- HouseCalls provides home visits for UnitedHealthcare Medicare Advantage members where advanced practice clinicians spend 45 minutes to an hour assessing health and social needs.
- The program drives greater access to care and earlier disease detection as 76% of members follow up with their physician within 90 days of a visit.¹
- Clinicians build rapport with patients, connect them to vital resources, and sometimes even help prevent serious health events like strokes.
Helping people get the care they need where and when they need it is a shared goal across the health care industry, but how to achieve it is not so simple. What will convince people to get the preventive care they need to identify issues early? How can health care be provided in a truly integrated, holistic way, addressing not just the patient's physical health concerns but also their behavioral health needs and the social drivers of health?
For UnitedHealthcare, one of the answers is HouseCalls. In this program, Medicare Advantage members receive an annual home visit from an advanced practice clinician, typically a nurse practitioner, who takes the time to understand individuals' physical, mental, and social needs and helps build a plan to address them.
"When we spend time in members' homes, we find the things that don't come up in the clinic but will absolutely affect their ability to stay healthy and manage a chronic condition," said Dr. Alexander Billioux, chief medical officer of UnitedHealthcare Government Programs.
In-depth visits, in-depth insights
A HouseCalls visit is quite different from a clinical appointment in a doctor's office. First and foremost, being at home often makes the member more comfortable while giving the nurse practitioner greater insight into their life. This matters, Billioux said, as so many preventable health issues are affected by everyday, non-clinical factors.
Susan Sanner, a HouseCalls nurse practitioner with over 10 years of experience, typically starts her visits by scanning the home environment to assess whether patients can effectively care for themselves. That could mean food in the refrigerator, adequate furniture, a functioning furnace, and an absence of clutter.
"I look for signs of healthy or unhealthy behavior," she said. "Those factors impact their ability to manage their health."
Another point of differentiation for HouseCalls is the length of the visit. Nurse practitioners are in the home for 45 minutes to an hour, compared to the standard 15-minute office visit. Billioux noted that this gives nurse practitioners time to build rapport and have an open conversation.
"When people go to a clinic, they develop a mental framework of what they need to talk about during the visit, based on what they think the doctor or nurse is interested in," he said. "They don't always get a chance to bring up that they don't have enough food or access to transportation."
Sanner agreed the visit format helps patients feel comfortable. She has more time to observe and react to verbal or body language cues and ask open-ended questions such as "Can you tell me more?" or "Do you have everything you need?"
"When you have the time to ask the right questions, people start to say the things they want to talk about but don't know how to bring up," Sanner said.
Addressing complex needs —and preventing adverse events
Billioux said those who reap the greatest benefits from a HouseCalls visit typically have been diagnosed with multiple chronic conditions or live in areas with a shortage of primary care providers (PCPs), making it more difficult for them to get to a clinic or doctor's office. And about one-third of HouseCalls visits occur in low-income communities.2
In the greater Atlanta communities that Sanner serves, she often sees patients struggling with heart disease, pulmonary conditions, and mental health needs.
"The increased time we spend during a home visit is valuable for getting insight into the issues patients face and identifying the resources that could help them," she said.
All the factors that make HouseCalls so effective from a care delivery standpoint — the extra time for the clinician to talk with the patient, the insights from being in the home environment, the connections to resources that can help enhance the patient's health and wellbeing — also make the program overwhelmingly popular with members, who have given it a 99% satisfaction rating.3
And perhaps most importantly, HouseCalls is not a one-and-done type of program, but rather one that encourages members to prioritize their health and get the care they need to maximize it: 76% of people have an in-office PCP visit within 90 days of their HouseCalls visit.
For Billioux, this reflects the key role HouseCalls plays in enabling continuity of care for members with complex needs.
"Providers often have narrow visibility into what's going on. They may not know how changes in someone's everyday life are affecting them," he said. "We're building a relationship with members that spans the continuum of their health."
While the majority of HouseCalls visits focus on general health and wellbeing and address common health concerns in older adults such as high blood pressure, they occasionally take a more dramatic turn and lead to life-saving health care interventions. By building a trusted relationship with their patients, nurse practitioners like Sanner are in a unique position to help prevent catastrophic events.
During a HouseCalls visit several years ago, Sanner's careful attention to a patient's unexpected high blood pressure reading led her to send him to urgent care — which may have prevented a stroke.
More recently, Sanner kept calm when a patient revealed a detailed plan to end her life in a mental health assessment. She called 911 and held her patient's hand as she was lifted into the ambulance. "It was daunting," she said, "but hearing something like that prompts you to act."
Sanner said performing HouseCalls visits certainly comes with challenges. But even on the most difficult days, she knows patients get something out of it.
"I find it fulfilling on a personal level," she said. "I love being able to make a difference in my community."
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This post was created by Insider Studios with UnitedHealthcare.
1Internal Data COSMOS Report, 2018.
2Optum 2020 HC Visits Analysis by Income Group and 2020 HouseCalls Overview and Impact Report.
3Optum HouseCalls satisfaction survey, December 2021.