By Philip Painter, M.D.
Something was different about Sue that day, UnitedHealthcare nurse practitioner Colleen Nolan noticed when she arrived for a HouseCalls visit at Sue’s home.
By visiting her at home in recent years, Colleen has built a relationship with Sue based on insights into her health history and lifestyle. Sensing that something was off that day, Colleen did what she was trained to do.
When Sue mentioned that she could not walk because of pain in her calf, Colleen used a screening tool to measure blood flow to her legs and feet. “She did that test,” Sue said, “and it was like, I never saw anybody get on a phone so fast.”
80% of what impacts a person’s health is the result of factors that happen outside of the doctor’s office, like access to safe housing and healthy food – factors known as social determinants of health.
Colleen helped make sure Sue got prompt treatment for poor circulation, a condition that, if left untreated, could have resulted in serious complications, perhaps even the loss of her leg. Instead, Sue made a full recovery.
Sue and Colleen’s story is part of a growing trend towards more comprehensive, personalized, and convenient care for older adults in the United States that can help improve health outcomes, quality of life and patient and provider satisfaction while helping to lower health care costs.
We know that 80% of what impacts a person’s health is the result of factors that happen outside of the doctor’s office, like access to safe housing and healthy food – factors known as social determinants of health. This more holistic look at wellbeing can lead to a better understanding of a patient’s functional capabilities, such as driving a car or balancing a checkbook, which can, in turn, signal other health problems.
With in-home care, in particular, the provider gains clinically valuable insight into an individual’s lifestyle, health status, and overall wellbeing. A UnitedHealthcare HouseCall often last 45-60 minutes, significantly longer than a traditional office visit.
A visit can reveal fall hazards in someone’s living space; a discussion about nutrition in the home might uncover food insecurity. This more comprehensive care often results in a referral to a specialist, a care management program, or to other resources in the community like counseling services.
Having the ability to support people in their homes is becoming increasingly essential to create a health system that is more consumer-centric, higher quality and lower cost.
For UnitedHealthcare, home and community-based services have helped reduce post-acute medical care costs, including lowering unnecessary hospital readmissions by 20% and overall hospital admissions by 25%.
In short, there’s momentum allowing for a wide range of health needs to be met in the home, including care for individuals with special needs and for palliative care. In-home care is also an important resource for rural and low-income individuals who may have transportation or mobility challenges among other obstacles.
Evolving yesterday’s house call to meet today’s health needs
Older Americans may remember a time when doctors showed up at the home with a black bag with tools of the trade like a stethoscope and blood pressure cuff.
For today’s house call, that proverbial black bag has more technology and capability in it to meet patient needs, but these trends go beyond in-home care to include a bourgeoning variety of programs and services offering digital and remote care options so patients can access care in a way that best meets their needs – whether that’s in-person, online, in-home, and across every point in between.
While in-office clinical care will remain a vital setting, the pandemic changed the way many people have traditionally viewed and engaged with the health care system. To put things into perspective, just 0.1% of UnitedHealthcare’s Medicare members used telehealth in 2019. By the end of 2020, nearly 40% had completed a telehealth visit.
Virtual visits and digital care platforms give patients the ability to manage their care by, for example, quickly scheduling appointments, messaging providers, or even comparing prescription drug prices. Virtual options for care also improve the ability of providers to screen for behavioral health issues. This has been an increasing concern during the pandemic, as surveys showed that about 25% of seniors reported anxiety or depression in August 2020, up from about 10% in 2018.
Not everyone will need this type of care, but we have the ability, thanks to technology, to increasingly find and support those who do. Artificial intelligence, in tandem with other assessment tools, has enabled clinicians to respond to patient needs right away, helping to prevent events before they occur.
While in-office clinical care will remain a vital setting, the pandemic changed the way many people have traditionally viewed and engaged with the health care system.
At UnitedHealthcare, our population health infrastructure combines claims and clinical information with real-time input from digital tools — like a digital scale or a continuous glucose monitor — and other relevant datasets such as those related to social determinants of health.
Being able to step beyond the physical office enables providers to provide longitudinal primary care, meaning they get to know a patient over time — learning their goals and what drives their overall health and helping coordinate care on a much more organized basis.
A greater focus on care outside the brick-and-mortar setting can improve provider satisfaction as well. A multidisciplinary model enables clinicians to spend their time differently, and getting to know a patient more fully.
That’s what happened with Sue and Colleen. Over time, they built a relationship that gave Colleen broader understanding of Sue’s health , which allowed her to help Sue get the care she needed at the right time and in the right setting to stay healthy and resume taking walks, something that was very important to her life.
“Healthy means independence,” Sue said. “Taking a walk is such a simple thing. I’m still independent because of Colleen.”
Dr. Philip Painter is Chief Medical Officer, UnitedHealthcare Medicare & Retirement.
Learn more about how UnitedHealthcare’s holistic approach to care delivery and support is driving better health outcomes, one person at a time.