CareSight®

Bringing Care Home
DELIVERING 24/7/365 IN-HOME MEDICAL CARE FOR YOUR MOST COMPLEX MEMBERS

A small percentage of your population is fueling runaway costs and placing an enormous burden on your bottom line. Meanwhile, your overall membership is aging and developing multiple chronic diseases along the way.

CareSight can help improve outcomes for your members in ways that go beyond what traditional care management strategies can accomplish. We’re a mobile medical provider group focused on supporting meaningful clinical outcomes and effectively managing medical expenses.

  • Improve quality of life for medically complex or frail members
  • Close quality care gaps
  • Reduce unneeded utilization
  • Reduce overall medical expenses
40% reduction in total cost of care
11% readmission rate
87–91% MLR
50% reduction in inpatient admission rates
82 Net Promoter Score
22 STARS/HEDIS measures directly influenced
16 additional STARS/HEDIS measures influenced
$1,400/year HCC capture (MA population)
WHAT WE DO

CareSight is a physician-led, in-home, medical care delivery service that improves the lives of your most medically complex and frail members by preventing unnecessary utilization and lowering overall healthcare costs. We are confident in our ability to drive positive change and will place our fees at risk to prove it.

You have made significant investments in health management across your organization. Let us help you increase your impact.

CareSight:

  • Pinpoints members who are both consistently high cost and can be positively impacted through additional home-based care and treatment.
  • Our interdisciplinary medical care teams average 18 in-home visits and spend over 11 hours per year with participants.
  • Integrates a comprehensive range of medical services, including primary care, medication reconciliation and adherence, disease management, complex care management and palliative care.
  • Connects, augments and enhances your current care management efforts, filling gaps where they exist.
  • Provides 24/7/365 availability for routine scheduled visits and urgent after hours care.
  • Quarterbacks the overall management of complex members to deliver a holistic and integrated experience.

 

WHO WE HELP

We focus on your members who:

  • Drive 50% of all hospital admissions
  • Account for 40% of total cost
  • Cost an average of $38k/year
  • Have 4+ chronic conditions
  • Are on 6+ medications

 

WHAT’S INCLUDED

CareSight offers a host of comprehensive and fully integrated at-home medical services 24/7/365, including:

  • Primary care
  • Caregiver and community resource coordination
  • Disease education and self-management
  • Admission avoidance
  • Post-acute transition
  • Advance care planning
  • Palliative care
  • Behavioral health screening and support
  • Quality gap closure and point of care testing
  • Medication reconciliation and adherence

 

My CareSight provider takes the time to listen to me and go over all of my medications with me. I have COPD, diabetes, and arthritis, so it’s not easy to get to my appointments. By coming to my home, she makes it convenient for me.

Robert M.
CareSight Member

HOW IT WORKS

Identify

IDENTIFY

Using multiple years of claims data, we tailor our model to the clinical and behavioral trends within your population. Our predictive models pinpoint the best opportunities within your population, those high-cost but addressable members who need more help. We align with you to set specific goals based on your data and your plan’s imperatives.

Engage

ENGAGE

To encourage your members to enroll in CareSight, we develop a 12-month communications plan incorporating the best practices of behavioral economics across multiple channels that is consistent with your brand voice​. In collaboration with your member engagement teams, we establish campaign goals, develop materials using simple and purposeful language, and track the results of our shared efforts.

Assess & Plan

ASSESS & PLAN

We partner with you to deeply understand your current provider network and existing resources so that we can effectively embed our team and extend your impact. We become credentialed advance practice providers in your network as a specialty medical group and staff a market-based care team based on geographic concentrations of your addressable high-cost members.
CareSight integrates and coordinates care to address medical costs, quality, and revenue challenges associated with high risk populations​. Participants average 18 encounters annually with our providers spending over 11 hours a year with them. ​The national average for physician face-to-face time with a patient is only nine minutes annually*.

Care

CARE

Our physician-led medical group provides high-touch clinical support via our home-based, medical care model. This multi-disciplinary team includes nurse practitioners, RNs, master’s level social workers, community health workers and care coordination specialists. We increase the quality and frequency of information sharing with each patient’s care team, close clinical gaps and help prevent unnecessary utilization. Our in-home evaluations assess lifestyle and living environment (medical, behavioral, and SDoH). We coordinate home visits with additional social and behavioral support from community resources.

Report

REPORT

Based on your specific goals (MLR, quality, retention), we hold ourselves accountable for delivering credible and meaningful outcomes. We offer a number of validated measurement methodologies, including total population, identified population, full or partial risk, and shared savings. Our rigorous approach to measurement ensures you can trust the progress we make together, and that real value is being created.

HEALTHY AT HOME

The current environment is creating unprecedented demand for virtual and remote care services, while placing specific strain on primary care delivery. This is particularly true for medically complex and frail individuals. Our in-home delivery model is led by physicians and advance practice providers. This is a powerful approach because it:

  • Creates better access to healthcare services
  • Is often a more convenient and safe way to deliver support to medically complex and frail individuals
  • Provides a 360-degree view of health and lifestyle for a more holistic assessment of needs, including social determinants of health
  • Increases engagement and trust with members, which in turn drives adherence and compliance
WHY CARESIGHT?
  • Proven–six year track record delivering clinical and financial results.
  • Deep experience in serving and achieving outcomes across all lines of business, including Medicare Advantage (MA), Managed Medicaid including Long-Term Services and Supports (LTSS), Dual Eligible, Institutional Special Needs Plans (ISNP) & Dual Special Needs Plan (DSNP).
  • Our national medical group partners are licensed and credentialed. We offer holistic, multi-disciplinary support.
  • Integration is a core competency, bringing together a range of in-home medical care capabilities without duplication of costs and interventions.

After getting a call about a lower blood pressure reading from a home-bound patient, PopHealthCare’s CareSight nurse practitioner visited my patient in her home, took her blood pressure, and reviewed her medications. Having another set of eyes on my patients in between their visits with me helps me provide the best level of care.

Dr. Zachary Suter, UR Medicine Primary Care
Pulsifer Medical Associates

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