Health plans and risk-bearing provider groups are looking for partners to help them work with complex patients to reduce unneeded utilization and to lower total cost of care. In a recent interview, Chris Dodd, M.D., chief medical officer at Emcara Health, the home-based primary care provider group of PopHealthCare, described its approach to providing home-based care for vulnerable populations at scale.
Dodd, an internal medicine physician and an instructor in the Department of Global Health at the University of Washington, said what led him to working for Emcara Health two years ago was that it is an established company and a national medical group that had a history of combining risk adjustment expertise with eight years of experience delivering home-based care for vulnerable populations and doing it at scale with multiple payer and risk-bearing provider group partners.
According to Emcara’s website, its physician-led, in-home medical care solution increases access to timely and longitudinal treatment for a health plan’s most at-risk members. It uses predictive models to pinpoint members who are consistently high cost and can be positively impacted through additional home-based care and treatment. Emcara deploys integrated, multi-disciplinary in-home care teams that apply appropriate interventions and referrals based on a patient’s social, behavioral, and physical needs.
“We are delivering risk-based products or care solutions in 19 states, with between 20 to 25 health plan partners, but also risk-bearing provider groups,” Dodd said. The company seeks to appropriately document conditions and close quality gaps, addressing social barriers. “Most of what we do is delivering longitudinal care. We call it advanced primary care because it's multidisciplinary — it's medical, behavioral, and social, and we're delivering that longitudinal care either as the primary care physician (PCP) of record or in collaboration with patients who have a community PCP.”
In a case study with a large health system posted on its website, Emcara Health noted that it delivered a positive Net Promoter Score (NPS) of 87 in 2020 and a 51 percent response rate, which has the potential to improve the plan’s Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey score. When comparing claims data from members enrolled in the Emcara Health program to those targeted for the program but not enrolled, the health plan realized the following outcomes:
• 27.5 percent net reduction in total cost of care
• 10.7 percent net reduction in hospital utilization
• 14.6 percent net reduction in ED visits
“We've been able to lower the total cost of care, because we think everything starts with building trusting relationships with patients,” Dodd said. “You have to have time to do that. You're doing it on their terms, in their home where they feel most comfortable, and where things go better. From a total cost of care reduction perspective, I think what's really exceptional is when you look at our collaborative model — that's where we're delivering advanced primary care, in collaboration with patients’ PCPs and the rest of the ecosystem. We're caring for patients, usually between 12 and 18 months, and we're actually able to, year in and year out, reduce the total cost of care by 10 to 20 percent.”
Dodd said that some companies working in the space tend to focus much more on the risk adjustment increases through documentation in terms of how they're actually lowering medical loss ratio [MLR]. “Most of our MLR reduction, 80-plus percent, is actually from utilization reduction. It is keeping people healthy at home and out of the hospital.”
As an example of the type of partnerships it develops Emcara recently announced a deal with GuideWell, the parent of Florida’s large Blue Cross health insurance plan. It will now offer house calls from primary care providers to select Medicare members in 17 counties in the Jacksonville, Orlando, Miami, Southeast Florida, Tampa Bay and Pensacola areas.
“Enabling Medicare members and their caregivers to see their doctors and providers at home — including getting mental well-being support and help enrolling in social programs — removes a number of barriers to accessing care like transportation,” said Camille Harrison, GuideWell executive vice president of Medicare and chief innovation and customer experience officer, in a statement. “At GuideWell, we are very focused on keeping members healthy as they age by addressing key social determinants of health that impact health outcomes and quality of life, increase patient satisfaction and ultimately control the cost of health care as a whole.”
A new market developing for their work is Medicaid managed care, Dodd said. For example, in California, he noted, there is a new funding stream to catalyze more innovation in the space. A new Medicaid approach called CalAIM “is a perfect framework for what we do,” he said. “Looking at a population, you can take the folks who are persistently high-cost, rising risk, and that have a heavy burden of behavioral and social barriers and deliver a completely innovative, different care model to them. One of the things that I think has made us successful is this recognition that if you're vulnerable, and you have a lot of complexity going on — whether you're a 33-year-old, single mom with bipolar disorder and diabetes, or whether you're 86 and you're living alone and you're frail, and you have congestive heart failure — that you need an entirely different care model, and that care model should have its foundation in the home, a truly patient-centered medical home.”