FAQs
Good questions deserve clear answers.
From getting care at home to making a referral, we’re here to help patients, families, providers and health plans understand how Home Reach works.
FAQs
Good questions deserve clear answers.
From getting care at home to making a referral, we’re here to help patients, families, providers and health plans understand how Home Reach works.
FAQs for: Patients, Families & Caregivers | Referring Providers | Health Plans
For patients, families and caregivers
What is Home Reach?
Home Reach is a physician-led primary care practice that comes to you. Our physicians and nurse practitioners see patients where they live and serve as their ongoing primary care team. We have cared for homebound patients in northern New Jersey for more than 15 years.
Who is Home Reach for?
Adults, most often older adults, for whom getting to a doctor’s office is hard, unsafe or exhausting. That includes people living with chronic illness, limited mobility, frailty or memory loss, and people recovering after a hospital stay. If leaving home takes major effort or help from someone else, we may be a good fit.
What counts as homebound?
“Homebound” doesn’t mean you never leave the house. It means leaving home is difficult, whether because of illness, frailty, or a condition that makes travel unsafe or exhausting. Many of our patients need a walker, wheelchair, special transportation, or another person’s help to get out, and getting to a doctor’s office takes a real toll. Patients can still attend medical appointments, religious services, or an occasional family event and remain homebound.
Where do you provide care?
We serve patients across Essex, Passaic and Morris counties, with Union County next. See our Service Area page for the full list of towns and ZIP codes, or call us to confirm we reach your address.
What care can I get at home?
- Primary care visits for new problems and ongoing conditions
- Annual Wellness Visits and preventive care
- A follow-up visit soon after a hospital or rehab discharge
- Wound care, including from our certified wound care nurse practitioner
- Memory and behavioral health screening
- Medication review with our clinical pharmacist
- Help from our social worker with community resources and caregiver support
- Support with planning your care and, when the time comes, hospice
- Orders for labs, imaging, home health and equipment
Will Home Reach replace my current doctor?
Usually, yes. Most patients come to us when getting to an office is no longer practical, and we become their primary care provider and work with their specialists. Some patients prefer to keep seeing their current doctor as well, and we can work that way too.
Who is on my care team?
Your physician or nurse practitioner leads your care. Medical assistants schedule visits and make check-in calls. A clinical pharmacist and a social worker support the team. Our Medical Director also serves as medical director of a local hospice program.
How often will I be seen?
Visits are scheduled based on your needs, with extra visits when something changes. Patients with stable medical problems are typically seen every other month.
What happens between visits?
Most patients join our Chronic Care Management program. Our team calls regularly to check on symptoms and medications and to coordinate care. Coinsurance may apply under Medicare.
What will it cost?
Home Reach bills your insurance like any primary care practice. For most patients with Medicare, a home visit is covered the way an office visit would be.
What insurance do you accept?
We participate with Medicare, Medicare Advantage and most major plans. See our Insurance page for the full list.
Do you see patients in assisted living or independent living?
Home Reach providers visit patients in independent living centers; we don’t see patients in assisted living facilities.
How do prescriptions and refills work?
Your provider reviews your medications at every visit. If you need a prescription, we send it to your preferred pharmacy. If you need a refill in between visits, our team will handle that too.
What if I need care after hours?
A Home Reach provider is available by phone 24/7/365 for urgent problems and can handle most concerns or schedule a visit. For any life-threatening emergency, call 911.
What happens if I need to go to the hospital?
If you need to be hospitalized, our team will stay in touch with the physicians at the hospital and we will be available to resume care when you are discharged.
Can my family be involved?
Yes. Family members and caregivers are welcome at visits. With the patient’s permission, we keep family informed, including adult children who live elsewhere.
How do I get started?
Call 973-664-0040. A patient, family member or caregiver can call. We will ask about health needs, insurance and address, then schedule a first visit.
For referring professionals and care partners
Which patients should I refer?
Patients who struggle to leave home and need ongoing primary care. Common examples:
- Multiple chronic conditions or frequent ED visits and admissions
- Dementia, frailty or significant mobility limits
- Recently discharged patients who can’t get to an office follow-up.
- Patients a practice can no longer manage well in the office
How do I make a referral?
Call 973-664-0040 or give our contact information to the patient or caregiver. Please fax any available relevant medical records, including problem and medication lists, to 833-493-1246.
How quickly will you see a new patient?
We typically see new patients within a week. For hospital discharges, we typically complete a transitional care visit within seven days.
Do you work with home health agencies and VNAs?
Yes. Home health and VNA teams are among our most frequent partners. We coordinate with their nurses and therapists.
How do you stay connected with hospitals and specialists?
We receive admission and discharge notifications through our population health platform, so we know when a patient goes in or comes home. We share visit notes with specialists and coordinate follow-up.
I’m a primary care physician. How will you work with me?
We are a primary care practice, and we know many patients have strong attachments to their current provider. We do not require an immediate complete transfer, so a patient can continue to see their previous PCP if they wish.
Do you work with hospice and palliative care?
Yes. Our Medical Director also serves as medical director of a local hospice program. We help patients and families with goals-of-care conversations and a smooth transition if hospice is the right choice.
For health plans and value-based care partners
What is your value-based care experience?
Home Reach has held value-based care contracts since 2010 and has participated in an ACO since 2018. More than half of our patients are currently covered by a value-based arrangement.
What population do you serve?
We presently care for over 500 homebound, high-complexity patients across Essex, Passaic and Morris counties, predominantly Medicare and Medicare Advantage. These patients carry heavy chronic disease burden and high utilization risk.
How do you use data to manage risk?
We use a population health analytics platform that ingests payer claims and admission and discharge feeds. It drives outreach, post-discharge follow-up and care gap closure. Chronic conditions and social needs are documented carefully at every visit.
What does your care model include beyond visits?
- Chronic Care Management with regular between-visit outreach
- A palliative approach to care when appropriate
- Routine behavioral health screening
- A clinical pharmacist for medication management
- A social worker for social needs and caregiver support
- A certified wound care nurse practitioner
- Close ties to hospice through our Medical Director
How can we discuss a partnership?
Use the form on our Contact Us page and choose Health Plan, or call 973-664-0040.