It is imperative that conditions such as diabetes and high blood pressure are not only controlled but are managed for overall health. As a health plan, we seek opportunities to provide our members with care needed to manage their conditions. We partnered with an in-home services provider network (IHSPN) to provide in-home screening services to our members. This in-home health assessment program offers a convenient alternative to members who have difficulty accessing needed health care.

Methods

Our health plan partnered with an IHSPN to conduct one in-home visit to our Medicaid population in seven counties. The in-home screening was performed by a health care professional for diabetic retinal eye exam, urine analysis, Hemoglobin A1c testing, serum creatinine, and serum potassium. Upon completion of the tests, results were sent to the member’s physician and he/she was encouraged to make an appointment with their PCP for continued care.

Results:

From January through December 2018, the following diabetic screening tests were completed: HbA1c testing 6.5% (1034/15,833), diabetic retinol eye exam 6.34% (1668/26321), and urine analysis 6.02% (561/9313). For the monitoring of ACE/ARBs and diuretic medication management, 2.28% (369/16208) of the cohort had completed their serum creatinine test and 1.80% (292/16208) of the cohort had completed their serum potassium testing.

Discussion:

Through the implementation of the IHSPN screening program, the health plan was able to target the hardest to reach members to complete required laboratory testing. This was especially true for members who face transportation barriers or access to health care in rural areas. The primary barrier was that members did not answer the phone to accept an appointment. There is an opportunity for the health plan to continue marketing this program to help more of our medicaid members close the gap for chronic conditions.

A postpartum visit is important for support of breastfeeding, screening for postpartum mood and anxiety disorders, follow-up of conditions such as diabetes and hypertension, and family planning. In 2017, a large health plan offered a comprehensive in-home postpartum assessment to Medicaid members.

Methods: The eligible population included 4,403 eligible Medicaid members who had a live birth between November 6, 2017 and November 5, 2018 and who have not completed a qualifying 21-56 day postpartum visit. An in-home service provider network telephonically outreached to members to schedule an in-home postpartum assessment and results are sent to the provider confirmed by the member (primary care provider or obstetrician). The assessment was performed by a qualified medical doctor or mid-level provider who specializes in perinatal care.

Results: From November 6, 2017 – September 6, 2018, (24) of the eligible population completed the in-home postpartum care visit with the in-home service provider network. Of the members that were successfully reached by phone, 464 members self-reported they completed their postpartum visit with their provider, 7 were uninterested at the time of outreach, and 6 members refused the service. Of the members who were not successfully reached, 2.57% of members did not answer their phone (113), 167 members (3.79%) had invalid phone numbers and 22.96% (1011) had their service timed out.

Discussion: Since the start of the program, several barriers were identified and addressed to improve the program and postpartum visit outcomes. A high volume of members self-reported completing their postpartum visits with their physician. A high volume of members were not outreached before the recommended postpartum timeframe (21-56 days) passed. Lastly, low member uptake in the service was potentially due to lack of understanding of what to expect during an in-home postpartum assessment.

Well child visits (WCVs) during early school years are important to track growth and address missed developmental milestones. Low income parents may find it difficult to schedule and complete their child’s annual visits due to barriers of transportation, time constraints, and clinic location/open hours. A large Health Plan partnered with an In Home Services Network Provider (IHSPN) to conduct in home WCVs for Medicaid pediatric plan members with the goal of increasing completed annual visits.

Methods: The IHSPN outreached to 15,608 Medicaid member parents by phone and mail to notify them of the opportunity to schedule in home WCVs. Eligible members included 3-6 year olds with missing annual WCVs as of October 2018 residing in four target California counties. Member phone outreach and completed appointments were tracked and reported to the health plan on a weekly basis. Outreach and scheduled visits occurred October – December 2018.

Results: 211 pediatric members were scheduled for appointments (138 members completed appointments). When contacted, 455 member parents refused the in home visit, with the majority of parents stating disinterst in the service (N=410). The majority of calls were not answered or went to voicemail (N=11,564). Members were also not reached due to invalid phone numbers (N=2,530).

Discussion: Results show that more member parents refused in home well child visits than scheduled them. The lack of interest could be due to the pilot occurring during the holidays and parental discomfort with an unfamiliar provider in their home. Other contributing barriers include invalid contact data and low success in phone outreach. Although the pilot had limited success, there is opportunity to increase untilzation by working more closely with providers to identify and directly refer interested members to the program or by adding well child visits during adult in home assessments.

Despite advances in osteoporosis screening and treatment protocols, osteoporosis continues to be under-diagnosed and under-treated, making it an underlying cause of fracture in older adults, resulting in significant morbidity and mortality. One in two women and one in four men over the age of 65 will have an osteoporosis-related fracture in their lifetime. The link between low bone mineral density (BMD) and increased fracture risk is well documented.

Methods: Medicare members selected for in-home BMD screening have had a fracture and no recent history for BMD test or prescription for a drug to treat or prevent osteoporosis. There were 801 members identified for in-home BMD screening whose fracture dates were between 7/15/2018 to 1/27/2019. In-home services provider network (IHSPN) telephonically outreaches to members to schedule an in-home bone density screening and results are sent to the member’s primary care provider.

Results: A detailed report of call disposition and completed appointments is provided by IHSPN to health plan. As of February 19^th, 83 appointments were scheduled (with 77 completed appointments) and 203 members were in the process of being scheduled for an appointment. More than half of the members (n=418) were unable to be reached due to invalid data and 79 members refused the in-home service. The overall completion rate for appointments was 20.8%.

Discussion: Barriers at the patient and health care system levels impede optimal delivery of in-home BMD screening to individuals with or at risk for osteoporosis. The period immediately following a fracture is an important teachable moment to educate members about BMD screening. Comprehensive osteoporosis management that incorporates in-home BMD screening along with member education to address knowledge deficits, vendor oversight to ensure timely completion of BMDs post-fracture, reliable member data to maximize outreach efforts, and coordinated care with provider can improve screening rates and health outcomes.