% of all enrollees, according to the Kaiser Family Foundation. Humana Inc. (NYSE: HUM), which is the second-largest MA payer, only owns 18% of the market, for context.

It’s hard to overstate how large of a strategic gamble this is for Enhabit. On one end, you can’t “negotiate” for better contracts if you’re unwilling to walk away from a bad one. On the other end, as Enhabit tries to build up its non-Medicare revenue (or MA revenue), reducing access to members of the country’s largest payer comes with inherent risks.

Broadly, Enhabit has been adjusting its revenue mix over the last couple of years to become a better partner to referral sources and set itself up for the future. When it spun off of Encompass Health (NYSE: EHC), close to 80% of its business was tied to traditional Medicare. Now, that number is closer to 60%.

As it takes on more MA – which now insures about 54% of Medicare beneficiaries – its goal is to mostly take care of patients under its improved (“payer innovation”) contracts. Over the last two years, Enhabit has been renegotiating contracts with MA plans, aiming to get higher rates, or at least higher-upside agreements.

UnitedHealthcare clearly fell short during negotiations.

“As we look to the future, the quickest way to get the majority of our non-Medicare business to the payer innovation contracts is to continue to focus on referrals within the payer innovation contracts, negotiate improved rates with non-payer innovation contracts, and, when necessary, terminate the lower reimbursing contracts,” Jacobsmeyer said Wednesday on the company’s second-quarter earnings call. “After over nine months of unsuccessful negotiations with UnitedHealthcare, we submitted our termination notice on August 1. We will dedicate our clinical resources to fee-for-service Medicare patients, and those members of the 68 favorable contracts. We remain committed to providing our strong quality of care to UnitedHealthcare members, if at some point they decide to contract with acceptable rates.”

Enhabit putting its foot down on UnitedHealthcare, and what it means for itself and the home health industry at large, is the topic of this week’s exclusive, members-only HHCN+ Update.

Putting a foot down

Enhabit said that moving away from UnitedHealthcare is squarely in line with its overall payer innovation strategy.

“In quarter one of 2023, 58% of admissions were in combined Medicare fee-for-service and payer innovation contracts, which left 42% of admissions in unfavorable contracts,” Jacobsmeyer explained. “In 2024, the percent of admissions in Medicare fee for service and payer innovation contracts has grown to 71%. This will continue to accelerate with the recent decision to terminate this national agreement.”

The Dallas-based Enhabit is one of the largest home health providers in the country. In total, it has 256 home health locations and 112 hospice locations across 34 states.

Capacity is the most cherished part of home health operations. Staffing is a barrier to growth, so what companies do with the staff they do have is of utmost importance.

It also happens to be providers’ best bargaining chip. Providers don’t want to leave home health-needy patients in the middle of contract wars, but MA members need home health access, and providers can take that away from plans.

With home health access dwindling – due to MA penetration and fee-for-service rate cuts – MA plans need reliable home health partners. They need to enable easy transitions from the hospital to the home, avoiding referral rejections when they can.

Enhabit’s termination of the UnitedHealthcare contract, and its coinciding public announcement of that, has drawn significant attention from Home Health Care News readers.

Providers have complained that, while UnitedHealth Group recognizes the value of home health care – considering its acquisition of LHC Group and its pending acquisition of Amedisys Inc. (Nasdaq: AMED) – it does not show it through UnitedHealthcare’s home health rates.

A move like this, from a provider as large as Enhabit, may serve as a wake up call to UnitedHealthcare. It will definitely serve as a point of reference and confidence for home health providers that are considering walking away from bad contracts themselves.

“As a regional provider of home health services, we had to look at those margins and how we best deploy our nurses and our therapists,” Jet Health’s then-CEO Stacie Bratcher said last January. “We were under water with one of our large providers. We had to decide, do we stay in-network with some really poor rates that were under what our per-visit rate was, or do we exit?”

Even if payers recognize the value of home health care, the departments that negotiate rates are sometimes incentivized to keep low rates in place. Jacobsmeyer has explained this dynamic on earnings calls before.

The current home health payment environment has providers turning every stone, looking for ways to keep a viable bottom line.

At some point, the juice is not worth the squeeze on bad MA contracts – both for struggling, smaller providers and for larger ones like Enhabit, which finally has better deals in place elsewhere.

“A year or so ago, we would not have been in the position to terminate that contract,” Jacobsmeyer said. “But now, with 68 agreements, including two national agreements, we feel confident that we’re going to be able to replace that census. Our current non-Medicare conversion rate is only at 48%, so we do have some non-Medicare that we don’t convert. So it’s really now going to be about replacing that census over this notice period.”

The post What Comes Next After Enhabit’s UnitedHealthcare Contract Termination appeared first on Home Health Care News.

In light of those sentiments and expected constraints, some believed MA plans could begin trimming their supplemental-benefits packages, which could lead to fewer home-based care offerings delivered under the Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI) options.

MA plans began touting their benefits to Medicare beneficiaries at the beginning of October – and early signs suggest a pullback is, indeed, taking place.

“Fewer plans are using SSBCI to offer benefits, with decreases in Social Needs Benefits (128 fewer plans than in 2023) and Meals (99 fewer plans),” Washington, D.C.-based research and advisory firm ATI Advisory wrote in a LinkedIn post.

Specifically, across EPHRB, SSBCI and VBID authorities in 2024, 867 plans will offer in-home support services (IHSS) as a supplemental benefit, according to ATI. This is a decrease from the 1,308 plans offering this benefit in 2023.

It’s not exclusively due to the brighter spotlight on plans, however.

“We suspect the main reason behind the decrease is that IHSS is a more administratively complex benefit to offer, especially compared to something like a grocery card,” Bill Winfrey, director of Medicare innovation at ATI Advisory, told Home Health Care News in an email. “To offer the benefit, plans must identify providers in a crowded marketplace, build a provider network to ensure market coverage and manage increasing labor costs that are driving up the cost of the benefit itself.”

Before heading into the 2024 plan year, IHSS had been one of the most popular benefits. There was a 364% increase in plans offering the benefit since 2020.

Dr. Sachin Jain, CEO of the Medicare Advantage organization The SCAN Group, recently discussed how MA plans may operate in this different environment with HHCN sister publication Palliative Care News.

“The way Medicare Advantage works is that we receive a risk adjusted, per member, per month payment in addition to revenue bonuses for [star ratings], which then fuels our ability to purchase services on behalf of our members,” Jain told Palliative Care News. “It just goes to reason that if we start getting paid less in aggregate, then our downstream entities are likely going to either see smaller increases or lower payments.”

CMS moved forward with changes to its risk-adjustment process earlier this year via its 2024 final rule for Medicare Advantage plans. The agency is implementing a 3.3% base-rate increase for MA plans while beginning a three-year phase-in of an updated approach to risk adjustment.

On top of that, the agency is transitioning its code system from Internal Classification of Diseases (ICD)-9 to ICD-19. It removed more than 2,000 of the diagnosis codes that MA plans use, with the affected codes “focused on conditions that are subject to more coding variation,” according to CMS.

“Paying Medicare Advantage plans more accurately for the care they provide is how we ensure that people enrolled in Medicare Advantage, especially populations with the highest health disparities and people in underserved communities, can continue to access the care they deserve,” CMS Administrator Chiquita Brooks-LaSure said in a statement.

An HHCN review of benefit announcements from some of the largest insurers reinforces the notion that fewer are touting home-based care offerings for 2024.

In recent years, many highlighted benefits for a certain number of hours of in-home support from in-home care technicians who can assist with light housekeeping and activities of daily living (ADLs). In-home companionship services and programs designed to ensure smooth hospital-to-home transitions were also common.

Few of the big insurers are touting the same degree of home-based care benefits for 2024 in their announcements.

Elevance Health (NYSE: ELV) highlighted supplemental benefits such as “dental, vision and hearing, transportation to medical appointments, assistive devices, utilities such as gas and electric bills, and groceries,” for example. UnitedHealthcare touted similar benefits, plus home delivery prescriptions.

Aetna – whose parent company, CVS Health (NYSE: CVS), acquired both Oak Street health and Signify Health – will offer an annual “healthy home visit” to members and access to primary care clinics.

Oak Street Health’s innovative care model provides comprehensive primary care with a focus on prevention and wellness. Aetna MA members will have access to all Oak Street Health primary care clinic locations across the country as part of the extensive Aetna provider network.

“[A health home visit] includes a comprehensive health risk assessment and non-invasive physical exam from the comfort of the member’s home,” Aetna wrote in an announcement. “The clinician will also evaluate the home environment to identify social support needs and risks that could result in early detection of health problems.”

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Broadly, prior authorization is the process that occurs when a health care provider requests a patient to receive a specific service, medication or procedure. The health insurance company then has to give the go-ahead.

From the home care and home health provider perspective, prior authorization can include a lot of tedious back office work, and it can also hurt patient care.

The process is put in place to ensure the health plan is going to cover the care and financial costs for a patient down the road.

Traditional prior authorization is not a seamless process. Patients can wait days – or weeks – to see if their care has been authorized. When there are significant delays, patients are much more likely to abandon their treatment plan altogether.

Since 2020, Cigna has removed prior authorization on more than 1,100 medical services in hopes of simplifying the health care journey for both health care providers and patients.

Cigna also plans to remove prior authorization for nearly 500 additional codes for Medicare Advantage plans later this year.

“Prior authorizations are an important step to ensure patient safety and affordability, but clinicians and health plans alike agree that more can be done to reduce the administrative burden on clinicians,” Cigna Healthcare CMO Scott Josephs said in a statement. “We will continue to engage with clinicians to align on care delivery goals and outcomes and evaluate whether there are other changes we can make without compromising patient safety.”

Home health providers have longed for a speedier prior authorization process. Home Health Care News reached out to Cigna to find out whether any of the prior authorizations removed were home health- or home care-related, but had not heard back by the time this story was published.

Either way, large insurers like Cigna and UnitedHealthcare – which has also done away with some prior authorization – moving away from prior authorization is a positive. Health care providers are likely to find these insurers are easier to work with in the future.

Better prior authorization

Digitizing the process has helped tremendously in some cases.

A study from America’s Health Insurance Plans (AHIP) found that when requests were submitted electronically, the prior authorization process fell from an average of 18.7 hours to 5.7 hours — a reduction in turnaround time of nearly 70%.

In July, the U.S. House Ways and Means Committee advanced the Improving Seniors’ Timely Access to Care Act, which was designed to improve health care for seniors by, in part, reducing those burdensome prior authorization processes.

The legislation would mandate the adoption of electronic prior authorization for Medicare Advantage plans. The bill also would improve transparency when it comes to MA policies, approval rates and the rationale behind requests being denied.

That bill is currently waiting on a score from the Congressional Budget Office.

The post Cigna To Shed Certain Prior Authorization Requirements, May Benefit Home-Based Care Providers appeared first on Home Health Care News.

Already, that home- and community-based care ecosystem includes capabilities such as Optum’s HouseCalls program and in-home assessments, plus Landmark Health, naviHealth and in-home testing initiatives – something UnitedHealth Group hopes to do more of in the not-so-distant future.

“Our approach focuses on providing quality care in the setting that makes most sense for the patients we serve,” Witty said during a Thursday conference call discussing first quarter financial results.

By the end of 2022, that ecosystem will likely include the operations of LHC Group Inc. (Nasdaq: LHCG) as well. UnitedHealth Group’s $5.4 billion purchase of the Lafayette, Louisiana-based home health company is expected to close in the second half of the year.

“Our pending combination with LHC Group will reinforce our ability to deliver care and support in the home as well as in other ambulatory locations,” Witty continued.

Advancing its value-based care strategy is a top priority for UnitedHealth Group, the parent company of diversified health services platform Optum and UnitedHealthcare, the nation’s largest health insurer.

Following a strong start to the year, UnitedHealth Group is now projecting Optum Health to add about 600,000 patients under value-based care arrangements, compared to its initial estimate of around 500,000.

Having a wide variety of home- and community-based care capabilities allows UnitedHealth Group to shift care into the most appropriate – and often lowest-cost – setting. It likewise adds appeal from a patient and member perspective, as most Americans, when possible, prefer to receive treatment in the comfort of their own homes.

Witty specifically pointed to how UnitedHealth Group’s “extraordinary” capabilities have positioned the company to serve the Dual Eligible Special Needs Plan (D-SNP) population in a way that “historically would not have been possible.”

Overall, UnitedHealthcare in the first quarter served about 1.5 million more people than a year ago across its health benefits offerings, with growth driven by strong enrollment in Medicare Advantage (MA), D-SNPs and the broader Medicaid market.

“We’re really moving at speed to bring together our home and community capabilities,” Witty said. “And if you look at what’s really driving alongside our value-based strategy for the clinics, [it’s] the rapid growth of our home and community offering, which has brought together naviHealth, Landmark. It will, over time, align with LHC, when it joins into the organization, built on our original ‘Optum At-Home’ product.”

UnitedHealth Group’s Q1 2022 revenues totaled $80.1 billion, up 14.2% compared to $70.2 billion in last year’s first quarter. UnitedHealthcare revenues were up 13.6% to $62.6 billion, while Optum revenues were up 18.9% to $43.4 billion.

‘We’re incredibly proud’

When Humana Inc. (NYSE: HUM) bought out private equity partners TPG Capital and Welsh, Carson, Anderson & Stowe (WCAS) for full ownership of Kindred at Home in April 2021, its leadership team immediately said the plan was to separate the home health and hospice operations.

The hospice divestiture process began in early 2022, with Humana reportedly working with Goldman Sachs and targeting potential PE buyers.

“As our experience has demonstrated, we can deliver desired experiences and outcomes for patients transitioning from restorative care to hospice through partnership models,” Humana CEO Bruce Broussard said in November, speaking about the decision to offload Kindred’s end-of-life care operations.

In light of that plan, many are now wondering if UnitedHealth Group will do the same with LHC Group.

LHC Group’s network includes hundreds of home health, hospice and home- and community-based services locations across 37 states and the District of Columbia. As of March, its hospice arm included 170 locations, with roughly 15% of home health locations co-located with hospice.

Witty declined to comment on divestiture possibilities, citing the fact the LHC Group deal isn’t yet finalized. He did, however, say that he “very much” likes “all of the aspects” that he’s seen of LHC Group.

“We’re incredibly proud of coming to an agreement with the LHC board to bring together the two organizations,” said Witty, noting that he spent time with LHC Group’s leadership team and founders on Monday.

LHC Group was co-founded by Keith and Ginger Myers in 1994.

“An unbelievable, positive culture inside the organization has been built up by Keith and Ginger since they first founded it,” Witty added. “Really a company with a true heart, and [it] really puts patients first and their families first. Extraordinary impact in all of their lines of operations and how they can have a significant impact on the lives of people who very often are excluded from care.”

Optum CEO Dr. Wyatt Decker echoed those sentiments.

“They’ve developed multiple capabilities, which actually really nicely complement our growing home and community platform,” Decker said Thursday. “The quality of care that they provide is remarkable.”

A pipeline of opportunities

LHC Group isn’t the only pending or recently finalized addition for UnitedHealth Group.

Optum and Change Healthcare (Nasdaq: CHNG), a large health care technology firm, are attempting to merge, despite pushback from regulators. Additionally, Optum recently acquired mental health provider Refresh Mental Health last month.

The Refresh acquisition is also reflective of UnitedHealth Group’s value-based care ambitions, as well as its desire to better pair behavioral health management alongside medical management.

With expected full-year cash flows of about $24 billion, UnitedHealth Group has runway for further dealmaking.

“I’d say, overall, our pipeline of opportunities … is probably as diverse as it has ever been – and probably deeper than it’s ever been,” Witty said. “I think from a potential capital-deployment capability, I think we feel pretty optimistic about that.”

The post UnitedHealth Group ‘Moving at Speed’ in Bringing Together Home-Based Care Capabilities appeared first on Home Health Care News.

The Minnetonka, Minnesota-based company showed few signs of a pandemic-driven slowdown and hinted at big home-based care moves on the horizon.

“Our broad home-based clinical care initiatives at Optum and UnitedHealthcare are central to improving near- and longer-term health outcomes for people with medical, behavioral and social needs,” UnitedHealth Group COO Dirk McMahon said during the company’s earnings call.

Overall, UnitedHealth Group’s full-year 2021 revenues were up 11.8% to $287.6 billion on a year-over-year basis, with substantial growth across the Optum and UnitedHealthcare businesses. Revenues climbed to about $73.7 billion during the fourth quarter of last year, a nearly 13% increase compared to the same three-month period in 2020.

Generally, growth in the UnitedHealthcare business was due to strong Medicare Advantage (MA) enrollment. Including Dual Special Needs Plans (D-SNPs), MA membership rose by about 900,000 individuals in 2021, with strong gains in both individual and group offerings.

Optum, meanwhile, was buoyed by a 33% increase in revenue per consumer in 2021 compared to the previous year. Optum Health served 100 million people at year end, compared to 98 million in 2020.

“We focus relentlessly on the quadruple aim, including lowering total cost of care, and providing better outcomes and outstanding patient experiences,” Wyatt Decker, CEO of Optum Health, said on the call. “And we are relentless in monitoring specific data points that help deliver that out – those outcomes.”

Decker and other UnitedHealth Group executives on the call explained how the health care and health insurance giant plans to progressively build out its multi-modality care platform moving forward through a combination of in-home physician and digital offerings.

Optum HouseCalls clinicians, for example, conducted over 1 million in-home visits in 2020. They eclipsed that mark in just the first half of 2021 – with more growth anticipated in 2022 and beyond.

It’s also important to note that Optum acquired in-home medical group Landmark Health last year.

“We say within Optum Health or Optum Care [that] the build out of the home and community platform is one of the more important areas that Wyatt and his team are focused on,” McMahon said. “There has been lots of development there.”

Among strategic benefits, seniors served by UnitedHealth Group’s home and community platform have experienced a 14% lower rate of hospital admissions compared to national averages. They also have a 14% higher rate of physician encounters, according to the company.

“We expect, during 2022 and beyond, to further build on these opportunities to connect and integrate multiple channels of care,” McMahon continued. “Simplify the experience for patients and providers, and deliver quality care that is affordable and in the optimal setting.”

As far as potential headwinds to its home-based care goals, there’s the ongoing pandemic and a worsening labor crisis, though UnitedHealth Group believes it can capably navigate both fronts.

In the third quarter, the company saw approximately 60,000 COVID-19 hospitalizations, “meaningfully above” the second quarter, with the month of August peaking at nearly 30,000.

National health care employment increased slightly in 2021, ending the year up 0.4%, or about 63,000 jobs, compared to December 2020. In particular, there was a clear shift from institutional settings to ambulatory care settings – like the home.

“The U.S. health care market is very tight right now,” Decker said. “For us and our care delivery assets, we are seeing … good retention, engagement and recruitment of physicians and care providers.”

The post UnitedHealth Group Hints at Big Home-Based Care Plans appeared first on Home Health Care News.

UnitedHealth Group (NYSE: UNH) is one of the largest and most pioneering health care organizations in the country. As such, one of its main strategic priorities is bringing more care into the home.

Internally, it’s clear that UnitedHealth Group and its different departments view investments around home-based care as a way to deliver cost-effective, highly impactful care to vulnerable populations. Externally, however, the company also sees “the home” as a key way to differentiate itself from its peers.

“We are helping people navigate care from everywhere — in the comfort and convenience of home, in a provider’s office, online and across every touch point in between,” Dr. Philip Painter, UnitedHealthcare’s CMO for Medicare and retirement, told Home Health Care News. “This flexibility is particularly important for our Medicare members, who may have complex care needs or mobility challenges.”

An internal medicine physician by training, Painter has spent decades caring for patients and working to develop programs for care delivery in the home.

He previously served in a senior-executive role focused on home-based clinical care. In his current role, he focuses on providing strategic and clinical guidance for UnitedHealth Group’s vast Medicare business.

The Minnesota-based UnitedHealth Group is one of the handful of companies that control the majority of Medicare Advantage (MA) market share in the U.S. UnitedHealthcare is the insurance arm of UnitedHealth Group, but the company also operates as a provider through Optum, a population-health focused segment that makes over 1 million in-home visits through its “HouseCalls” program each year.

UnitedHealth Group’s CEO Andrew Witty touted the company’s commitment to caring for patients inside the home during its Q2 earnings call in July.

Specifically, Witty mentioned how home- and community-based services have helped reduce post-acute medical care costs significantly. That includes lowering unnecessary hospital readmissions by 20% and overall hospital admissions by 25%, according to the top executive.

Painter reiterated those points in his conversation with HHCN.

“UnitedHealth Group brings unique capabilities to this space,” Painter said. “For example, the many decades of experience we have serving tens of millions of members at UnitedHealthcare coupled with the advanced clinical, data and analytics capabilities offered by Optum. These are cutting-edge technologies and tools we leverage in-house, allowing us to pivot to meet demand and new circumstances.”

Leading the way

It’s not just about a shift toward the home, Painter said.

More so, it’s a realization that 80% of what impacts a person’s health happens outside of a doctor’s office. Reaching seniors during that 80%, oftentimes at the home, is critical to making a difference, he emphasized.

“Our focus is on leading the way in creating a modern, high-performing health system,” Painter said. “An important part of that roadmap is transforming the way care is delivered. And ultimately, [it’s working] to improve quality, health outcomes and patient experience.”

Among the steps it is currently taking, UnitedHealth Group is aiming to do just that through disease management programs, innovative digital tools and 24/7 on-demand access to registered nurses or in-home care with a licensed provider.

One example includes UnitedHealthcare’s Rx Online Marketplace program, which allows Medicare members to save money on prescriptions and have them delivered to their home.

“This year, most UnitedHealthcare MA plans offer $0 copays for Tier 1 and Tier 2 drugs ordered through the OptumRx home delivery pharmacy,” Painter said. “Home-delivery pharmacy benefits can be a great way to save money and a trip to the pharmacy.”

Another is the aforementioned HouseCalls program that Optum provides. The program works by offering Medicare members yearly visits with a clinician from home, coordination for further care with the patient’s primary care provider, general health screenings and education on chronic conditions management.

While Optum’s HouseCalls clinicians conducted over 1 million in-home visits in 2020, they eclipsed that mark in just the first half of 2021, more than doubling the number reached after the same period last year.

“Besides the usual needs for regular preventive care, HouseCalls visits are especially crucial as some older adults may have put off necessary care during the COVID-19 pandemic,” Painter said. “That person-to-person connection and rapport helps create a friendly environment where getting care can become that much easier and convenient — helping to keep people healthy.”

To that point, data from Epic Health Research Network shows that hospital admissions remained below expected levels through at least April 9 of this year. In the week beginning on April 3, hospital admissions were 85.5% of what would be expected based on historic patterns.

Averaged over the first quarter of 2021, hospital admission rates were 89.4% of what would have been expected in the absence of the pandemic.

UnitedHealthcare has now provided more than 10 million HouseCalls visits since introducing the program in 2012, according to the company.

“The bottom line is more people are looking for ways to access care outside a strictly clinical brick-and-mortar setting,” Painter said.

Health plans leading the charge

The top 10 MA plans in the U.S. control over 75% of the market. But then there are dozens of others outside of those that are trying to make their mark.

Other than UnitedHealthcare, some of the larger ones include Humana Inc. (NYSE: HUM) and CVS (NYSE: CVS).

A commitment to home-based care solutions is not a differentiator between larger MA plans and smaller ones. Both groups are striving to do more work in the home, through their own providers — like UnitedHealth Group and Optum — or through provider partnerships.

Yet a similarity among those that are committed to home-based care solutions is that all of them believe it could be a true differentiator in the marketplace.

“I do think that plans think about these benefits as a way to differentiate themselves in a crowded marketplace,” Tyler Cromer, a principal for the Washington, D.C.-based research and advisory firm ATI Advisory, told HHCN earlier this year. “And providing the right combination of benefits that really meet member needs could result in a competitive advantage in any individual market.”

Some plans are leveraging proprietary technology to do so, while others are using innovative and unique supplemental benefits. Some are doing both.

The supplemental benefits allow these smaller plans especially to be more creative.

Painter helped explain why he believes it’s so important to be honed in on home-based solutions right now.

“First, the convenience of telehealth has always been apparent, yet adoption rates weren’t widespread — until now,” he said. “Many health plans are encouraging the use of virtual visits, including for behavioral health, to help keep people safe in their homes during the pandemic, which has introduced the convenience to a wider audience.”

The prevalence of telehealth has created more touch points for insurers and providers, and helped them reach patients in their homes more often.

In addition, COVID-19 has turned the home into the most desirable place of care for a lot of seniors who traditionally would have been seeking care in brick-and-mortar offices or facility-based settings.

“Similar to how telehealth enables efficient and accessible care, the response to the pandemic has created momentum around the concept of a patient’s home as a site for medical services,” Painter said. “This idea relies heavily on the adoption of technology and advanced digital tools. Some areas where home health is advancing [include] chronic disease management and infusion services.”

Health plans dictate, in many ways, how and why health care is delivered in the U.S.

Their attention being paid to home-based care will — maybe more than any other factor — shift care into the home.

Those plans believe they, and the health care system overall, will benefit from that. And indirectly, so will home-based care providers.

The post ‘We Bring Unique Capabilities to the Space’: What UnitedHealth Group Is Doing in the Home appeared first on Home Health Care News.

Overall, UnitedHealthcare partners with more than 1.3 million physicians and care professionals across the U.S., plus another 6,500 or so hospitals and other care facilities. In 2020, UnitedHealthcare had more MA enrollees than any other group.

“We know the majority of older adults want to stay in their homes and communities as they age, and UnitedHealthcare continues to design plans that place the home at the center of health care support and delivery,” Steve Warner, senior vice president of Medicare Advantage in UnitedHealthcare’s Medicare & Retirement division, told Home Health Care News.

America’s largest health insurers — UnitedHealthcare, Humana Inc. (NYSE: HUM), Aetna, Blue Cross Blue Shield plans and others — have built out their home strategies in a variety of ways.

In some cases, that has meant the launch of internal in-home primary care and remote monitoring programs to better track members’ social determinants of health. In others, it has meant partnering with in-home care providers to offer the types of new supplemental benefits that the U.S. Centers for Medicare & Medicaid Services (CMS) has increasingly signed off on over the past few years.

“The interconnectedness of the health care system means that every touchpoint along a consumer’s health care journey is important,” Warner said. “Particularly for high-risk individuals and others who depend on a variety of needs being addressed from home, the people who provide these services are an integral piece of a shared community of support.”

On its end, UnitedHealthcare says it’s doing more than ever to support health and wellness from the comfort, safety and convenience of the home.

In 2021, most of its plans, for example, will include HouseCalls, a program that offers Medicare and Medicaid members a yearly in-home visit with a licensed clinician. The company expects to complete nearly 1.7 million HouseCalls visits for members in 2020.

HouseCalls has been particularly valuable during the COVID-19 pandemic, too, with the number of home visits in the third quarter growing by nearly 30% year over year, according to UnitedHealth Group CFO John Rex, who addressed the topic during an Oct. 14 earrings call.

“We continue to deepen our engagement with those seniors most in need, increasing the distribution of remote digital sensor kits to collect and monitor vital health data and address gaps in care generated by the pandemic,” Rex said at the time.

‘Health is more than medical care’

Apart from its HouseCalls program, at least six UnitedHealthcare plans are offering in-home support services under the “primarily health-related” supplemental benefit pathway in 2021, according to state-level data compiled by Washington, D.C.-based research and consulting firm ATI Advisory.

In comparison, only two UnitedHealthcare plans offered in-home support services supplemental benefits this year.

Geographically, the two UnitedHealthcare plans offering in-home support services in 2020 covered slightly more than two dozen counties. Next year, the six plans doing so will cover more than 250 counties, according to ATI Advisory’s data.

“They have made a very significant, clear increase in the coverage,” ATI Advisory CEO Anne Tumlinson told HHCN. “I think it speaks a lot to the power of these benefits.”

Overall, 429 MA plans will offer in-home support services across 36 states and Puerto Rico next year. Many more will also likely offer home-focused supplemental benefits through the Special Supplemental Benefits for the Chronically Ill (SSBCI) pathway in 2021.

These trends in supplemental-benefit design are, in part, linked to the realization that a large chunk of a person’s health is ultimately impacted by functional ability and social factors, including access to food, friends and transportation.

“We know that health is more than medical care, and that factors outside a doctor’s office play a significant role in influencing a person’s health and well-being,” Warner said. “This reality factors into how we design our plans and support older adults.”

UnitedHealthcare isn’t just coordinating and covering services that take place within its members’ homes.

At times, it’s even helping to provide the home in the first place.

“At an enterprise level, UnitedHealthcare continues to make significant investments in affordable housing as part of the company’s ongoing efforts to remove social barriers to better health for people in underserved communities,” Warner said.

Since its affordable housing initiative kicked off in 2011, the company has worked with a range of advocates to invest more than $500 million in developments that increase access to housing, health care and social services.

Telehealth is ‘here to stay’

The U.S. tallied 91,530 new COVID-19 infections on Election Day, adding to the skyrocketing cases numbers reported in the past week.

The COVID-19 pandemic is changing the health care landscape, Warner recognized, but it isn’t altering UnitedHealthcare’s commitment to helping members access the care they need. That’s true whether they reside in a clinical setting or at home, he added.

To maintain that commitment, UnitedHealthcare has turned to more telehealth solutions.

“In just one month earlier this year, for example, more than 12% of our UnitedHealthcare Medicare members had a telehealth visit with their doctor – up from just a fraction of a percent last year,” Warner told HHCN.

In 2021, all standard MA plans from UnitedHealthcare will offer telehealth visits with a $0 copay.

“As in-person visits resume, telehealth utilization is moderating, but remains significantly higher than the pre-COVID baseline,” Warner said. “We believe higher utilization and increased comfort level in embracing telehealth is here to stay.”

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It’s a point several home care providers are actively tackling through ride-hailing partnerships, especially as potential hospital and health system referral sources prioritize social determinants of health — often the root cause of seniors’ chronic illnesses. Comfort Keepers, 24 Hour Home Care and Right at Home, for example, are among the many industry pioneers that have carved out relationships with Lyft Inc. (Nasdaq: LYFT) and Uber Technologies Inc. (NYSE: UBER).

“For me, there are two big components [to offering transportation], with one being the medical piece and allowing people to access health care and appointments in a much easier way — typically at a lower cost than a taxi or other means of transportation,” Ward, 24 Hour Home Care’s regional director of strategy and partnerships, previously told Home Health Care News. “The second piece is geared toward socialization, helping clients get to religious functions or meet up with friends.”

A new study backed by a handful of well-known organizations is now highlighting just how impactful ride-hailing partnerships can be for home care providers — and the seniors they serve.

Published Monday in the Journal of mHealth, the study was led by USC Center for Body Computing researchers, with involvement from AARP Foundation, UnitedHealthcare and Lyft.

The study’s main goal: to test whether cost-free, on-demand rides truly reduce social isolation and improve medical access for seniors. 

“Older adults with chronic disease lack access to reliable transportation and turn to time-consuming, costly, or high-burden solutions such as relying on family members or government-subsidized shuttle programs, which are often ineffective and unreliable,” Dr. Leslie Saxon, director of the USC Center for Body Computing and principal investor of the study, told HHCN in an email. “Not only is access to medical centers essential, but it is well known that social isolation and other factors impact overall health.”

In total, about 150 English-speaking adults 60 and older from the Los Angeles area participated in the study, using Lyft to schedule rides through both its mobile app and a special call-in feature.

An AARP grant provided three months’ worth of unlimited rides for participants, who also wore wrist-worn activity trackers to monitor daily activity. Researchers additionally asked participants to complete pre- and post-study surveys to help gauge satisfaction, well-being and other characteristics.

Of the 150 or so older adults who participated in the study, 93% used Lyft, with the vast majority doing so through the mobile app, dispelling popularly held beliefs about seniors’ willingness to adopt certain technologies. 

“Participants are willing to adopt novel technology solutions if the benefit is there. This is especially resonant given the subjects were novice app users, previously only using their smartphones for email and web browsing,” Lyft VP of Health Care Megan Callahan told HHCN in an email. “This demonstrates that older populations are willing and capable of adopting new technologies — and Lyft in particular. This is a key finding as Medicare Advantage (MA) plans and [senior care providers] expand their use of Lyft for older adults.”

About 12% of destinations scheduled through Lyft were for medical appointments, with the remainder for errands, entertainment, fitness classes and social visits.

On average, participants scheduled about 70 rides during the study, with the average ride costing about $20.

Difficulty with transportation is linked to as many as 30% of seniors missing doctor appointments, a big factor in U.S. health care economics.

In fact, absenteeism costs the health care industry as much as $150 billion in lost revenue annually, according to previous research from health care technology firm SCI Solutions.

About 90% of study participants reported heightened quality-of-life thanks to increased access to transportation; about two-thirds reported an increase in social visits.

“Access to transportation can be a key factor for people keeping up with medical appointments and social engagements, both of which can be beneficial to overall health as we age,” Steve Warner, UnitedHealthcare’s Medicare Advantage product lead, told HHCN in an email. “That’s one of the reasons we are proud to support this research and also currently offer no-cost transportation options for health care needs through select Medicare Advantage plans.”

Providing transportation services to seniors — specifically those who are MA beneficiaries — will be a driving force in Lyft’s health care business in 2020 and beyond, Callahan reaffirmed.

Lyft currently has MA partnerships with insurers such as Humana Inc. (NYSE: HUNM), Blue Cross Blue Shield and Cigna.

“In addition to partnering with [senior care] providers across the country, as well as technology solutions for older adults like GogoGrandparent, we’re also focused on working with Medicare Advantage plans, including select Blue Cross Blue Shield plans, and Humana MA plans through LogistiCare,” she said. “We actually plan to partner with the majority of MA plans by 2020.”

While the Journal of mHealth study suggests transportation can be a game-changer for seniors’ health and quality of life, others have somewhat dampened expectations.

A 2018 study from Penn Medicine researchers published in JAMA Internal Medicine found that offering a free Lyft ride to Medicaid patients for an upcoming medical appointment did not reduce the rate of missed appointments.

The post Lyft, UnitedHealthcare See Transportation as a Game Changer for Seniors’ Health appeared first on Home Health Care News.

Those are just a few select findings from the American Health Rankings 2019 Senior Report from the United Health Foundation, a not-for-profit arm of insurance giant UnitedHealthcare.

The data comes from more than a dozen sources, including the Centers for Disease Control and Prevention, the Administration on Aging’s State Program Reports and the Dartmouth Atlas of Health Care, in addition to other sources.

Among the findings: The number of home health aides nationwide has increased 44% since 2013 — up from 93.8 workers per 1,000 seniors 75 and older to 135.5 per 1,000.

Access to home health aides is one of 34 different factors that contributes to making a state healthier for seniors, according to the report.

“We see a significant difference in the states that have the highest number of home health care workers — Minnesota [with] about 264 home health aides per every 1,000 adults age 75 and older — and states that had the least,” Rhonda Randall, executive vice president and chief medical officer of UnitedHealthcare National Markets, told Home Health Care News.

UnitedHealthcare National Markets is an arm of UnitedHealthcare that partners with employers that covers health benefits for active employees and retirees.

Florida — the state with the fewest home health workers per capita — has 32 home health workers for every 1,000 adults age 75 and older.

Hawaii is the healthiest states for seniors, according to the report, followed by Utah, Connecticut, Minnesota and Colorado, respectively. The least healthy states for seniors are West Virginia, Oklahoma, Louisiana, Kentucky and Mississippi.

While home health plays a role in earning states a high overall senior heath ranking, Randall says top states usually perform well in many measures — some of which also include social factors and access to gerontologists.

Behavioral health of seniors declining

Despite the growing availability of care, behavioral and social factors pose a growing challenge for seniors today.

“We’re seeing there is an increase in the rates of depression, challenges with mental health and the suicide rate among seniors has been rising over the last few years,” Randall said.

Today, 16% of seniors 65 and up struggle with depression, according to the report, up 19% from 2018. Additionally, excessive drinking among that population has increased to 7.4%, up 12% from 2016.

Meanwhile, the number of seniors who chose not to go to the doctor because it’s too expensive is also increasing. In the past year, 5.2% of seniors reported forgoing doctor visits for financial reasons.

Randall is hopeful that recently expanded Medicare Advantage benefits can help address at least some of these problems.

The Centers for Medicare & Medicaid (CMS) recently announced that MA plans may begin covering benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions starting in 2020. That could include different services to address mental health and other social determinants.

“We’re really happy about that policy change and allowing Medicare Advantage plans more opportunity to innovate,” Randall said.

However, there’s no quick fix to improve seniors’ behavioral and social health, she said. In addition to awareness and access, markets need professionals who are qualified to support and care for those individuals.

“The next area is policy. Are there any policies that are prohibitive or that need to change in order to attract more professionals?” she said. “So when we’re looking at what’s the solution, it’s often not a single solution. It’s a comprehensive call to action.”

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