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Insurers embrace home-care programs to manage patients' health

But some wonder if the goal is really to maximize Medicare payments

While insurers increasingly turn to at-home care management programs to improve the health of their senior members and keep them out of the hospital, but some officials are concerned that the trend might be an attempt by insurance companies to maximize reimbursement, according to an article from the Tampa Bay Times.

Humana at Home--a care management program that is available to Medicare Advantage members in 49 states--selects participants based on the severity of their health needs. Some can be treated over the phone, while others with more severe health problems can receive in-home care. The home visits don't include hands-on medical care; rather, they are performed by social workers and nurses who assess the seniors' living conditions, their activity level and likelihood of falling at home, and make sure they are following their health management plans, the article said.

Humana at Home is growing as a result of some early successes. A recent internal analysis found participants had 45 percent fewer hospitalizations than expected, and another study found participants were 26 percent more likely to live longer, according to the Tampa Bay Times. Other insurance companies are following suit, too, as both OptimumCare and WellCare have started in-home health management programs, and they even provide transportation and meals as well as check body mass index, blood sugar levels and take blood pressure readings, the article says.

But the Centers for Medicare & Medicaid Services has raised concerns regarding in-home assessments, saying that Medicare Advantage plans may be using them to generate more payments under CMS' risk-adjustment methodologies, the article adds. CMS attempted last year to change the Medicare policy that would exclude some services performed during at-home assessments, but backed off these proposals after receiving pushback from the insurance industry.

On the provider side, CMS has increasingly cracked down on fraud in the home health industry, recently drafting new rules that would collect baseline data on probable fraud payments and launch a preauthorization pilot project in five states.

To learn more:
- read the Tampa Bay Times article

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