“The significance of these investments from two impressive entities further validates WellBe’s commitment to be a payor-agnostic, in-home, full-risk medical group,” WellBe Senior Medical CEO Dr. Jeffrey Kang said in a press release.

Excellus BCBS’ investment follows a partnership announcement in March of this year. As part of that partnership, Rochester-based WellBe will provide care directly to the homes of 30,000 of Excellus BCBS’ most vulnerable Medicare Advantage members in upstate New York. Members who are eligible for this program have high utilization rates, behavioral health needs, risk for readmission and ED visits, a slew of prescriptions and sometimes a combination of the four.

“Our collaborations with WellBe support the health plan’s goals around improving health outcomes and addressing the affordability of health care,” Excellus BCBS President and CEO Jim Reed said in a statement.

WellBe Senior Medical and its affiliated medical groups offer home-based care to patients with complex health challenges, including over 100,000 Medicare Advantage patients in ten states.

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“We’re like the advocate and navigator … when you’re building a home, you’ve got plumbers, you’ve got electricians, you’ve got masons. You’re not an expert, so you hire a general contractor to figure all that out. We can fill that role for the consumer,” WellBe Senior Medical CEO Jeff Kang explained during the latest episode of HHCN+ TALKS.

Kang is the former CMO of the Centers for Medicare & Medicaid Services (CMS). Since his time with the agency, he’s worked with payers and providers. Now, he’s bridging the gap between the two with WellBe.

The Chicago-based WellBe offers home-based medical care services to patients who are facing multiple complex health challenges. It is backed by the private equity firm Chicago Pacific Founders.

Kang sat down with HHCN to talk about the current state of home-based care, what providers can do to enhance their value proposition and much more. Highlights from the conversation are included below. View the episode here.

HHCN: I would love to talk about your background, because I think it’s a pretty unique one. Could you take us back to your days at CMS, and even before that?

Kang: 40 years ago I was a geriatrician up in Boston, and actually did home visits before anyone ever knew what a home visit was. For about 10 years, I was running a group practice, doing that, caring for people in nursing homes, in the home etc.

Then, as you said, I went to CMS. I was the first and longest-serving chief medical officer at CMS. I actually was responsible for the conditions of participation, so we regulated the home health agencies.

From there I went to Cigna for about nine years, so I certainly understand the health insurance side. I was their chief medical officer.

Then I went to Walgreens, where I ran all their clinics. They had about 800 clinics around the country. I learned about consumer health and consumerism from a retailer.

Then I went to ChenMed, a private medical group that takes care of the elderly patients and they deliberately locate their clinics in low income areas. Now, I’m CEO of WellBe Senior Medical, which we’ll get into. I’ve seen health care from the retailer’s perspective. I’ve seen it from a health insurance perspective. I’ve seen it from a federal perspective. I’ve seen it from the provider perspective, certainly in the home.

How do you think home-based care, in general, has changed since your time at CMS? Obviously, COVID accelerated things, but where have things changed and where have things stayed the same?

I was at CMS from 1995 to 2002. Let’s go by segment or sector.

Home health agencies existed then, and it was covered by Medicare. I think the big difference between then and now was the implementation of OASIS, we actually did the rules for that. It basically changed home health from a fee-for-service per-diem model into a bundled or capitated model, similar to a hospital DRG episode. I think that was a big change for home health agencies.

When I look at home care, or personal care, that largely hasn’t changed. The issue there has been, who’s going to pay for it? The big difference, probably, in the last maybe 10 to 15 years is that Medicaid, state agencies, have actually started paying for it, as part of an effort to keep people out of nursing homes and in the home. You can get personal care assistance in many states, not all states. The goal there is to provide those personal care services to keep people out of nursing homes.

Durable medical equipment in the home is largely unchanged. Home infusion has changed a fair amount because there are more drugs that can be delivered at home. Otherwise, from a reimbursement perspective, it hasn’t really changed that much.

Hospice in the home has not particularly changed that much. There have been some variations around cost qualifications, how to get into hospice and how long you’ve been in hospital, but in general, not much. That’s from a traditional Medicare perspective.

There has been an increasing amount of efforts by Medicare Advantage plans to step up and provide what they’re calling transitions of care programs, or post-acute care programs. Basically, following the hospitalization if someone doesn’t qualify for skilled home health, but they still need some transitions of care support. The last big change, which is fairly recent – let’s call it the WellBe Senior Medical model – is primary care or longitudinal care in the home. It’s difficult to do in Medicare fee-for-service. It can be done, but I think that’s largely accelerated by Medicare Advantage plans.

A long time ago, home-based primary care was the norm. Then for a while it went away because it was more viable if 15 or 20 patients came into one place, as opposed to you going to all of the patients. What made that viable again, as a business model?

If you look at Medicare fee-for-service reimbursement, in order to economically make home-based primary care work, back then, you would have to do maybe 12 visits a day. This is a little difficult with the drive times and everything.

Under current Medicare rules, you might be able to get around eight to 10 visits a day because now Medicare’s starting to pay for care coordination visits and post-hospitalization visits. The big difference for WellBe is that we are only doing four to five patient visits a day. That’s because the patients who are really sick, they really need it.

The big difference is the introduction of a value-based model. We are not actually dependent on fee-for-service billing. We are, essentially, both the provider and the payer. We’re economically responsible for the hospital bills, the radiology bills, the specialist bills. That’s a value-based model or a full risk model. We can make it work because we’re prepared to spend the time with the patient and keep them healthy and out of the hospital. We make money by keeping people healthy and out of the hospital. It’s completely flipped. In the fee-for-service world, you make money by just seeing as many patients as you can a day, but that’s not necessarily good for the patient.

When you’re in a value-based care model, you’re not worried about increasing utilization too much, because you’re doing it for the patient. You’re not worried about overutilization or underutilization.

It’s interesting, people do get a little more worried about underutilization. A lot of health policy experts will estimate anywhere from 40% to 60% of the care that’s occurring in this country is either unnecessary, avoidable or due to error. We’re really not at risk of doing too little care. From our perspective, the goal is to provide as much primary care as possible for the avoidance of multiple emergency room visits, multiple hospitalizations.

Last time we spoke, you wanted WellBe to be the general contractor of home-based care. Can you explain what you meant by that?

From a consumer’s perspective, there’s skilled home health, there’s home care, DME, home infusion, hospice, Meals on Wheels. It’s a plethora of things. The challenge, from a customer’s perspective, is how to orchestrate and organize. Many of these things actually need a doctor’s order. For personal care, you need a functional assessment from a physician to qualify.

In many ways, groups like WellBe are essentially that physician, nurse practitioner, quarterback. I use the word general contractor. We’re like the advocate and navigator, out of all of those things that can be done in the home. When you’re building a home, you’ve got plumbers, you’ve got electricians, you’ve got masons. You’re not an expert, so you hire a general contractor to figure all that out. We can fill that role for the consumer.

Joining with primary care providers, whether it be regular primary care or home-based primary care, seems like an option for home health providers to start dipping their toes into risk.

I think that’s correct, but I will just say it’s going to take a while.

In Ohio, for example, we have 30,000 members or so. From a home health agency’s perspective, that’s just a really small drop in the bucket of the available lives, or members, that they’re trying to serve. I don’t think, right now, we’re large enough to have a really exclusive arrangement and make it worthwhile for a home health agency.

I think there is an opportunity for home health agencies to get in this value-based world. There’s this concept in value-based care of an episode. When you think about it under the Oasis, payment, that’s an episode of care, post-hospitalization. One of the potential outcomes of that episode of care is if you do a really good job, you can actually lower hospital readmission rates. I do think there are opportunities for home health agencies to basically say, if we can lower your hospital readmission rates, let’s actually gain share in some of those savings. I think there are home health agencies that are beginning to move in that direction.

What do providers get wrong sometimes about the way payers think?

I’m not sure they get it wrong. I think it’s a little more of trying to figure out how to best kind of talk in their language. It’s trying to figure out the outcome that the payers really care about. From a home health agency perspective, they care about readmission rates and lowering that, so that’s an opportunity.

From a personal care standpoint, there’s been a lot of progress here because the payer there for a lot of this is Medicaid. They care about keeping people out of a nursing home. If you’re going to work with the Medicaid payer, you’d say your nursing home rate admission rate is Y. We start serving the patients and can reduce that by 10%. Is there an opportunity then for [the home care provider] to share in some of those savings?

It’s more about figuring out what the payers really care about and then helping them solve that problem.

Do you have a prediction for the next five years for the home-based care space at large?

Lots of new entrants coming in, which is good. I think everyone deserves a WellBe-like model whether we’re delivering it or someone else is delivering it. I think there are many of our fellow companies that are also going into Medicare fee-for-service, but they’re doing it through the ACO REACH program. That makes a ton of sense. We’ve decided not to do that, but at some point we may come around to that. I do think applying this model to adult Medicaid, in particular the long term-care population, makes a ton of sense.

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The company did not disclose the investment amount.

The funds will further fuel WellBe’s national expansion. Currently, the company operates in seven states across the U.S. Most recently, it set up shop in Oregon.

“The additional investment allows us to continue to grow — that’s really the bottom line,” Dr. Jeffrey Kang, founder and CEO of WellBe Senior Medical, told Home Health Care News. “Otherwise, we have all of the services and all the infrastructure and technologies in place to be successful.”

The Chicago-based WellBe offers home-based medical care services to patients who are facing multiple complex health challenges. WellBe is also backed by the private equity firm Chicago Pacific Founders.

The company serves the Medicare Advantage (MA) population, and has more than 107,000 MA members to date.

CVS Health’s investment in WellBe is a move to increase access to care for seniors, it believes.

“CVS Health Ventures is committed to helping provide seamless access to quality health care, especially for vulnerable populations like seniors,” Vijay Patel, managing partner of CVS Health Ventures, said in a press statement. “WellBe’s innovative approach to in-home medical care aligns with our vision of redefining the way health care is delivered in a multi-payer, patient-centric manner. Our collaboration with WellBe will support their mission to empower seniors to live healthier, happier lives in their homes.”

WellBe has an aggressive growth strategy in place that will allow the company’s care services to be available to more seniors. By the end of 2024, the company aims to have a presence in 12 markets.

Additionally, the company still sees more MA opportunities, and will continue on this path while also considering entering the Medicaid arena.

“Medicaid is right for this,” Kang said. “Just think about any health insurance that has really sick people who have a hard time accessing physicians. That’s what this model works really well for. As we sit today, about 20% of our members are actually dual-eligible already.”

WellBe is CVS Health’s latest home-based care interest. The latter has become a significant presence in the home-based care space in recent years.

Last year, CVS Health completed its $8 billion purchase of Signify Health, a value-based platform that offers at-home health risk assessments, among other services.

Plus, CVS Health also closed on its $10.6 billion deal to acquire primary care provider Oak Street Health last year.

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“We’re working on additional expansions, likely to come in 2024, that will bring us into Washington, and a couple other states out in the Pacific Northwest,” Mike Stuart, chief growth officer at WellBe, told Home Health Care News. “We’re excited to get started in Oregon.”

The Chicago-based WellBe offers home-based medical care services, including integrated mobile urgent care, in seven states: Georgia, Illinois, Ohio, Utah, West Virginia and Pennsylvania. The company serves just north of 106,000 patients.

Its latest expansion will allow the company to serve rural communities across Oregon.

“The mission of WellBe is to serve members that are truly homebound, frail, polychronic and elderly,” Stuart said. “These are people who, frankly, just need these services the most and benefit from care being brought to them. It’s a natural progression to bring care to rural communities. In many rural areas, you’re seeing hospital closures. There’s a lack of providers in those regions, and patients have to travel pretty significant distances to get care.”

This leads to patients delaying much needed care. It also means that patients aren’t receiving preventative care, according to Stuart.

“There’s a missed opportunity for preventative care, because a lot of patients that live in those communities tend to wait until they get to the point where they need to go seek out medical services,” he said. “By that point conditions have worsened. Things that could have been caught earlier have progressed a little bit further. This is an opportunity to bring early disease detection and proactive care directly to members.”

Though care disparities in rural communities have been receiving more of a spotlight recently, Stuart points out that there are very real challenges providers need to address in order to successfully deliver care in these regions.

“The logistics on it are very complex. In terms of delivering home-based care, figuring out how to adequately staff, particularly in areas of the country that have staffing shortages,” he said.

Stuart noted that broadband issues and transportation are other logistical challenges that providers have to overcome in rural communities.

At WellBe, being payer agnostic — working with multiple payer sources and health plans — has allowed the company to create better density for its care teams by strategically deploying them.

“We’re able to support greater numbers of members, which makes our teams more efficient,” Stuart said. “Additionally, we’re solving those challenges like lack of internet access by being able to meet patients directly in the home. Because we’re able to go directly to the home, we actually get a better understanding of what’s going on with the members within their own home environment. A lot of times patients present themselves at the clinic in one way, but the realities of the home are very different.”

Ultimately, Stuart sees this as an opportunity for WellBe to expand its reach.

“Just like we’ve expanded nearly statewide in other states, our goal is to continue to grow in Oregon to cover more and more of the counties there,” he said. “In terms of the future, this is an opportunity to plant a flag in the Pacific Northwest and to grow into adjacent states and additional markets. We’re trying to bring comprehensive care to as many frail elderly seniors as possible across the country.”

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The Chicago-based WellBe offers home-based medical care services, including integrated mobile urgent care, in six states: Georgia, Illinois, Ohio, Utah, West Virginia and Pennsylvania.

The organization partners directly with health plans, health systems, and provider groups to work with their patients — typically the top 10% of seniors that have complex conditions.

“90 to 95% of what can be done in a clinic setting, we can actually deliver in the home,” Mike Stuart, chief growth officer at WellBe, told Home Health Care News. “Oftentimes, these are frail, homebound patients that struggle to complete appointments in a clinic setting, so we’re able to bring this care model to their home.”

WellBe’s leaders consider crossing that 75,000- patient threshold to be a significant accomplishment.

WellBe launched in its first two markets — Georgia and Illinois — in 2020. Back then, the company had roughly 5,000 patients under its care. Since then, it’s been a rapid progression, according to Stuart.

“We were able to really demonstrate what can happen when you bring this type of comprehensive model into the home,” he said. “Health plans are looking for ways to differentiate and improve medical cost and quality across the health care spectrum. Within Medicare Advantage lies the top 10% of seniors with complex conditions, and many of these patients face challenges that go beyond the chronic conditions.”

Currently, WellBe works with a mix of regional plans, multi-state plans and large national plans.

“We’re grateful for the partnerships that we have,” Stuart said. “These are really some of the most innovative health plans in the country today. We look forward to the opportunity to further our partnerships with them and to bring this model to more of their members. At the same time, we want to increase density with this model because we’re payer agnostic.”

One of its most notable partnerships is its collaboration with Aetna.

In addition to metric success, WellBe is focused on expanding the company’s care delivery model across the country.

“This is an innovative model that really is designed to provide this comprehensive care nationwide,” he said. “This gives us the opportunity to work with an increasing number of innovative health plans and providers in those markets to care for additional patients. This significant growth we’ve seen is really a testament to the market demands, and then also just the unique aspects of our model.”

Stuart noted that WellBe is caring for its over 75,000 patients under full global risk.

“When you think about that journey into value-based care — this is the far end spectrum of that, where we take full responsibility, not only clinically for these patients, but also financially in partnership with the health plans we work with,” he said.

Being a company that takes on full global risk allows WellBe to provide guaranteed earnings improvement back to the health plan for the entire attributed population, which is a big advantage for those organizations.

Looking ahead, WellBe has plans to enter another state. The company will begin operating in Oregon next month.

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Since then, he has held leadership roles at Cigna (NYSE: CI), Walgreens Boots Alliance (Nasdaq: WBA) and ChenMed, a primary care practice for seniors.

At WellBe, he’s still helping deliver primary care to seniors, but specifically in the home. And, using his past experiences as a guiding light, he wants WellBe to be a “general contractor” of all home-based care for its patients.

“We’re the prescriber, but also the navigator, the advocate – the people that pull it all together,” Kang told Home Health Care News.

In health care – but also in home-based care, specifically – the ability to pull everything together is becoming an area of great importance.

Moving care to the home is a goal for many health plans, providers and health systems in this day and age. But the ability to actually navigate that care, and make sure the patient is receiving appropriate services in the home, is essential if those stakeholders want to deliver on the cost saving and quality outcomes that they believe home-based care can enable.

“I think that interest has always been there,” Kang said, referring to home-based primary care specifically. “I think the key really is that most groups wanted to do it on a fee-for-service basis. The challenge there is they get worried that utilization will go up. The difference is, we’re prepared to do this on a full-risk basis with guaranteed earnings improvement upfront.”

The Chicago-based WellBe offers at-home primary care services in six states: Georgia, Illinois, Ohio, Utah, West Virginia and Pennsylvania.

“I don’t think it’s plan interest that’s changed,” Kang continued. “I think it’s providers that are willing to do this on a full-risk basis, rather than a fee-for-service basis.”

Home-based primary care is an old idea with new legs, especially after the public health emergency kept people – especially seniors – from visiting brick-and-mortar facilities for health care.

Both home health care and personal care are also more popular than they have been in modern history. There’s also emerging models like hospital at home and SNF at home that allow higher-acuity patients to receive care in their most preferred and comfortable setting.

All of those things are great, in a vacuum. But Kang believes there needs to be a WellBe to make sure all of those types of care are leveraged properly and available to patients.

“The point is, everyone just wants to do their little piece,” Kang said. “But no one is really asking the patient to help them do it. There’s that general contractor function that is totally missed … and we have the power of the pen, we can write the order.”

WellBe’s model was created to care for patients throughout their care journeys, whether it be for chronic care, acute care, palliative care, post-acute care or end-of-life care.

In certain markets, such as Chicago and Atlanta, the company partners with Aetna to deliver at-home primary care services to thousands of patients.

Kang believes WellBe’s model is especially valuable to plans because they have a hard time bringing all of these services together for their members.

Take Medicare Advantage (MA) supplemental benefits, for example. Those benefits are there for seniors to gain access to a larger suite of services, but many go unutilized. When they are utilized, the plans have a hard time keeping track of them.

“The health plans are running around adding all of these supplemental benefits,” Kang said. “It looks great on paper, but getting timely access to those and pulling all those together together is next to impossible.”

In terms of contracting with home health and hospice providers, WellBe generally uses the health plan’s networks of both.

But, within those networks, the company finds its preferred providers.

There are downsides and upsides to a full-risk model, of course. But when it comes to leveraging home health care, for instance, the equation is simple. If a patient could benefit from home health care, WellBe will order those services.

“If we believe that getting a skilled nurse in there – even pre-hospitalization – is going to improve outcomes and lower costs, we are able to go ahead and make that order and then pay for it ourselves, all because we’re at full risk,” Kang said.

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LHC Group Inc. (Nasdaq: LHCG) as well as partners Texas Health Resources and Methodist Health System are expanding their joint venture in Texas.

The three health care organizations announced on Thursday that they’re purchasing and sharing ownership of Regent Home Health, a provider that currently serves patients and families in Fort Worth, Texas. Upon closing, the agency will rebrand under the “DFW Home Health” name and relocate to McKinney.

Financial terms of the deal were not disclosed.

“We are thrilled by this latest opportunity to join our partners at Texas Health Resources and Methodist Health System in expanding home health services for Dallas-Fort Worth and the Metroplex region,” LHC Group Chairman and CEO Keith Myers said in a statement. “Together, we continue fulfilling our mission to grow and reach as many people as possible with the kind of high-quality care that is increasing in both demand and importance to our overall health care system.”

The Regent deal is expected to close on June 1. At that time, the rebranded Regent will join LHC Group’s existing JV operations in the Dallas-Fort Worth area.

DFW Home Health is a separate legal entity jointly owned by LHC Group, Texas Health Resources and North Texas Health Facilities Management Inc., a subsidiary of Methodist Health System. The provider has been in operation since 2012 and currently operates four agencies in its market.

The forthcoming expansion is just the latest example of LHC Group’s JV strategy. The Lafayette, Louisiana-based home health, hospice and personal care services provider is the main JV partner for nearly 400 U.S. hospitals and health systems.

Anthem finalizes myNEXUS purchase

The Indianapolis-based health insurer Anthem Inc. (NYSE: ANTM) has finalized its acquisition of myNEXUS, a comprehensive home-based nursing management company for payers. The transaction was initially announced toward the end of March.

Anthem and its affiliates serve more than 116 million people nationwide. Meanwhile, myNEXUS delivers integrated clinical support services for approximately 1.7 million Medicare Advantage members across 20 states.

Following the closing, myNEXUS will operate as a wholly-owned subsidiary of Anthem and join the company’s Diversified Business Group. Financial terms of the transaction were not disclosed.

“We are excited to combine myNEXUS’ power of digital and advanced analytics to expertly manage and coordinate home-based health care with the offerings that the Diversified Business Group brings, including a deeper set of clinical pathways and member navigation, as well as social drivers of health and behavioral health, to create truly integrated solutions,” Dr. Prakash Patel, president of Anthem’s Diversified Business Group, said in a press release. “The addition of myNEXUS fits with Anthem’s strategy to deliver whole-person care and offer a seamless end-to-end experience that will help improve outcomes, reduce readmissions and improve members’ and their family’s experience of well-being.”

myNEXUS was previously owned by WindRose Health Investor, a New York-based health care private equity firm.

“We are thrilled to have had the opportunity to partner with myNEXUS and its management team,” Oliver Moses, managing partner of WindRose, said in a statement. “The incredible growth myNEXUS achieved over the course of our investment is a testament to the company’s ability to deliver improved clinical outcomes for home-bound patients, enable high-quality providers and improve the cost of care for its payer customers.”

Amedisys, Sound Physicians team up

Amedisys Inc. (Nasdaq: AMED) and Sound Physicians are teaming up to launch a new home health pilot in the Southeastern U.S.

Sounds Physicians is a physician-led partner to hospitals, health plans, post-acute care providers and others. The Baton Rouge, Louisiana-based Amedisys and Sound Physicians are working together to launch the “Home Health Advanced Program,” anticipated to begin sometime in May.

Under the new program, Amedisys and Sound Physicians will care for Medicare fee-for-service patients who meet certain diagnoses criteria and acuity levels. The pilot will meld Amedisys’ personal care capabilities with telemedicine services through Sound Physicians, while also adding a layer of enhanced care coordination during the first two-to-three weeks of a home health episode.

“This long-anticipated innovation will further prove the value of care in the home for higher-acuity patients and caregivers,” Amedisys Chairman and CEO Paul Kusserow said in a statement. “The combination of the highest-quality home health care in the industry and coordinated personal care support to help patients and caregivers with activities of daily living is the key to future innovations like these and has enormous implications for the future of health care.”

Patients who receive services through the Home Health Advanced Program will experience no additional costs.

Medical Mutual, WellBe eye new markets

Medical Mutual and WellBe Senior Medical are launching a new home-based medical care program in both Cleveland and Columbus. The launch will bring WellBe’s in-home care services to thousands of additional patients in Ohio.

WellBe Senior Medical is a physician-led medical group that provides specialized care in the home setting to individuals with multiple chronic conditions. Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio.

“Being able to provide a way for Medical Mutual members to access in-home care is an important step to help vulnerable patients facing serious illness take control of their health,” Dr. Jeff Kang, CEO and founder of WellBe Senior Medical, said in a press release. “WellBe’s team-based approach to in-home medical care brings geriatric care to the patient, rather than the patient going to where care is delivered.”

Eden Health takes over hospital’s home health services

Eden Health — the home services division of the Vancouver, Washington-based EmpRes Healthcare Management LLC — has reportedly acquired the Whidbey Island Hospital District’s home health program.

According to local news outlet the Whidbey News-Times, the transaction is a way for Whidbey Island Hospital District — also known as “WhidbeyHealth” — to cut costs. Eden Health plans to admit the hospital’s current patients and hire hospital employees who work in the home health department.

Unique for a home health provider, Eden is an employee-owned business.

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Aetna and WellBe had already launched a partnership in July in Atlanta, where they are serving about 5,000 patients in the home.

Chicago-based WellBe Senior Medical has a vision of bringing the culture of “house calls” back onto the forefront of care. Broadly, its latest in-home primary care initiative is something that benefits all three parties: WellBe, Aetna and the patient, according to company leaders.

“Our goal is to help people age in their homes with dignity and respect. … Our model goes all the way from prevention to end of life,” Jeff Kang, the CEO of WellBe Senior Medical, told Home Health Care News. “In many ways, it’s a return to what I think is the essence of medicine.”

WellBe’s model is built to care for patients throughout their aging journey — whether that be through chronic disease care, acute care, palliative care or end-of-life care.

WellBe’s in-home care model can do about 90% of what a doctor can do at a traditional office in the home, Kang said. 

An interdisciplinary team approach dictates the workflow of the licensed clinicians on WellBe Senior Medical’s staff. It is formed by physicians, nurse practitioners, social workers, paramedics and other health care professionals.

On its end, Aetna is a managed health care company that sells traditional and consumer directed health care insurance. It includes medical, pharmaceutical, dental, behavioral health, disability and long-term care plans, and it works primarily through employer-paid insurance, benefit programs and Medicare.

It has been a subsidiary of CVS Health since late 2018, another company that has shown it’s on board with moving care to the home.

In order to ease the burden of COVID-19 on hospitals, for example, CVS Health’s Coram enhanced its capabilities to treat more infusion patients in home-based settings during the early months of the outbreak in the U.S.

“Aetna is proud to collaborate with WellBe Senior Medical to deliver care to patients in the most convenient way possible,” Gregg Kimmer, Aetna’s chief Medicare officer for the Great Lakes market, said in a press release. “By seeing patients in the comfort of their own home, we can improve their health care experience.”

The house call concept seems simple and efficient enough, but it’s the efficiency that has actually plagued the model for years, at least under the traditional Medicare fee-for-service framework. 

Where a house call company can see four to eight patients per day, office-based doctors can see over 20 because patients are coming to them. Even if in-home primary care has always been a better option for certain populations, it didn’t fit within a quantity-driven reimbursement model. 

That’s why Aetna’s Medicare Advantage capabilities makes the partnership work, Kang said.

“Aetna is a Medicare Advantage plan. And in this model, if we can help them improve the outcomes and lower costs, we have a reimbursement mechanism where they’ll pay us to do that,” Kang said. “We actually make more money if we keep people healthy and out of the hospital, so it’s completely flipped from fee-for-service.”

In a fee-for-service arrangement, the lower volume of visits would hinder WellBe Senior Medical’s ability to stay afloat financially. The partnership with Aetna, however, incentivizes better care.

It’s also an especially useful partnership during COVID-19, when the most at-risk patients on a health plan need care most, but are also unable to get to — or are refusing — primary care more than ever.

“There has been a lot of interest in the health plan community around models like these,” Kang said. “I would say Aetna had the foresight to do something about it earlier rather than [later] — other plans are kind of a little slower to get there. … Interest in these models has been dramatically accelerated now because of COVID-19.”

WellBe will also work with home care and home health providers for physical therapy and skilled nursing needs. It also teams up with them for help with activities of daily living (ADLs).

“Right now, those home health agencies are calling the doctor in the office for orders,” Kang said. “Now, there is really a doctor in the home that they can work with to get orders done. And I think it’s an opportunity for better coordination and integration with a home-based medical group, rather than an office.

VillageMD, which just received a $1 billion investment from Walgreens Boots Alliance (Nasdaq: WBA), is another primary care provider moving further into the home that recently made headlines.

The primary care provider will be heavily relying on home care and home health providers as they do so, VillageMD CMO and co-founder Dr. Clive Fields recently told HHCN.

WellBe Senior Medical is hoping to continue to grow itself. It just signed on with another Medicare Advantage plan out of Chicago — MoreCare — which is based out of Cook County, Illinois.

Although Kang couldn’t unveil specifics yet, WellBe is on its way to a few more partnerships in Chicago and elsewhere, too.

“The system is set up with the convenience of the doctor,” Kang said. “It needs to be set up for what’s right for the patient.”

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