Thoughts on MA Home Health Care Visits ?

[frayne]

I'm 72, wife is 69, we are both in pretty decent shape and have our annual physicals. Every time I get these calls, I politely tell them to push it back until the next quarter because we are basically too busy with life, i.e. grandkids, golf, extra activities, etc. Am I missing something here or is this just another insurance company scheme to game the system ? The link provided seems to think so, your thoughts or experience ?

https://www.health.harvard.edu/blog...rance-companies-make-house-calls-201512168844

 

[MichaelB]

You’re not missing anything and there’s no reason you should allow the insurance company to sponsor a house call.

 

[frayne]

You’re not missing anything and there’s no reason you should allow the insurance company to sponsor a house call.

Thank you.

 

[Z3Dreamer]

On a different site, I get involved in a number of debates on this topic. Gets very heated as those who are against MA see many bad things with house calls. Those who reason that MA plans can be useful, see them as part of preventative medicine.

I had previously read the article. It does say that in some cases hospitalizations are reduced but it draws the overall conclusion that for the author, it is bad.

IMHO, in some cases, they can be a good thing. Now, what about "When should I take SS?" and "What is a SWR?" In other words, the good or bad is subjective.

 

[MichaelB]

My mum has MA and since she got sick I’ve taken over her affairs, including health insurance. Her previous plan (UHC) called for over a year, 2-3 times per week. The calls never got past them demanding I first prove my identity while they refused to do the same, and then citing HIPAA regulations, even though her HCPOA was on file, and refusing to share any info with me.

One time, the nurse who called agreed to chat with me. She first said they wanted to give her an “assessment and free checkup” to see how they could “act as her advocate to improve her chronic care by better coordinating resources”. That included the possibility of changing her providers.

She followed that by adding they would also look for untreated conditions. The justification was this would be of great benefit to her health. They insisted, even after letting them know my mum lived in an ALF with 24/7 health care, lots of advocacy and excellent care coordination. To this the nurse simply stated the insurer sponsored visit might do a better job of identifying and coordinating care resources.

I asked them to stop calling, and they did. Unfortunately, her employer changed retirement health care plans in January and this has started again with Aetna.

My takeaway on this is they have 2 objectives. One is for patients with chronic conditions, and the goal is to organize care using insurer preferred or lower cost providers. The second is as expressed in the link in the opening post, to identify additional conditions that allow for a more complex health risk profile and lead to higher reimbursement rates.

I’ve been involved with the finances, health care and health insurance of my pops, aunt, and now my mum. One thing that is perfectly clear is the entire system is built around the payments system, not the health or needs of the individuals.

 

[Gotadimple]

What MichaelB said.
This is all about reimbursement. With Medicare Advantage, the plan agrees to a base payment for a set of services, they generally can't bill Medicare for anything because they are at risk for the cost of other services not in the basic set they negotiated. So, these plan doctor visits do two things: gives them data to share at the annual rate negotiation with the government that their costs are going up, and, perhaps meet certain quality of care measurements that are baked into their rate from the government.

- Rita

 

[jollystomper]

DW and I had them about a month ago. We have few health issues, and nothing the insurance company and our doctors do not already know about. I talked to our GP beforehand, they did not raise an issue either way. It took about an hour for both of us. Mainly questions, weight and BP measurements. Yes, the allure of gift cards was a factor .

 

[audreyh1]

You’re not missing anything and there’s no reason you should allow the insurance company to sponsor a house call.

Right, it’s getting annoying! And I’m not even on Medicare! Yet I get calls from BCBS a couple of times a year offering to send a nurse to my home to do a check-up. They ignore me when I tell them I get an annual checkup by my doctor and push this visit anyway. Sorry, I don’t want a private insurance company medical team visiting me or my home.

So I’m hoping this goes away once I start traditional Medicare.

 

[rk911]

what is MA?

 

[audreyh1]

what is MA?

Medicare Advantage.

 

[rk911]

Medicare Advantage.

thanks.

 

[mcbraemer]

My DW was on her employer subsidized MA plan for her first year of retirement. During that year she was hounded with these home visit offers. Why? As mentioned in some of the previous comments, it's all about the money.
To quote the referenced article:
"each of us covered by these plans is assigned a risk score. As we develop more health problems, our risk score increases. "The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts plan payments from Medicare. Generally speaking, the more diagnoses recorded, the higher the payment,"
We quickly switched to standard Medicare, and one of the best Med Supplement plans, and the harassing phone calls stopped. Incidentally, her total monthly cost for Medicare including the Supplement and a Part D plan is less money than her employer "subsidized" initial plan. Seems the discount she was receiving was stingy, even after 20 years with the employer.
We are both quite pleased with the outcome (we are both now on the same programs) medically and financially.

 

[aja8888]

"each of us covered by these plans is assigned a risk score. As we develop more health problems, our risk score increases. "The home visits conducted by Medicare Advantage plans allow for the capture of more diagnoses, which in turn increases the risk score that adjusts plan payments from Medicare. Generally speaking, the more diagnoses recorded, the higher the payment,"
\

Funny, Joe Namath never mentions this when spouting his MA TV commercials!

 

[Teacher Terry]

I wouldn’t answer the phone calls. Glad that I am on regular Medicare.

 

[Mark1]

You’re not missing anything and there’s no reason you should allow the insurance company to sponsor a house call.

+1
I have seen one exception with my BIL, where a visit might be worthwhile. In BIL's case, he went to a primary care doctor a hand full of times (probably <5) in his entire adult life, due to the expense. For example, BIL probably had no blood work his entire life.

He said yes to the visit after he got on Medicare and retired and the visiting nurse told him of all of the services that were entirely free (vaccines, blood work, etc.). He followed up on many of the free services, so in his case I think there was some value.

 

[audreyh1]

+1
I have seen one exception with my BIL, where a visit might be worthwhile. In BIL's case, he went to a primary care doctor a hand full of times (probably <5) in his entire adult life, due to the expense. For example, BIL probably had no blood work his entire life.

He said yes to the visit after he got on Medicare and retired and the visiting nurse told him of all of the services that were entirely free (vaccines, blood work, etc.). He followed up on many of the free services, so in his case I think there was some value.

Yes, someone who has had little routine medical care especially recently would probably benefit.