NORTHSTAR MEDICARE ADVANTAGE
Clinical programs · In-home health assessment
To: Chief medical officer
From: Clinical programs
Re: In-home health assessment program, launch decision
| Members | 1,140,000 |
| Visits a year, at full scale | 392,000 |
| Vendor fee per visit, 2026 dollars | $451 |
| Visits adding a new paid diagnosis, 2020 risk model, 2019 to 2021 | 60% |
| Treatment ordered at the visit | none |
| HIV diagnoses added by insurers, home visits and chart reviews, on HIV treatment | under 17% |
| Same measure, one insurer's chart review of its home-visit patients | 67.4% |
| Added CMS payment per visit, 2024 risk model, 2026 rates, at most | $1,813 |
| Risk score uplift per visited member, modelled | +0.112 |
| CMS coding adjustment to risk scores, all plans, already applied | −5.9% |
| Vendor fees, annual, at full scale | $177M |
| Added payment from CMS, annual, at full scale, 2026 rates | $711M |
What the analyst was told
What the analyst was told
What the patient was told
You got sick.