Blue Cross Blue Shield of Massachusetts this month introduced a new home-based initiative that will serve Medicare Advantage members with multiple chronic conditions and has the potential to generate long-term savings by cutting down on emergency room and inpatient utilization. The Blues insurer says the program is the first of its kind in New England and aligns with CMS star ratings objectives.

Through a partnership with Landmark Health, LLC, eligible members may receive chronic care management and urgent visits in their homes. Landmark is a national provider group focused on delivering in-home care services exclusively to the most chronically ill and has completed more than 85,000 house calls, including nearly 20,000 urgent visits, since it was established in 2014.

“We wanted to find a better way to care for our seriously ill Medicare Advantage members who find it difficult to see their PCP and could benefit from in-home care,” explains Bruce Nash, M.D., chief physician executive at the Massachusetts Blues plan. Nash tells AIS Health that the insurer considered several partners for the initiative, but what set Landmark apart from the rest was that it is the only provider group offering this kind of care model in the home, and its staff of physicians and other health care practitioners is available 24/7 to see members.

The insurer this month began mailing letters to qualifying members inviting them to participate in the voluntary program and has identified between 3,000 and 4,000 members who are eligible throughout Massachusetts. These members make up 8% to 12% of the plan’s MA population and account for 20% to 25% of MA costs. The program is being offered to members with multiple serious chronic conditions, such as cancer, heart disease, depression, diabetes or kidney disease.

The new program rolled out in the Worcester area on April 3 and will expand to Springfield and Boston throughout 2017.

Model Could Lead to Lower ER, Inpatient Use

Nash says the insurer expects the model will produce “strong clinical outcomes and a reduction in emergency room, inpatient and urgent care visits among participants, which will help create long-term savings.” Data from Landmark’s experience in other regions have demonstrated solid performance on clinical quality measures and a 40% reduction in hospital admissions, according to Nash.

The program also aligns with all of the appropriate clinical measures that are part of the CMS star quality ratings program, “so we hope to improve our performance on several of the star measures as well,” he adds. The Blues plan’s MA HMO currently holds a 5-star rating from CMS. And because this is a case management program, the insurer was afforded the flexibility within CMS guidelines “to design it and offer it to members who need it the most,” says Nash.

An “added bonus” of the Landmark partnership is that its care team will inform members who are eligible for its new value-based insurance design (VBID) program targeting hypertension of that initiative. The Massachusetts Blues plan is one of 11 plan participants this year to test VBID under CMS’s new model (MAN 10/13/16, p. 8).