You have no idea how many over 65 people we saw because they messed up their meds, especially when they were on insulin or blood thinners, and usually because their vision wasn't as good as it once was. It's especially a good idea for people living alone.

They also look at things like accidents and broken hips ready to happen, like non secured area rugs on slick floors, those need non skid pads as we get older.

They're not there to criticize or nag. Trust me, they've seen far worse than mild disarray that we most live with. They are there to help if you need it, to recommend fewer visits if you don't.

Suddenly I'm a little more impressed with the Humana bloodsuckers.

I spent a week in the hospital in early November after major surgery. The hospital sent their home care nurses to my home once or twice a week to see how I was doing and followed up on my wound care. I appreciated the hell out of it, especially after my staples were removed and my incision split back open. I called the nurse, she came out on a Sunday, called the Dr and got instructions from him on caring for the wound and I avoided another trip to urgent care on the weekend. My insurance company paid for it all including gauze, tape and the silver treated, bacteria preventing dressing.

It's a benefit I didn't even know I had.

Just my two cents

called a 360 exam and most MD's don't do it thoroughly enough to be accepted by the insurance company.

They will send out most likely a nurse practitioner who will do a head to toe, vitals, and meds. The idea is that they document every health problem you have or have had and document a plan of care or treatment for it. By documenting EVERYTHING in this thorough manner, you are allocated more appropriate funds for medicare next year.

So you go to your MD and he lists, say high blood pressure and high cholesterol. Okay great.

But the NP lists your old back surgery, kidney stones, osteoporosis, pre-diabetes...all these things that you may have had or currently have but aren't under treatment for.

So based on what your MD lists as high BP and high cholesterol, medicare says gee, she's pretty healthy. Let's allocate $10,000 for her care next year (2016). But your kidney stone acts up and you're in the hospital for that. Then, your osteoporosis gets the best of you and you break an arm going down the stairs so your'e in the hospital for that. That doesn't mean you pay more in 2016, it just means that medicare didn't allocate the proper amount for your care that you were anticipated to have. It means the hospital gets paid less and your MD gets paid less for your visits

But if you've got all these problems listed, then Humana says "gee, she could break an arm or have some issues with blood sugar" and they allocate $40,000 for your care. That means if you go to the hospital, the hospital gets a higher payout. Your DR gets more $$ per visit for you because you're assumed to have more health concerns than just high blood pressure and high cholesterol.

It's a way to anticipate your medical needs over the next year.

Medicare MD's are capitated. That means that they're paid $X for your visits, regardless of what you have done or not. So if you've got Asthma, and go to the doctor weekly and get duonebs and other breathing treatments, but these aren't documented in your yearly 360 exam, then that dr is going to get the $ per visit that he would get if you were just getting regular checkups and medicine follow-ups.

I know this because I work for a medicare advantage insurance company (one of the top 3) as an RN. We do 360's in our office, but we have NP's that go out and do them at home, as well as some visiting MD's.

It's also a good way to get a handle on what's going on in a patient's life that they may not tell the MD about, or think to tell them about. Do you have running water (you may, but many patient's don't). Is your house safe and habitable? Are there any reasons why how and where you live may negatively affect your health (have diabetes, but no refrigerator so no way to store insulin. Have restricted diet but no stove so have to buy take-out food, have osteoporosis but wobbly stairs which increase fall).

Many patients also have polypharmacy, which means they take more than 7 meds a day. Many people's heart Dr and lung dr and PCP and etc don't talk to each other, so patients may be on duplicate meds or meds that counteract with each other. He/She will go over the meds and make sure there's no duplicates or harmful combinations.

You may live in a great place with great support and only take 3 meds. But it's easier for Humana to do this wholesale for EVERYONE and have fewer people falling through the cracks than to do it on risk assessment alone. Risk assessment is only as good as the data that is provided, and what has happened in the past. The key is preventing bad things from happening in the future and to keep near misses and accidents from happening.

The person doing the visit will be an RN, most likely a nurse practitioner.

It will not be an insurance executive looking for hidden cigarettes in the drawers and butts in the trash can.

This is a good thing.

but this is a good thing. The trend is definitely preventative vs. post-hoc.

I work in an urgent care center for medicare patients, but my team deals specifically with chronically ill patients with multiple comorbidities, polypharmacy, poor adherence, and high rehospitalization. Yes, there are people who have to go to the hospital repeatedly, but most don't. THe hospitals want to CYA so they admit anyone with a complex health history. My job is to keep them out of the hospital for unnecessary means. I streamline meds, I streamline specialists. I do A LOT of education on medication, health conditions, importance of taking meds and adhereing to diet....but when you have someone without a fridge (many of my patients don't have one), or someone who only has a hot-pot for cooking (many of my patients live in boarding homes and have no stove), AND they live on $500 a month SSI and get $40 a month in food stamps, it's hard to eat a low salt, low fat, low carb, high protein diet.

Chronic Care/Complex Care and the prevention of complications is big business in Insurance now. Our center does a lot of good. We're a great resource for patients for many reasons, and it's hard for me---someone with multiple advanced degrees and a working knoweldge of the health care system to navigate things. I think it's practically impossible for someone with a limited income, limited education, hard of hearing, hard of seeing, memory problems, etc, to navigate the system.

My job is equal parts RN, Educator, Friend, Case Manager, Social Worker.

We are also seeing an increase in the number of home-visiting MD's. That increases how often pt's are seen by their PCPs', and there is a direct correlation between seeing your PCP and not going to the hospital as much. So having a MD that goes to the house every 3-6 months and an NP that goes once a month really helps with understanding medications, barriers to care at home (also noticing abuse and neglect), and keeping patients healthy so that their only contact with health care isn't when they're in a crisis situation in the ER.

Doctors unless you had a major problem, perhaps they finally realized it was cheaper to keep people well. This is the new medical strategy.

to make sure everything is copacetic with you.

I likewise am on Medicare with Humana as my Advantage plan provider. I went with them after researching the various plans available to me, because of the experience an older friend of mine had with Humana. She had a pulmonary embolism two years ago, was in a medically induced coma for about five days, spent another week in ICU and a few more days in a regular unit. After she returned home they sent a home health care person to make sure everything is okay.

It's really not a big brother thing, but the sort of attention and care we should all be getting.

But still, if you want to refuse the visit, it's perfectly within your right to do so.

I'm not taking full advantage of all the little perks Human offers me either. Although they haven't wanted to make a home visit so far.

Insurance companies are now trying to get a 5 star rating. They can do that by doing extra things like these home care visits. They kind of have to prove they are a platinum insurance carrier when it comes to health care. He also told me that they can't cancel me for anything but non payment and even then they have to jump thru hoops to do it.

If they get a 5 star rating they are eligible to make a lot more money because they can sign up new customers any time of the year not just during the October sign up period.

I don't think home health care visits are bad if people need them. But I don't want the insurance company to be in charge of what I can or can't do. They are already running the medical profession.

If my doctor thinks I need a home visit I am fine with that.

Problem is I don't need anything right now. I'm perfectly healthy, feel great and don't want any more medical care than I'm already getting. I'm fine. But I might very well be in the minority. I know lots of people my age who have diabetes or heart problems or whatever. They probably will be grateful.

[font size="4"]Home is where the money is for Medicare Advantage plans

Feds wanted to ban costly 'house calls,' but backed off due to lobbying blitz[/font]

http://www.publicintegrity.org/2014/06/10/14880/home-where-money-medicare-advantage-plans

and insure you are taking care of yourself a follow up after office visits - did you do what was discussed , eating right etc.. It all comes down to cost
Some of it will be very intrusive and when I heard about it in a plan meeting I just was glad that at present, I don't have any medical problems but looks like you live long enough they will be on you just cuz you are old too.even if you are not taking pills if you are insured
As you said they pay the bills
and they are trying to pay less
sometimes they contract the hospital group to do this too.

Hello all!
Most of this thread relates to older individuals on Medicare.... I am only 51 years old in excellent health so no Medicaid - and am only concerned with getting all available screening exams [cancer prevention] etc.... which in my opinion should be covered by insurance. I am very concerned that this in home visit will be used against me in some way by Humana to either deny me some coverage, or to kick me off of Humana insurance... or more likely jack up my premiums... they already increased my premium substantially last year.

I have considered DENYING this in home visit.... and I understand that Humana says it is OPTIONAL... but I also fear now that after incessant badgering on a monthly basis.... if I say NO, I think they will retaliate by raising my rates...

I do NOT trust them as their motives are clear: to spend less money...

I would appreciate any feedback on if anyone had a negative experience with Humana after having had this in home visit... relative to having their premiums go up, or having other problems relative to being covered or having some or part of their coverage denied...

Thanks

Sounded like a good deal for someone to come to my home instead of having to make an appointment with my Dr. All my health issues (which are pretty non-existent) are already shared with the ins company anyway, so what does it matter if I get my BP checked in a Dr's office or at home? But having said that, I declined. At the time I didn't understand the service. They never called me back and I kind of wish they would.

I would never allow it.
I'm 70 years old, healthy, take no drugs, do yoga, don't need Medicare, the pill-pushers.

companies make a lot of money with those visits.