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Case Study: How At-Home Care Improved a Rural Patient’s Health

JUNE 23, 2022

As told by HealthComp Case Manager, Georgia, BSN, RN, CCM


1. OVERVIEW
One of our members, a woman with Crohn’s disease, was missing her medical appointments. We asked her why and she shared this was because she could not drive and her husband had to miss work to take her to her appointments – an hour’s drive each way. At times he could not leave work so they would have to miss her appointments. Other times, he would have to take vacation days to drive her.

2. CHALLENGES
Without proper treatment and with missed appointments, this woman experienced an increase in symptoms. Although Crohn’s disease is incurable, its symptoms can be managed with lifestyle changes and medications – hopefully leading to a patient’s long-term remission and inflammation healing. But for Crohn’s disease patients like her, symptoms can worsen if left untreated, leading to someone having further digestive damage and even possibly needing surgery. So, we needed to get her help quickly to help improve her health outcomes.
We started looking into available rideshare and community resources this woman could take advantage of. When we researched her location compared to government offerings, her area had limited options. Rideshare was quickly eliminated as a practical solution. She would have had to pay for it herself – on top of infusions and out-out pocket deductible, and co-pays, which could get pricey fast. Other free options still meant it would be two-hours round-trip for travel to her appointments.

“We listen to members to find out what their true needs are and what stumbling blocks keep them from adhering to treatment.”

3. SOLUTION
We started looking into if the patient was interested in having treatment performed at another point of care – like in her home. We looked into if the doctor would order this medication to be given at home, as well as a provider that could offer this service.
In short, we managed many moving parts. Sometimes in situations like these, doctors feel a candidate should not receive care at home. In other cases, a doctor supports this, but the patient is uncomfortable having someone come into their home in this way. Or sometimes, there’s no available agency or provider, depending on the medication and corresponding protocols that need to be administered. So, we addressed issues such as these when deciding.
In the end, we found a home health organization that had the right medication protocol and allowed at-home infusions. Everyone from the doctor to the patient agreed that home was the best point of care in this circumstance. It was a priority for the woman that her husband didn’t have to transport her.
We were able to secure a Preferred Provider Organization (PPO)-level discount on home health care – great savings-wise for her and the group employer.

“Case managers develop a rapport with members after a while. Members come to see us as friends or family members.”

4. IMPACT
The patient never missed another treatment after she was directed to the right point of care that suited her lifestyle. Her symptoms and lab work improved, and she’s since been discharged from case management and is doing well. Her husband has also missed fewer workdays because of her home health care.
Since then, we remain in direct contact with her as a support system, to make sure she’s still active, feels good, and that she has the right insurance coverage.
By helping her have her infusion venue switched over to home health, we increased her compliance, resulting in good disease control. We also helped her avoid hospital admissions, resulting in nearly $18,000 in employer savings. Additionally, in-home infusion versus outpatient infusion at a clinic saved the employer nearly $130,000 annually.

“At the end of the day, her husband could stay at work and she could stay at home; she got her medicine and her symptoms improved.”

Chad Harris

Chief Executive Officer

 

Chad Harris serves as the CEO of HealthComp and is a values-driven healthcare leader with over twenty years of experience running business process and information technology businesses as a senior executive. Chad has a reputation for creating and controlling rapid growth by focusing on the intersection of customers, market dynamics, and the new digital world.

 

Chad has held many senior executive positions and led global teams of more than 10,000 people across dozens of counties. Chad has grown both large and small businesses, from those with less than $100M of revenue to those producing multiple billions of revenue, focusing on delivery, customer satisfaction, and innovation to create market leadership.

 

Chad's philosophy is to inspire change by doing what comes naturally, putting the needs of others before his own, working incredibly hard, and focusing on "how" to accomplish things, never "if they can be accomplished."

Thomas Martel

Chief Growth Officer

 

Tom serves as the Chief Growth Officer at HealthComp. In this role, Tom focuses on strategic initiatives aimed at accelerating HealthComp’s growth nationwide. His passion lies in assessing market and enterprise structures and creating efficiencies that enable teams to deliver best-in-class performance.

 

Previously, Tom led Cigna’s largest employer segment, largest region which was comprised of several health plans including the two largest health plans. He worked closely with Market Presidents and their leadership teams to develop and execute local market strategy and deliver growth for the enterprise. Tom earned his degree from Saint Anselm College and holds certifications from The Wharton School and the Darden School of Business at the University of Virginia. In his spare time, he enjoys sailing and holds a Master Captain’s license with the U.S. Coast Guard. He is also active in community outreach programs including local food bank and shelter services.

Sanoj Balakrishnan

Chief Technology Officer

 

Sanoj Balakrishnan serves as the Chief Technology Officer at HealthComp. In this role, he oversees the company’s overall technology strategy and architecture, building secure and highly scalable distributed systems.

 

Most recently, Sanoj served as Head of Healthcare Digital Business and Technology at Cognizant, working with payers and providers in developing solutions that reduced healthcare costs and provided a best-in-class experience for members. Earlier in his career, he worked at technology organizations in a variety of software engineering and architecture roles. Sanoj earned his B.S. from University of Mumbai and Computer Systems Management from National Institute of Information Technology.

Justin Tran

Executive Vice President, Product

 

Justin serves as the Executive Vice President of Product at HealthComp. He has 8 years of experience in developing and delivering solutions that reduce health care costs, improve quality, and provide a best-in-class experience for members. Most recently, Justin was an Associate Partner and business unit leader at McKinsey & Company where he helped large carriers and healthcare technology companies build new clinical services and solutions for fraud, waste, and abuse. Justin earned his B.S. in Accounting and Data Informatics from Indiana University, Bloomington.

Tucker Stein

Chief Financial Officer

 

Tucker serves as the Chief Financial Officer of HealthComp. Tucker previously worked for The Boeing Company in a number of finance and strategy roles, most recently as a finance lead for the Transactions and New Business Development group. In this role Tucker led investments and strategic partnerships for Boeing’s Space and Communications portfolio. Tucker earned his MBA at Stanford’s Graduate School of Business and his Bachelors of Science at the University of Redlands.

Tom Georgouses

General Counsel

 

Tom is involved in multiple areas of HealthComp including Operations, Compliance and Legal Affairs. Tom was admitted to the California Bar in 1990 and started his legal career with Stammer, McKnight, Barnum and Bailey, LLP. When he left the firm to join HealthComp in 2014, he was the Managing Partner (he had represented HealthComp since 2003). In private practice Tom’s areas of focus included healthcare and transactional work. Tom holds a Bachelor of Science Degree in Business Administration-Finance from California State University Fresno and received his Juris Doctorate from San Joaquin College of Law.

Rishab Bansal

Chief Transformation & Operations Officer

 

Rishab serves as the Chief Transformation & Operating Officer at HealthComp. Rishab focuses on transforming and modernizing HealthComp’s operations to provide delightful and distinctive experiences to its members, providers, and clients. His agenda includes integrating all entities towards a One HealthComp vision, driving profitable growth, and delivering value and business outcomes.

 

In his former work over the last 2 decades, he has helped clients across industries to transform themselves by bringing industry-leading practices and digital and data-led disruption. As the trusted advisor to the C-suite, Rishab helped his clients leapfrog on their transformation journey to accelerate business outcomes and helped them unlock new opportunities to drive profitable growth, profitability, and enhanced experience for their employees and clients.

EDI Information

If you are a healthcare provider and have the capability to submit healthcare claims electronically and use one of the clearinghouses listed below, please use the associated payor ID to submit claims destined for HealthComp.

Clearinghouse Medical Payor ID Dental Payor ID
Availity 85729
Capario HCOMP
CareVu 85729
Dental XChange DX029
Emdeon/WebMD 85729 85729
Claimant.com 85729
I-Plexus Solutions 85729
McKesson (RelayHealth) 85729
CPID:
HCFA - 3206
UB - 2934
NDC 85729
Office Ally 85729
OptumInsight (Formerly Ingenix) 85729
Tesia 85729

We strongly advise that you confirm our payor ID with your clearinghouse before you submit claims electronically to us.
For questions regarding our EDI capabilities, please contact our EDI Coordinator



Elaine Davis

Chief Human Resources Officer

 

Elaine Davis serves as CHRO for HealthComp. Elaine previously served as CHRO for Continuum Global Solutions and has served in executive leadership positions for Xerox and GlaxoSmithKline. Elaine holds Bachelor’s and Master’s degrees from the University of California at Berkeley.