Medicare Advantage plan Aetna and primary care provider WellBe Senior Medical are teaming up in the Chicagoland area to serve about 2,000 patients in their homes. The partnership further highlights the growing momentum behind in-home primary care models, which often enlist the services of home health and home care providers to care for vulnerable populations.
Aetna and WellBe had already launched a partnership in July in Atlanta, where they are serving about 5,000 patients in the home.
Chicago-based WellBe Senior Medical has a vision of bringing the culture of “house calls” back onto the forefront of care. Broadly, its latest in-home primary care initiative is something that benefits all three parties: WellBe, Aetna and the patient, according to company leaders.
“Our goal is to help people age in their homes with dignity and respect. … Our model goes all the way from prevention to end of life,” Jeff Kang, the CEO of WellBe Senior Medical, told Home Health Care News. “In many ways, it’s a return to what I think is the essence of medicine.”
WellBe’s model is built to care for patients throughout their aging journey — whether that be through chronic disease care, acute care, palliative care or end-of-life care.
WellBe’s in-home care model can do about 90% of what a doctor can do at a traditional office in the home, Kang said.
An interdisciplinary team approach dictates the workflow of the licensed clinicians on WellBe Senior Medical’s staff. It is formed by physicians, nurse practitioners, social workers, paramedics and other health care professionals.
On its end, Aetna is a managed health care company that sells traditional and consumer directed health care insurance. It includes medical, pharmaceutical, dental, behavioral health, disability and long-term care plans, and it works primarily through employer-paid insurance, benefit programs and Medicare.
It has been a subsidiary of CVS Health since late 2018, another company that has shown it’s on board with moving care to the home.
In order to ease the burden of COVID-19 on hospitals, for example, CVS Health’s Coram enhanced its capabilities to treat more infusion patients in home-based settings during the early months of the outbreak in the U.S.
“Aetna is proud to collaborate with WellBe Senior Medical to deliver care to patients in the most convenient way possible,” Gregg Kimmer, Aetna’s chief Medicare officer for the Great Lakes market, said in a press release. “By seeing patients in the comfort of their own home, we can improve their health care experience.”
The house call concept seems simple and efficient enough, but it’s the efficiency that has actually plagued the model for years, at least under the traditional Medicare fee-for-service framework.
Where a house call company can see four to eight patients per day, office-based doctors can see over 20 because patients are coming to them. Even if in-home primary care has always been a better option for certain populations, it didn’t fit within a quantity-driven reimbursement model.
That’s why Aetna’s Medicare Advantage capabilities makes the partnership work, Kang said.
“Aetna is a Medicare Advantage plan. And in this model, if we can help them improve the outcomes and lower costs, we have a reimbursement mechanism where they’ll pay us to do that,” Kang said. “We actually make more money if we keep people healthy and out of the hospital, so it’s completely flipped from fee-for-service.”
In a fee-for-service arrangement, the lower volume of visits would hinder WellBe Senior Medical’s ability to stay afloat financially. The partnership with Aetna, however, incentivizes better care.
It’s also an especially useful partnership during COVID-19, when the most at-risk patients on a health plan need care most, but are also unable to get to — or are refusing — primary care more than ever.
“There has been a lot of interest in the health plan community around models like these,” Kang said. “I would say Aetna had the foresight to do something about it earlier rather than [later] — other plans are kind of a little slower to get there. … Interest in these models has been dramatically accelerated now because of COVID-19.”
WellBe will also work with home care and home health providers for physical therapy and skilled nursing needs. It also teams up with them for help with activities of daily living (ADLs).
“Right now, those home health agencies are calling the doctor in the office for orders,” Kang said. “Now, there is really a doctor in the home that they can work with to get orders done. And I think it’s an opportunity for better coordination and integration with a home-based medical group, rather than an office.
VillageMD, which just received a $1 billion investment from Walgreens Boots Alliance (Nasdaq: WBA), is another primary care provider moving further into the home that recently made headlines.
The primary care provider will be heavily relying on home care and home health providers as they do so, VillageMD CMO and co-founder Dr. Clive Fields recently told HHCN.
WellBe Senior Medical is hoping to continue to grow itself. It just signed on with another Medicare Advantage plan out of Chicago — MoreCare — which is based out of Cook County, Illinois.
Although Kang couldn’t unveil specifics yet, WellBe is on its way to a few more partnerships in Chicago and elsewhere, too.
“The system is set up with the convenience of the doctor,” Kang said. “It needs to be set up for what’s right for the patient.”
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