NHP sees home-care program curbing costs

TAKE CARE: Nurse practitioner Joan Walton, standing, and community health worker Anelle Diaz, right, work with Maria  Virella in  Virella's  Woonsocket home. / PBN PHOTO/ MICHAEL SALERNO
TAKE CARE: Nurse practitioner Joan Walton, standing, and community health worker Anelle Diaz, right, work with Maria Virella in Virella's Woonsocket home. / PBN PHOTO/ MICHAEL SALERNO

Remember house calls? Nurse practitioners and community health workers through Neighborhood Health Plan of Rhode Island’s Health@Home program are making house calls to some Rhode Island residents.

Seven employees (one social worker, two nurse practitioners and four community health workers) provide home-based concierge medical care to some “super utilizers” of health care. With multiple medical problems and several hospital admissions and emergency room visits every year, such Medicaid-eligible patients typically incur medical expenses of $58,000 to $60,000 annually, said Dr. Francisco (Paco) Trilla, NHP’s chief medical officer.

Neighborhood has voluntarily enrolled 450 members in Health@Home,120-125 of whom now receive home visits. The remaining members are monitored by Health@Home teams, said Tom Boucher, senior manager of communications and public affairs.

He says emergency room visits and hospital admissions for these 450 members have been reduced by 26 percent and 30 percent, respectively, when compared to these individuals’ hospital usage during the same time period in 2014.

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NHP expects the Health@Home program, which launched in January, to save at least $2.7 million in net expenses by year’s end. NHP, said Trilla, has a cost-sharing program with the state. “If we make $100 of profit, some amount of that will go to the state.”

We “call it risk sharing and gain sharing,” said Alison Croke, NHP’s director of operations and strategy, community based care.

Seven percent of Rhode Island Medicaid patients account for approximately 66 percent of program spending, which costs the state more than $1 billion a year, said Trilla.

Much of that spending is because people aren’t accessing the [health care] system when and where they need it,” explained Elizabeth Roberts, secretary of the R.I. Executive Office of Health and Human Services. Sending health care providers to people with multiple chronic illnesses has so many benefits, in terms of quality health care and finances, she said.

While patients with relatively high fixed costs, such as dialysis, don’t offer opportunities for significant cost savings, said Trilla, the program can help save money and improve the health of patients with depression, diabetes, congestive heart failure or anxiety who are frequently hospitalized.

Maria Virella, 48, a Woonsocket resident on Medicaid, is one such patient. Suffering from diabetes, hypertension, congestive heart failure, spinal stenosis, depression and anxiety, Virella said, “They [her Health@Home team] come and check up on me, they check my high blood pressure. … I wish Joan [Walton, the nurse practitioner] would be my doctor. They’re like my angels.”

In 2014, Virella had three emergency room visits and three hospitalizations at Landmark Medical Center, including one nine-day stay. In the four or five months she’s had her Health@Home team, she’s had no hospital visits.

She used to go to the hospital because of her back pain, said Walton. “Now, she calls us first; we have her pain pretty much under control with medication. [Patients] can get to us right away. If they call a doctor’s office, they have to wait [for a return phone call]; then they panic and call 911.”

Patients have 24/7 phone access, as well, and bilingual community health workers visit Spanish-speaking patients.

Health@Home teams work with patients over a six to 12 month period, with the goal of transitioning them back to their office-based primary care provider.

Trilla based Health@Home on a program he had established in California and on other national models, including Veteran Administration programs.

Because NHP is not licensed to perform Health@Home’s direct clinical care, Trilla established a closely held corporation, PPC Inc., which leases the services of NHP employees to provide the care. And, rather than resorting to the traditional “fee for service” payment model, NHP pays PPC Inc. a fixed amount per enrolled patient per month.

Payment reform and employing teams – pharmacists, nurse practitioners, physician assistants, community health workers and social workers – to treat patients, are both important, said Trilla.

Can a program like this be scaled up? “It’s definitely scalable; this can be incorporated into any insurance plan benefit,” said Roberts. “I think you’ll find more and more insurance companies offering this.”

Trilla agreed: “I think it absolutely can be scaled up here across the state.” He added he would share relevant information with other health insurers.

“This program is like the best thing in this town,” said Virella. “It helps a lot of people, especially the poor [who] don’t have rides [to doctors’ offices]. Nobody helped me before.” •

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