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In-Home Assessment Program

Background

Sunflower Health Plan has contracted with U.S. Medical Management (USMM) who has subcontracted with any of the following provider organizations — MedXM, Advance Health, Matrix Medical Network, Episource, or Censeo Health — to perform in-home health assessments for Sunflower members.

The subcontracted provider networks consist of both physicians and non-physician providers.

These providers are licensed in Kansas and credentialed with Sunflower Health Plan.

An in-home health assessment is an evaluation of the member’s overall health. The face-to-face visit takes place for an hour with the provider in the member’s home or HIPAA-compliant location. The medical professional will go over the member’s personal and family health history. In addition to the history, the medical provider will also examine vital signs and screen for chronic conditions. 

The medical provider may also collect specimens for lab tests for:

  • Hemoglobin A1C - Diabetes Monitoring Test
  • Microalbumin - Kidney Function Monitoring Test
  • iFIT - Colorectal Screen

Members are selected for the in-home assessment program based on medical history data indicating that the member has a chronic condition(s). Members typically have outstanding care gaps, have not been engaged with their primary care provider, and have multiple chronic conditions.

The subcontracted vendors will mail or fax your office a provider summary, which includes when the visit was completed and any associated findings. The vendors will provide a copy of the actual assessment so that you or your office may follow up with the member.

The in-home assessment is done to supplement the work you are doing or to re-engage the member with your office through reinforcing the importance of regular follow-up visits and assisting with appointment scheduling. The visit will be submitted as a claim for a home visit and will not affect any performance-based incentives or negate any provider payments such as seen with annual wellness exams, well child exams or routine follow up appointments. There is no cost to the member for this program.

No, this visit does not take the place of any existing doctor’s appointments and is in no way meant to replace the care that the member receives through their primary care provider.

The medical provider that performs the in-home assessment does not have access to the member’s complete medical history or medication list. Therefore, they do not write prescriptions or initiate referrals. They will, however, send case management referrals for outstanding items.

The in-home assessment is used to paint a picture of the member’s health, not to recalculate benefit coverage, change rates or charge additional fees.

Yes, the member may decline the in-home assessment. Declining the in-home assessment has no impact on the member’s eligibility for services with KanCare.

No. The health home program through KanCare ended in 2016.