Jessica Tassan’s grandmother hadn’t seen a primary care physician in a decade when the nurse from health care provider Signify Health made a home visit at the end of July. Sensitive and personable, the nurse alternated between making jokes and asking about loneliness and depression. Her comprehensive review included teaching Tassan’s grandmother how to better use her inhaler for asthma.
Two weeks later, her grandmother’s insurance company followed up and put her in touch with a primary care doctor.
“Honestly I was blown away by how great of an experience it was,” said Tassan, a health care research analyst who observed the visit.
Tassan works for investment bank Piper Sandler Companies and follows Signify, Teladoc Health, Amwell, and other public health care services companies. The nurse visit gave Tassan unique insight into how Signify works, one month before the company announced last week that it would be bought by CVS Health for $8 billion.
What comes next may position CVS to enter a new phase of delivering health care, as CVS executives said in a call with investors after the announcement that the deal would lay a foundation to expand into home health care.
CVS declined to specify what that might entail. However, experts said such a vision could include adding home visits to the menu of primary and urgent care services currently delivered in CVS stores and through its telemedicine program.
“This transaction is a significant step forward in our strategy to enhance our care delivery for consumers and to be able to meet their needs when and where they want care. And the home is increasingly part of that choice,” said CVS chief executive Karen Lynch.
CVS has already come a long way from its roots selling health and beauty products, growing to a drugstore chain and then as a pharmacy benefit manager with the acquisition of Caremark Rx. The company furthered its reach into the health care ecosystem by acquiring MinuteClinic in 2006 and then health insurance company Aetna more than a decade later. The retail giant has since expanded into telemedicine and primary care.
Signify operates a network of 10,000 doctors who visit patients in their homes. But these modern house calls are much different from the nostalgic image of small-town family doctors making their rounds. The bulk of Signify’s business involves sending providers to patients’ homes to conduct risk assessments on behalf of insurers, mostly Medicare Advantage plans, not to actively treat a particular condition.
While the assessments are comprehensive, as Tassan witnessed, one of their purposes is to document how ill their members are, metrics that help determine the amount of reimbursement insurers receive from the federal government.
Companies like Signify that conduct health risk assessments have historically been hired by insurers for patients who don’t regularly visit a doctor, as was the case for Tassan’s grandmother.
The visits also help insurers proactively understand and address specific needs of patients in a more cost-effective fashion, critical for insurance plans that are reimbursed on a predetermined amount.
The company coordinates some follow-up care with other sources and also shares information with a patient’s primary care provider and the health plan so they can connect patients to additional services and care.
Signify said that delivering more care in a person’s home is a potential natural extension to the work it is already doing. While it would not commit to sending doctors to patients’ homes to care for their illnesses, the company said it would discuss the possibilities with CVS after closing the deal and noted CVS has the resources to accelerate its growth.
“Signify is identifying patients’ clinical, behavioral and social needs, and connecting patients with needed follow-up care. This is a large part of what primary care consists of,” the company said in a statement. “While we are not — as of today — providing treatment, it is a subject that we have spent a lot of time considering, given that we have a very large and highly qualified mobile network of clinicians.”
However some are skeptical that the company could pivot to providing in-home treatments so seamlessly.
“There is this perception that Signify’s already in the people’s homes, that flipping that to a home care model should be relatively easy. Well, that’s not the case at all,” said Sean Dodge, an analyst with RBC Capital Markets LLC. “They’re visiting people’s homes, and running down a clipboard and documenting, not providing care.”
Dodge also said there are logistical, operational, and regulatory hurdles to expanding home-based care. Such services would ultimately be driven by the cost of having physicians travel to see patients.
“You’re not going to have a 25-year-old person with a flu or a cold that’s just going to have a physician show up and sit by your bedside and take care of you,” Dodge said. “I think it’s going to be for people that are older and more frail and sicker, where it justifies the expense of paying a physician to go in and spend time with these people.”
Tassan said that while Signify visits are not currently providing care in the home, they can uncover more information on members’ health and wellness and are more comprehensive than standard annual exams.
“An annual wellness exam is seven to eight minutes long, and rediagnoses existing conditions,” Tassan said. “In-home evaluations are much more thorough, the patient is much more comfortable, they are more inclined to show some things, show you medications they’ve been taking, tell you they don’t know how to use their inhaler.”
But there are still gaps between Signify’s services and doctors delivering comprehensive care to patients in their homes. Signify may have a base of clinicians already in patients’ homes, but those clinicians might not want the responsibility of treating patients.
“The nurse I spoke to said explicitly, ‘I like my job because I get to go home and don’t have to worry if a patient takes my advice or what happens,’ ” Tassan said. “Her obligation is to be present and excellent in the hour she’s with the patient. And she doesn’t have to worry about what comes next. To me, that suggests their clinical base . . . wouldn’t be willing to expand their scope.”
Dodge noted that CVS could still benefit from Signify in the interim even without yet providing home care. By understanding more about patients, and seeing their living conditions, CVS can help spot circumstances outside of the health care realm that make people sicker — such as poor access to transportation, lack of a healthy diet, and other environmental factors. Those insights could help the company decide where to invest to improve patients’ health.
Whether CVS will obtain home care, and meet the needs of those who need it most, is still a question, said Alan Cohen, a research professor of markets, public policy, and law at Boston University Questrom School of Business.
“Whether or not CVS-Signify would increase access to rural and underserved populations is debatable,” Cohen said. “CVS and Signify claim that they will do this but, if we draw from the experience of the CVS — and other — retail clinics, few of them operate in medically underserved areas, and it is doubtful that access to care will increase appreciably in these areas.”
Jessica Bartlett can be reached at email@example.com. Follow her on Twitter @ByJessBartlett.