Blue Shield of California Targets Patients with Complex Needs in House Call Program

Blue Shield of California has teamed up with Landmark Health to offer more house calls to members with chronic conditions—at no additional cost.

The insurer has enrolled 3,500 people in the program over the last year and has provided 15,000 in-home visits in that opening window, Blue Shield announced Wednesday. The key, the team told FierceHealthcare, is making sure both members and physicians understand that this is not meant to replace primary care providers (PCPs).

Instead, Landmark’s providers work alongside a patient’s existing PCP to provide care, particularly in the case of an urgent emergency to avoid a pricey, unneeded hospital admission.

“We see this as a real strategy—comprehensive, coordinated care for a physically vulnerable population,” said Malaika Stoll, M.D., senior medical director at Blue Shield of California.

The majority (92%) of the participants are in one of the insurers’ Medicare or Medicaid plans, and the average age is 72. Many have multiple chronic illnesses to manage; for example, 99% of the population has hypertension, 76% has chronic kidney disease and 69% has diabetes.

Members are identified using an internal algorithm, based on claims data, and then invited to the program through both calls and letters, according to Blue Shield. Primary care doctors are also notified of eligibility.

Michael Le, M.D., co-founder and chief medical officer at Landmark, said that the provider teams go out and meet with PCPs to get them on board—their support and endorsement is crucial to enrolling additional people into its interventions.

Instead of overtaking primary care’s role in these patients’ lives, Le said Landmark’s home health teams can offer extremely valuable information

“We view ourselves as a specialist,” Le said.

The home health interventions also target behavioral health needs that are common in this population as well, so it offers a holistic approach.

For example, a 92-year-old Los Angeles man who was enrolled in the program was a previous stroke victim and had heart and vision issues. In addition, he was suffering from depression and anxiety and refused to go to doctors’ appointments because they were stressful.

The Landmark caregivers identified that he was dehydrated and prescribed daily water intake. They also reevaluated his medications. Addressing the dehydration improved the man’s insomnia and malnourishment and made it easier for him to see PCPs and specialists to manage his conditions.

Stoll said a crucial target for the program is postoperative care, which can be a fragile time for seniors especially. Having home health providers checking on patients regularly can mitigate concerns during the recovery process.

Blue Shield ensured that the program was included in the existing coverage because cost is often the central barrier to people with complex needs, Stoll said.

“We get in our way a lot of time around access to care with copays and things like that,” she said, “but in here it’s no cost to the members. We’re really trying to encourage members with chronic conditions to get the care they need at no cost.”


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