Seeds of Innovation

Speakers of the house calls

Make home visits culturally sensitive to engage patients.

Lola Butcher

If a patient isn’t coming to the clinic for medical care, perhaps the medical care needs to go to the patient.

That’s the thinking behind a new effort to provide in-home comprehensive health assessment services to homebound Asian American patients who have not been getting primary care services, says Joe Shen, vice president of multicultural marketing for EmblemHealth, an insurer with 3.1 million members in the New York City market.

EmblemHealth and the Coalition of Asian-American IPA (CAIPA), the city’s largest independent physician association serving Asian Americans, launched the initiative late last year. Any CAIPA patient—a population that includes Chinese Americans, Korean Americans, and other groups—is eligible for the program if they meet the criteria (they are homebound, overdue for primary care, and so on).

Yin Tung

Unlike standard home-visit programs, this one is designed to provide culturally sensitive care by physician assistants who speak the patient’s home dialect, says Yin Tung, CAIPA’s vice president for network management. Traditional health plan home-visit programs can be disruptive, rather than helpful, for older Asian American patients, especially those who speak little or no English, he says.

“A lot of times, the patient doesn’t understand who the provider is or what they’re doing,” he says. “So they pick up the phone and all our doctors say ‘Someone just came and visited me and did this, did that. I have no idea what is going on.’”

The goal of this program is to learn about the patient’s overall situation, including physical condition, behavioral health needs, and medication use.

“Some people just need someone to put all their prescriptions out on the kitchen table and say ‘Oh, you shouldn’t be taking X with Y,’” says EmblemHealth President and CEO Karen Ignagni, who was head of the trade association for the country’s health insurers for almost 20 years before running EmblemHealth. “In their home, it’s easier for patients to show their prescriptions and really share how they are feeling from a mental health perspective.”

The assessment includes a physical exam but, equally important, learning about the barriers—transportation, lack of confidence in providers or others—that explain why the patient has not been getting medical care. The physician assistant educates the patient about the importance of preventive care, and, if appropriate, schedules a visit to the doctor’s office on the spot.

In the first six months of the program, about 40 of the 100 patients who received in-home assessments were identified as needing extra support. Of those, 10 were referred for case management to help them comply with their medication regimens. In some cases, social workers are deployed to help patients with nutrition, housing, or other needs. Sometimes, patients just need someone who speaks their own language to listen.

“A lot of times, we find that seniors are isolated and just need to have someone to talk to,” Tung says. “By providing that ear it opens them up, and that’s how we get them engaged so they get the services that they need.”

The home-visit program sprang from the value-based contract—shared savings and bonus payments for hitting quality goals—between EmblemHealth and CAIPA.

“Year after year, we were finding a set of patients who were not getting the care they need and we have not been able to close these gaps,” Tung says.

CAIPA leaders analyzed their own records to see that, in many cases, these patients were elderly and homebound. At the same time, EmblemHealth was working on new strategies to improve population health management.

“As we think about this concept of right care–right time–right setting, we realize that, in some situations, the right setting is the home,” Ignagni says.

In the first months of the program, all EmblemHealth members who were approached about an in-home comprehensive health assessment agreed to participate, and 97% said they were satisfied with the experience. That makes Ignagni think the program is worthwhile. “Patients’ preferences and responsiveness really tell you a lot about the efficacy of a particular program,” she says.

Over time, the program will be evaluated on utilization metrics, including ED visits and hospitalization rates. Beyond that, the program will be valuable if patients get preventive and specialized services—for example, case management for a chronic condition or help getting proper nutrition—that can improve their health status.

“Those are some of the less tangible benefits that are coming out of this,” he says.