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A growing number of health plans recognize the value of home-based care, with some taking active steps to ensure their members actually utilize these care services.

Engagement with health care services has historically been a persistent challenge for health plans, as SCAN Group CEO Dr. Sachin Jain has previously noted.

“Patients are not necessarily engaged in their care,” he said at the Home Care Innovation + Investment Conference in 2023. “They’re a lot like unemployed people, where at some point they reach a critical point where they actually stop seeking out care because it’s so complex and challenging.”

SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 310,000 members. The Long Beach, California-based Medicare Advantage (MA) plan is part of the SCAN Group, a nonprofit organization focused on helping senior citizens stay healthy and independent.

Increasing engagement by connecting members to the right resources and services is Dr. Khin-Kyemon Aung’s top priority as vice president and medical director of population health at SCAN Health Plan.

“My role is really to think holistically about our members’ — medical, behavioral health and social — needs and identify ways that we can support them as they navigate our very complicated health care system,” she told Home Health Care News.

For Kaiser Permanente, offering community-based support is crucial to improving member engagement, according to Bill Gammie, senior operations director of post-acute utilization for Kaiser Permanente’s mid-Atlantic states.

“We want to ensure members have quick access to all the [offerings] within the Kaiser Permanente network,” he told HHCN. “We also want to make sure that we’re interacting with them and supporting their healthy days at home.”

Kaiser Permanente is one of the largest health systems and medical groups in the country. Its health plans cover nearly 13 million people across eight states. Gammie works across the organization’s mid-Atlantic region to support skilled nursing facilities, hospice, palliative care and home health.

Strategies to increase engagement

Kaiser Permanente’s use of care management is a key strategy to ensure members use home-based care services.

“We’re connecting with members on a consistent frequency,” Gammie said. “We’re asking various lists of questions to make sure that we’re getting a deeper understanding of where the gaps may be, and what services in the home can help them. We also leverage information to be able to identify if there are risks in regards to social determinants of health.”

With this information, the organization connects members to the appropriate home-based care services or program.

The organization also operates a community support hub, called Thrive Local, which it leverages to help members connect with resources.

“We have this available to members, so they’re receiving what we deem their social health,” Gammie said. “They’ve got a safe place to live, they have access to healthy food, and to make sure that there are good relationships to help align the full spectrum of a member’s needs.”

At SCAN Health Plan, connecting members to the right home-based care resources is a three-part journey, according to Aung.

The first part involves helping members navigate care when they first enroll. Next, in the case of a serious health event like a hospitalization, the health plan assists members. Third, the organization works to proactively engage members when it notices that an individual might require more care.

“This [third part] is related to risk, ratification and monitoring of a variety of needs that members may be having,” Aung said. “At SCAN, we really try to focus on all three of these strategies to make sure our members are connected to the right resources at the right time.”

Overcoming hurdles

Strategies to keep members engaged are not without their challenges.

One common challenge that Aung noticed was that members are often overwhelmed by the number of outreach efforts they receive from various organizations.

“What happens is that members are often receiving all these different phone calls,” she said. “There isn’t always someone who is there for them when they really need help. That’s something we’re very much thinking about, how we can be proactive in the care that we provide and not duplicate services that are already being provided by the medical groups, and really work collaboratively.”

To combat this, SCAN Health Plan spends time building relationships with the primary care practices, medical groups and hospitals, so that all of the organizations the member is interacting with are on the same page.

“It feels like the left hand is talking to the right hand in that it’s a coordinated, orchestrated type of clinical experience, so that members don’t feel like they’re getting the run around,” Aung said. “Members are being pulled in different directions. They’re hearing one message that’s aligned, and that’s a huge area. I think it is a challenge with all the fragmented systems that we have in health care.”

Looking ahead, Gammie pointed to the continued evolution of home-based care and the importance of continued investment in this sector as paramount to the work of organizations like Kaiser Permanente.

“Continue to invest and evolve — those that have done that will be the ones that will make a greater impact in the communities they serve and have better relationships and better alignment with dynamic payers,” he said.