The program entices physicians to manage the entire care of these chronically ill seniors. "For a doctor home visit, you can only bill Medicare for about $150. But with the bundle payment, you get around $5,000 to manage all their healthcare for a period of time," says Paul Roller, MD, with Geriatric Healthcare Services.
Roller, whose patients are almost all on Medicare, saw a business opportunity emerging from this, considering the potentially rocky future of ever-changing healthcare reimbursements. "In the Medicare business, you have to go where the patients are rather than wait for them to come to you," Roller says.
He's started a company called Concierge at Home. "Our program uses geriatric care managers to assess and identify the needs of the senior patients and then offer a network of providers to fill those needs," Roller says. Those providers could be for meals, legal services, home modifications, transportation, or most any personal services. If clients choose to hire the providers in Concierge's network, they get a discount price.
In addition to serving as care managers, Concierge at Home sends physicians or physician's assistants right to the client's home. The physician bills Medicare for the visit.
The ease of access to a physician reduces hospital admissions, especially emergency room visits, which is where the big costs are. "Especially now that Medicare will not pay anymore if a patient comes back for the same diagnosis within 30 days," Roller says.
Concierge also provides Transition Coaches to perform as the patient's advocate. "Any changes in their level of care — hospital to nursing home to independent living facility — the coaches make sure it all goes smoothly, that the prescriptions arrive, the movers are there, or whatever might be needed," Roller says.
Before a discharge, the coach heads off anything that might become an issue. For instance, they can warn a client that a medication the surgeon has prescribed will cost them $300 and then approach the surgeon for a more affordable alternative. Roller says it's not uncommon in his practice to see patients for a follow-up who never got their prescription filled because of the expense.
The coach's familiarity with the patient and their environment also allows them to assess potential dangers in a transition. For example, the coach might talk with the hospital about delaying the discharge until the entry steps can be altered for the client to be able to handle post-surgery.
Another unique offering of Concierge will be the "face-to-face medication utilization assessment from our pharmacy partners," Roller says. A pharmacist comes to the house and reviews all the medications. He counsels the client on when to take them and on less expensive alternatives. "The estimated savings to the patient could be over $150 per month in medication costs," Roller says.
Almost nothing is off limits for the Concierge. "If you want your mom to have a manicure or get her hair done every week, we'll make it happen," Roller says. The goal is to keep the client at home or at least delay their progression into more complex care facilities, if possible.
Concierge at Home's first client starts this month. "I'm still getting my feet wet, but I don't want more than six clients per month right now, because I'm not sure how it will impact my practice yet," Roller says.
"But if everything goes the way it should, the patient in the Concierge at Home program will be the exact patient that will already be approved for Medicare's Independence at Home program. Then we can roll them over into that program."
With or without the Medicare program, Roller hopes down the road to be able to demonstrate that the Concierge program saves money over traditional care plans. "If we can show that we're decreasing costs, then we can go to hospitals and insurers with this option."
This managed care approach to healthcare and keeping people in their homes makes sense, Roller says. "We should have been doing it all along. Medicare's been designed to care for you when you're sick. But when you're not sick, there's nothing."
He quotes the cheapest one-bedroom assisted-living expenses at $2,800 per month, including two to three meals a day, housekeeping and medicine management. "We can bring all those services to their home for less. Even with lawn care, food, and mortgage costs, if they want to stay at home, we can do this cheaper and bring the services into their house."
