Optum home care program linked to fewer emergency, hospital visits for Medicare Advantage members: Study

Medicare Advantage patients who receive in-home health visits through the Optum HouseCalls program spend less time in the emergency room and inpatient hospital settings, according to a study by Yale Medicine and Optum researchers.

According to the June study published in Medical Care, HouseCalls are done by licensed clinicians who provide primary care and can address urgent needs. The clinician then shares assessment results with the patient's primary care physician and can refer them to other support services.

The study found reductions in emergency room visits and inpatient hospital stays for patients receiving home visits from Optum across four conditions: Type 2 diabetes, hypertension, coronary artery disease and depression. About half of traditional Medicare patients are estimated to have at least one of these conditions.

Researchers used Optum data to compare health outcomes for more than 48,000 MA beneficiaries with one or more of the conditions and who received an in-home visit in 2018 to more than 36,000 beneficiaries without a visit in 2018 but with a future visit in 2019.

"Resources allocated to these sources of morbidity and disability translate into unsustainable healthcare expenditures per capita," the researchers wrote. "There is an urgent need to redesign care delivery models that maximize prevention and facilitate proactive disease management approaches that can result in less resource-intensive care and improved outcomes."

Four key takeaways:

  1. For patients with coronary artery disease, there were 4.6 percent fewer inpatient stays and 4.1 percent fewer emergency room visits.

  1. For patients with Type 2 diabetes, there were 5.2 percent less inpatient stays and 4.1 percent fewer emergency room visits.

  1. For patients with hypertension, there were 5.1 percent fewer inpatient stays and 4.4 percent fewer emergency room visits.

  1. For patients with depression, there were 2.5 percent fewer inpatient stays and 3.7 percent fewer emergency room visits.

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