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How Blue Shield's Innovative House Call Services are Adapting to Stay-at-Home Orders

Telemedicine fills the gap when providers and members are at risk of contagion

Blue Shield of California’s network of home-visit specialists, ranging from the routine to palliative care, has rapidly responded to the COVID-19 outbreak, shifting much of their work to telemedicine to continue providing care, while keeping members safe.

While house calls have been vastly scaled back during the COVID-19 pandemic, plan members still can get the care they need, and at-home visits are still an option, if necessary.

Heal house call_2coivd2

For example, Heal Inc., a provider that serves Blue Shield PPO and Trio members, has moved the bulk of home visits online. Heal rolled out its telemedicine app on March 24 in California, seven other states, and Washington, D.C. Users select “talk to a doctor” in the app, then can receive the basics of a regular office visit at home. Doctors can order lab tests, write prescriptions, and refer members to specialists.

Heal’s app and website provide a list of symptoms for patients to self-screen for their risk level.

Patients who are at high risk for COVID-19 have gotten tested. Heal is balancing the delivery of care with the dangers of sending people to medical facilities.

"If we think you have COVID-19 and if the symptoms are mild, then the care plan is to stay home,” said Nick Desai, chief executive officer of Heal, speaking recently to CNN Business. “We want to keep people out of the hospital."

And members not at risk of COVID-19 who also live in places where Heal is available can still schedule an in-person follow-up appointment after a telemedicine visit.

Assessing COVID-19 risk from home

Other Blue Shield of California providers simply are working with existing platforms to serve patients by telephone or video. Landmark Health serves a targeted population of about 16,000 Blue Shield members suffering from multiple, specific chronic conditions. The provider, which is available to members in Medicare, Medi-Cal and Cal MediConnect, is conducting video visits via various commercial applications, with the aim to launch patient apps in the coming weeks. During the last 16 days of March, Landmark experienced an increase in video and phone visits by roughly 14 times its normal volume.

“We shifted a majority of face-to-face visits to phone and video,” said David Hirota, Landmark’s senior medical officer and infectious disease specialist, in a written statement on the organization’s website. “And in-person urgent care is still available with all the careful protections in place for patients who need high-touch medicine.”

Heal Telemedicine

Similarly, Blue Shield’s home-based providers in palliative care have made a big pivot. These providers focus on patient- and family-centered care that emphasizes quality of life and seek to ease the symptoms of serious illness. Among an informal poll of 20 of Blue Shield’s 44 providers across California, all have the capacity to give care by phone, and 17 said they can do video calls. Those working with video were using a variety of commercial options, such as Doximity, Zoom, FaceTime, Microsoft Teams, and GoToMeeting.

House calls are still an option – if needed

Yet palliative providers are still making in-person visits when appropriate. All of them said they still do acute home visits for symptom management and other urgent issues for patients who screen negative for COVID-19. Almost all still do initial home visits for patients who screen negative for COVID-19.

“Our providers are working tirelessly to ensure that our members still receive the best care,” says Kristen Vallone, program manager for advanced illness and palliative care at Blue Shield of California. “Many are willing to go in and care for members at home still, with proper personal protective equipment.”  

Blue Shield launched its palliative care effort in 2016 as a pilot program first in San Francisco and in Sacramento the following year. Its success spurred the program’s expansion throughout California and now, Blue Shield and its subsidiary Blue Shield of California Promise Health Plan are the only plans to offer members home-based palliative care in all 58 counties in California.