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Q&A | Cost Effectiveness of Health

How a health plan is taking primary care to seniors in their homes

Q&A | Cost Effectiveness of Health

How a health plan is taking primary care to seniors in their homes

As another manifestation of the recent trend toward increasingly delivering care in patients’ homes, Welcome Health, an independent primary care medical group, is revolutionizing geriatric care in Southern California and the Southwest. And its nationwide aspirations are one more indicator of the potential for this trend to redefine how healthcare is delivered across the United States.

Welcome Health was founded by Long Beach-California-based SCAN Group, which controls SCAN Health Plan, one of the nation’s largest Medicare Advantage (MA) health plans. SCAN  —  originally called the Senior Care Action Network  —  was formed from the combined efforts of experts in medicine, gerontology, psychology and social services as an organization focused on keeping seniors healthy and independent.

Scott Weingarten, MD, CEO of Welcome Health, and Binoy Bhansali, SCAN’s head of corporate development, have led the process of developing the partnership and launching Welcome Health. They shared insights into the implications of such an enterprise for the nation’s healthcare system.

Q

We have been hearing a lot about the greater emergence of hospital-at-home initiatives in response to the pandemic. How would you say Welcome Health fits within that trend?

Scott Weingarten, MD

I would say our program absolutely reflects the larger trend toward greater use of in-home care. Welcome Health is a little different from hospital at home because we're starting out with primary care. So if a senior who is a Welcome Health patient, for example, wants a physical exam, or if they had high blood pressure and wanted their blood pressure checked, we could have physicians or other allied health providers go out into that senior’s home or reach out to the senior remotely via telemedicine to deliver that service.It would be at some point a natural evolution to include hospital at home, but we're much more comprehensive. We will see seniors for most medical conditions in their homes.

And there are clear reasons why we will be seeing ongoing adoption of primary care and hospital care at home. It promotes improved health in a way that ultimately will help bring down the overall costs and keep people healthy.

For hospital at home, there's good scientific literature — randomized controlled clinical trials, which I absolutely love — where they randomized patients to either receive their care at home or receive it in the hospital. And those who received their care at home had lower mortality rates and an overall better patient experience. So there’s very good science supporting the use of hospital home for patients with selected conditions. Given that it's more convenient, we see the acceleration in the adoption of hospital at home in the future. This is what led Binoy and SCAN’s president and CEO, Dr. Sachin Jain, and others to found Welcome Health before I got to SCAN —  if you look at seniors today, many of them are not happy with their current healthcare options.

I think this issue was epitomized in Dr. Eric Topol’s book The Patient Will See You Now. Topol says patients in many cases are looking for care that meets them where they are and that is more convenient, more affordable and of higher quality than what's available to them today. We are also finding that many patients, particularly seniors, have mobility or transportation issues — or their kids might need to take a day off work to take them to the doctor, for example.

So with affordability and quality of care in patient experience being our north star, we said to ourselves that we need to serve seniors better.

And then you have the impact of COVID-19. I'll speak for my mother for a second. She's mobile, but she was scared  during the COVID pandemic that if she went into the doctor, she would catch COVID from the person sitting next to her in the waiting room. Her son, the doctor (me), could not convince her to go see her doctor despite more attempts than I could count during the entire pandemic until she was fully vaccinated.

And I don't think my mother's alone. I think there are other seniors out there afraid of getting COVID if they go to their doctor's office, and they are looking for an alternative, like receiving care in their home. So for all these reasons, our goal is to deliver as much care in the home as possible, particularly to seniors and Medicare Advantage patients who desire that care in the home.

Binoy Bhansali

Also, if you think about what other risk-bearing primary care players got right, it was the business model: to be able to take full risk and have the flexibility to invest in what would keep the patient healthy and independent. But what they didn't necessarily do was to transform the care model. So we think what Welcome Health is poised to do is both —to build upon so many of the lessons learned from risk-bearing providers that are out there in the market today and to truly transform the care model to be centered around the home.

It’s also essential that the approach be guided by the principles of geriatrics. We think that is critically important as we address things like prevention and the real management of somebody's life as they age. Without that as a foundation, we would not succeed.

Can you give us some background about SCAN  and Welcome Health, and how that arrangement came about?

Bhansali

SCAN Health Plan was founded in the 1970s, and its original intent was to find unique ways to keep seniors healthy and independent. Starting in the 1980s up to the early 2000s, SCAN received funding by the federal government in what was called the Social HMO Demonstration Project to fund services that were not covered by Medicare at that point. In the early 2000s, SCAN became a nonprofit Medicare Advantage [MA] plan, and it since has grown to 220,000 members. As we think about the next phase of growth for SCAN, we are entering new markets, namely Arizona and Nevada in 2022, with our MA product, and we’re also diversifying our organization to serve our members in unique ways.

A major part of that diversification is building companies. SCAN is partnering with seasoned entrepreneurs to build companies from scratch that are payer-agnostic and can bring high-quality care to seniors. While we are investing in these companies to extend our reach and impact, SCAN is also a first customer and capital partner to the companies as they go out and build scale. Welcome Health is an important part of that effort.

Weingarten

I'm a physician by background  —  an internist. I spent the majority of my career at Cedars Sinai, most recently as a senior vice president.  I have also taken care of many patients. In my role at Cedars, I oversaw a lot of the value-based care initiatives. I came over to SCAN only recently and was very excited about all the organization’s initiatives — including the opportunity to lead a comprehensive geriatric in-home care program.

Q

What is it about your program that sets it apart from other approaches, particularly those that hospitals are pursuing ways to extend their ability to deliver care beyond their walls? And how does the program work from the patient’s standpoint?

Weingarten

This will be a new offering, at least in the markets that we serve to the best of our knowledge. We haven't identified any other services out there that deliver care the way that we described it. We employ primary care physicians with an emphasis on geriatricians.

But, again, the focus is primary care. So we also are partnering with other providers because some of our patients will need some subspecialty care. And we will partner with health systems and the communities that we serve to help us deliver that subspecialty care when it's required. And some patients, despite our best efforts, unfortunately, will also need to be hospitalized. So we also need to partner with hospitals in the communities that we serve.

Q

Where are you in terms of implementing this strategy? And what's your time frame? What are you looking at in terms of a developmental process? And what kind of investment in infrastructure does this program require?

Weingaten

We are in the process of launching it. And we've hired some of the top geriatricians in the greater Los Angeles community who are excited about new care delivery model for seniors and about transforming care. So we've been extremely fortunate and bringing them on board. And we're developing all of the processes and the infrastructure so that we believe early next calendar year, the first half of 2022, we will begin treating our first patients.

Bhansali

We made a meaningful investment in the company to get it through Phase 1 of growth. That means we have to build the team, build the technology and the logistics infrastructure to serve patients in this way, and build out the partnerships and marketing prowess to attract patients into the model.

So all those pieces are well underway to being built now so we can start seeing patients in the first quarter of 2022. SCAN will be a significant capital partner to this business, and certainly a customer. But at the end of the day, we are thinking about the impact we want to have on the broader community, which is to extend the reach of high-quality services to as many patients as possible.

Welcome Health is not a SCAN-focused business. It's a payer-agnostic business that will strike contracts with other health plans and other entities over time, as well.

Q

How do you look at this undertaking from a cost-benefit perspective? In other words, how do you see it transforming into something that is viable from a financial standpoint?

Weingarten

SCAN did market research and focus groups, and they found there’s a tremendous unmet need. Many patients were saying things like, “My gosh, if there was a service that could care for me in my home, I would prefer that. Sign me up! I don't like the challenges of going to the doctor's office or waiting in emergency departments on weekends if I don't have to.”

So we got a clear message from patients that they are looking for this type of service, which gives us reason to believe adoption will be significant. And we have a business plan, with five-year projections and investment required and break even. But we believe a significant percentage of seniors will opt for more convenient, high-quality and affordable geriatric care in the home when it is available.

And just like what Topol talks about in his book, seniors will look back and say, “Do you remember the days when, if you had something simple that could be cared for in the home, you had to get on the freeway and pay $20 for parking and sit in a waiting room for half an hour for something that took the doctor five minutes to do?” And people will reflect and say with amazement, “Was that really the way a lot of care was provided in 2021? I'm having trouble believing that!”

Bhansali

We also are totally committed to this approach. Over time, we'll continue to fund the business and bring in other investors over time to fund the business alongside us. We just want to have the best minds and best partners around the table who can amplify the impact of a great service. That's our orientation. And it’s a national strategy. It will take years, but over time, we would like to build a national business that can bring Welcome Health’s services into the hands of as many seniors as possible.

Weingarten

And we think an initial focus on [Los Angeles] County and Orange County is a great place to start. If those counties were a state, it would be the fifth largest state in the country, after California, New York, Texas and Florida. So we have a lot of seniors, a lot of MA patients to serve, even just starting with a local strategy.

Q

What advice would you have for healthcare organizations similar to yours, or just for providers in general, that are considering participating in an initiative like this one?

Weingarten

If you go outside of healthcare and look at services industries, you’ll see that the company that provides the highest-quality service leading to the best experience at the most affordable cost almost always wins. It would be unrealistic to think healthcare would be an exception to that rule. So we have to think about meeting the patients where they are.

And it’s clear than in many cases, patients will prefer their care be delivered in the home, because it means they don’t have to struggle to go into the doctor’s office for a relatively minor condition or for a physical exam. And for seniors, it eases the burden for their children from possibly having to take a day off work each time a parent needs to go to the doctor.

I think that why we can expect this trend to continue, and you need to take a far-sighted view.

So my one other piece of advice is to stay on top of this trend. If you don’t, you could find yourself left behind in five years from now.

About the Author

Eric C. Reese, PhD,

is an editor and writer, HFMA, Westchester, IL

Sign up for a free guest account and get access to five free articles every month.

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