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Equitable, accessible care: extending the reach of primary docs into homes and communities

By Marc Rothman, MD on 4/11/22 3:44 PM

To fulfill its vision to achieve the highest level of health and well-being and to eliminate disparities in health care quality and access for all they serve, the Centers for Medicare & Medicaid Services’ (CMS) supports a range of initiatives designed to provide equitable, cost-effective, and person-centered care. This vision is ambitious, but achievable if all within the extended care team – and the organizations that support them – collectively embrace initiatives that meet the medical and nonmedical needs of beneficiaries in cost-effective ways. 

The in-home evaluations (IHEs) offered by Medicare Advantage plans are one such initiative. A new white paper prepared in partnership with Signify Health, Manatt Health demonstrates how IHEs deliver value consistent with CMS’ strategic goals for the Medicare program. The paper offers recommendations for how CMS could extend that value to beneficiaries across the Medicare program beyond those enrolled in MA plans. 

The Manatt paper identifies four areas in which IHEs can impact health outcomes:

  • Health equity. IHEs reach some of the most vulnerable Medicare populations—those who are cut off from needed services due to social determinants of health (SDOH) and/or other barriers—to identify unmet needs, and help connect patients to primary care and other needed services. 
  • Person-centered care. IHEs identify social, economic, and environmental factors with the potential to impact health outcomes, not just medical ones, to facilitate the development of individualized care planning, patient engagement, and care coordination strategies.
  • Access to care. IHEs are a cost-effective way to identify and potentially address care needs that may otherwise remain untreated when enrollees face challenges accessing care. 
  • Cost-effective care. IHEs frequently uncover care needs that can be addressed in lower cost, community based settings, thereby avoiding emergency room and inpatient care. 

This view is wholly consistent with our experience at Signify Health and the 1.9 million IHEs we conducted last year. Bringing health care services to people – particularly in the security of their own home – has unique advantages for Medicare beneficiaries and extends the reach of the primary care physician. If a doctor can proactively send a physician’s assistant or nurse practitioner to the home of an aging patient to check on their health status, monitor their medication adherence, or be alerted to a social or environment situation that is of concern to their health, it would result in more equitable and patient centered care and the avoidance of emergency interventions. 

This view is echoed by the physicians such as Dr. Puneeta Sharma who shared their perspectives in the white paper: 

“In reality, a majority of our patients’ care is conducted outside the walls of the practice and the hospital. During an in-office evaluation, there is minimal insight into a patient’s life. We know so little about what is motivating their behaviors and impacting their choices. To design a comprehensive benefit that meets the needs of our patients and their caregivers, we have to look beyond the four walls of the hospital.”  Dr. Puneeta Sharma, MD, MHCM, CPE, Chair of Medical Subspecialties, Medical Director of Palliative Care, Valley Medical Group, Ridgewood, New Jersey

Despite the important benefits that IHEs offer, there is currently no provision for this broad scope of in-home primary and preventive service in traditional Medicare. Signify Health agrees with the recommendations offered in the white paper outlining how IHEs could be covered as a benefit in the original Medicare program or in certain advanced alternative payment models.

Providing person-centered care requires a clear view into the daily lives of patients, and there is no better place to do that than the home. By considering the clinical, behavioral, and social aspects of a person’s life, IHEs offer care teams another lens through which they can view the needs of the whole person to improve their health, wellbeing and quality of life.

Watch: Learn more more about in-home evaluations and what to expect from a visit with a Signify Health clinician.