Home Health
EviCore by Evernorth® Home Health offers enhanced utilization management and care coordination to help ensure patients receive quality, clinically appropriate home-based care. We offer added value with our national network of home health agencies, which connect patients to providers on behalf of our health plan clients.
Medical Necessity Reviews
EviCore Home Health evaluates the medical necessity of requests using evidence-based clinical guidelines based on criteria such as frequency of episodes in care and number of visits.
Patient-Centric Coordination
EviCore prioritizes communicating with providers to ensure patients receive appropriate care. Together, we design individualized care plans that focus on patient goals; further, we monitor progress and risk factors to reduce readmissions.
Network Management
Through value-based contracts, network management improves patient outcomes, positively impacts recovery and enhances quality of life. We monitor provider performance within our national home health network, assist patients with finding in–network providers and decrease the time from request to first visit.
A shift in the population to older age groups, including those with chronic conditions, continues to accelerate and requires new models of care. Delivering quality care in the home setting can be more effective at improving health outcomes while providing essential support to reduce hospital readmissions and unnecessary visits to the emergency department. By coordinating care across your providers and avoiding duplicate treatments, your care team can focus on making sure you receive the right care at the right time. This leads to a more patient-centric care plan.
Agency Network
Evernorth® Health Services offers flexible provider network options to support the program that works best the patient. Our open framework allows clients to incorporate the Evernorth national home health network, use their own network or use a combination of both. By using the EviCore Home Health provider network, clients can benefit from discounts, reduced administrative work time and a quicker transition from request to first visit. Plus, the EviCore Home Health agency network has over 6,000 locations nationwide that provide up-to-date contracts, deep discounts, and relief from administrative burdens.
Patient Satisfaction
Our clinicians have extensive knowledge of the post-acute and home health care landscapes and ensure delivery of the appropriate level of care. We focus on timely decisions, and survey results show 95% of patients were satisfied with our response time.
Readmissions
Not receiving home health services may place patients at risk for readmission. It is estimated that the cost of hospital readmissions tops $26 billion annually, and many of these readmissions are avoidable. Our strategies, which focus on helping improve patient health to reduce the potential for future costly care episodes, reduce readmissions by 8%.
Frequently Asked Questions
The EviCore Home Health program provides skilled care services, such as nursing, physical therapy, occupational therapy, speech therapy and social work, in the comfort of the patient’s home.
The process begins with a referral from a licensed medical provider (such as a doctor, nurse practitioner or physician assistant) to a home health agency (HHA). The HHA will do the following:
- Receive the request for a medical necessity review, if required, from the patient’s insurance company.
- Send a skilled provider (e.g., a nurse or physical therapist) to the patient’s home to perform a thorough assessment.
- Develop a suggested plan of care, which is sent to the referring provider for review.
- Submit the assessment and care plan to clinical reviewers at the insurance company if additional visits are needed. These reviewers compare the information to evidence-based guidelines and collaborate with the home health provider to determine coverage.
This program ensures patients receive high-quality, coordinated care, tailored to their individual medical needs, at home.
- Individuals with chronic illnesses, such as heart disease, diabetes, kidney disease or pulmonary conditions like Chronic Obstructive Pulmonary Disease (COPD).
- Those recovering from surgery, a recent inpatient admission, or an illness.
- Anyone needing education on their condition and/or medication.
- Individuals who have frequent visits to their doctor or the hospital.
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