In the end, it was a simple urine test that saved Paul Engwall’s life.
The 72-year-old Lyndon, Illinois, resident saw his primary care doctor regularly and considered himself healthy, so he was reluctant to take a house call offered by his Medicare Advantage insurer.
But after a friend died of cancer, he and his wife, Lorna, reconsidered. In November 2016, they scheduled a visit with Hesper Nowatzki, a nurse practitioner with UnitedHealthcare’s HouseCalls program. After what seemed like an ordinary assessment, Paul’s urine dipstick test revealed an “outrageously abnormal amount of protein,” according to Nowatzki.
“That took me on a long strange trip,” Paul Engwall told FierceHealthcare. “I’m one of four brothers and I always thought I was the healthy one.”
The high protein levels in Paul’s urine were signs of kidney disease, and Nowatzki quickly referred him to a nephrologist. A kidney biopsy and further testing later showed he had an aortic aneurysm that was on the brink of rupturing, prompting immediate surgery.
Paul made a full recovery, but the impact of that urine test—one that is often overlooked during a primary care visit—wasn’t lost on his wife.
“Hesper saved Paul’s life,” Lorna said. “If she hadn’t done that one little thing—if she had just done everything else and not the dipstick, we still wouldn’t have known anything was wrong with Paul.”
HouseCalls sees rapid growth since 2012
That level of preventative care is a staple of UnitedHealthcare's HouseCalls program, which recently surpassed 5 million visits. The program has grown significantly over the last several years, staffing 350 advanced care practitioners in 2012 to 1,700 clinicians across 45 states and the District of Columbia.
The program was solidified six years ago with the purchase of XLHealth, a Medicare Advantage plan that focused on beneficiaries with chronic conditions that were also eligible for Medicaid. At the time, UnitedHealth predicted it would add about $2 billion in revenues.
During the company’s earnings conference last fall, UnitedHealth Group Chief Financial Officer John Rex highlighted the acquisition that appeared small on the surface but provided “unique capabilities providing in-home health assessments, primarily to seniors.”
The program has surpassed 1 million visits in each of the last three years, and the company expects to complete 1.4 million visits in 2018. That’s up from just 262,000 visits in 2012.
It’s difficult to quantify the returns on the program, said Jennie Roberts, vice president of clinical quality at UnitedHealthcare, but there’s value in the number of hospitalizations and high-cost admissions the program prevents in the long term.
“The benefit is during these health assessments, really having members identify opportunities around whether they need follow-up treatment or follow-up treatment plans,” Roberts told FierceHealthcare. “Honestly, that will drive up some costs initially, especially if members aren’t engaging with care.”
In the long term, however, it translates to fewer hospitalizations and better outcomes. A 2015 study published by the Rand Corporation found that those enrolled in UnitedHealth’s HouseCalls program had 14% fewer hospital admissions and a lower risk of nursing home admission compared to Medicare Advantage beneficiaries that weren’t enrolled in the program. Visits to specialists increased as much as 6% in the year after a HouseCall visit.
The HouseCalls assessments are intended to supplement primary care visits, but many members end up feeling it was the most thorough exam they’ve had, Nowatzki says. Practitioners typically spend 45 to 60 minutes with each member, often addressing issues that a primary care physician can’t, such as access to food and transportation that may be inhibiting access to care.
But Nowatzki says she’s also surprised at the number of recommended tests and evaluations that members say their doctors haven’t talked with them about.
“In the confines of an office visit, it’s a time factor,” Nowatzki says. “The focus is not necessarily on prevention like my job is.”