My insurance co. wants to do 2 home visits a year.

[Heddi]

8. I'm distrustful of insurance companies even though (in spite of) working for one

but this is a good thing. The trend is definitely preventative vs. post-hoc.

I work in an urgent care center for medicare patients, but my team deals specifically with chronically ill patients with multiple comorbidities, polypharmacy, poor adherence, and high rehospitalization. Yes, there are people who have to go to the hospital repeatedly, but most don't. THe hospitals want to CYA so they admit anyone with a complex health history. My job is to keep them out of the hospital for unnecessary means. I streamline meds, I streamline specialists. I do A LOT of education on medication, health conditions, importance of taking meds and adhereing to diet....but when you have someone without a fridge (many of my patients don't have one), or someone who only has a hot-pot for cooking (many of my patients live in boarding homes and have no stove), AND they live on $500 a month SSI and get $40 a month in food stamps, it's hard to eat a low salt, low fat, low carb, high protein diet.

Chronic Care/Complex Care and the prevention of complications is big business in Insurance now. Our center does a lot of good. We're a great resource for patients for many reasons, and it's hard for me---someone with multiple advanced degrees and a working knoweldge of the health care system to navigate things. I think it's practically impossible for someone with a limited income, limited education, hard of hearing, hard of seeing, memory problems, etc, to navigate the system.

My job is equal parts RN, Educator, Friend, Case Manager, Social Worker.

We are also seeing an increase in the number of home-visiting MD's. That increases how often pt's are seen by their PCPs', and there is a direct correlation between seeing your PCP and not going to the hospital as much. So having a MD that goes to the house every 3-6 months and an NP that goes once a month really helps with understanding medications, barriers to care at home (also noticing abuse and neglect), and keeping patients healthy so that their only contact with health care isn't when they're in a crisis situation in the ER.