Detection Of Undiagnosed Disease In Medicare Beneficiaries After A Clinical Home Visit

Undiagnosed chronic conditions are a common and costly problem in Medicare patients. This study examined whether a clinical home visit program was associated with an increased future detection of undiagnosed diabetes, chronic obstructive pulmonary disease (COPD), and atrial fibrillation. Members of Medicare Advantage Plans (MAP), including Chronic Special Needs Plans (C-SNP), were identified who received a comprehensive geriatric home visit under United Health Group's HouseCalls program and those who did not. Members with no medical or prescription drug claim for diabetes, COPD, and atrial fibrillation in the 12 months prior to the visit were selected. New diagnoses were then identified based on claims for office visits and/or prescription drugs in the 6 months after the HouseCalls visit. Members who received a visit had a significantly higher rate of detection of previously undiagnosed diabetes and COPD, but not of atrial fibrillation. The detection rates for diabetes within 6 months of the visit were 2.8% versus 2.3% (P < 0.01) for MAP and 7.1% versus 5.6% (P < 0.01) for C-SNP members. For COPD, 2.5% versus 2.2% (P < 0.01) of members in MAP and 5.3% versus 4.3% (P < 0.01) of members in C-SNP were newly diagnosed. New diagnoses for atrial fibrillation were not significantly more common for members in MAP (1.4% versus 1.3%)) and C-SNP (1.9% versus 2.1%). These findings suggest that a home visit program, such as HouseCalls, is a promising avenue to address the hidden disease burden and unmet care needs in the Medicare population.