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In our recent white paper, ‘The Correlation Between Enhanced Member Experience and Improved Primary Care Engagement,’ we address peer-reviewed studies that demonstrated that Medicare beneficiaries who see a primary care provider (PCP) regularly have fewer hospitalizations and lower health care costs. Yet, certain factors make it challenging for some individuals, particularly older Americans, to see a PCP regularly.

At Signify Health, our mission is to build trusted relationships to make people healthier. Our national network of more than 12,000 clinicians works to help people gain a more comprehensive view of their health by conducting In-home Health Evaluations (IHEs). During an IHE, clinicians identify chronic conditions, close gaps in care, and address social determinants of health, making it possible for health plan members to get connected to the right care for their unique needs.  

We’re proud to showcase the clinicians helping us build a more connected, effective care
experience for all – and their personal stories that make this important work feel #ClosetoHome.
This is Lisa’s story. 

Lisa Anger, a nurse practitioner with Signify Health, has learned to trust her instincts, especially when someone’s health is on the line. Fortunately for one health plan member on Anger’s schedule, her instinct saved a life.

Recently, while completing the In-home Health Evaluation, Anger noted a member had a very low pulse rate. Lisa advised him to seek care immediately to rule out any underlying issues.

The member immediately sought care at a local hospital and needed heart surgery. “I am very thankful for the visit – it saved my life,” the member later told a Signify Health team representative during a phone call to thank Anger for her quick action.

Putting People First

Fortunately, Anger doesn’t often need to offer life-saving clinical guidance during every visit, but she strives to put people first daily regardless of their needs. Whether it’s high blood pressure or a medication issue, she looks for ways to help every health plan member stay healthy.

“Because we have time with members in the home, we’re in a position to notice things others may miss. We can then refer the member back to their primary care provider for the follow-up they need.”

Anger has been with Signify Health since 2022. After six years as a nurse practitioner in the acute care setting, she wanted to try something new.

“Mostly, health care is very quick now. You may only have a few minutes with your doctor, which may not leave enough time to ask questions. With Signify Health, I have the time to go in-depth with health plan members. This is what I want from my nursing career,” she said.

Healthy Hearts

In the spirit of ‘Move More Month,’ observed every year in April, Anger has practical tips to share, many especially important for those at higher risk of heart attacks and strokes. Here are a few suggestions you can also keep in mind:

March is National Kidney Month. In August 2023, as part of In-home Health Evaluations (IHEs), Signify Health announced the launch of a comprehensive kidney health evaluation to support the early detection, diagnosis, and management of kidney disease for eligible health plan members. 

At Signify Health, our mission is to build trusted relationships to make people healthier. Our national network of more than 12,000 clinicians works to help people gain a more comprehensive view of their health by conducting In-home Health Evaluations (IHEs). During an IHE, clinicians identify chronic conditions, close gaps in care, and address social determinants of health, making it possible for health plan members to get connected to the right care for their unique needs. 

One of the most important parts of managing your health is having open and productive conversations with your primary care provider.

At Signify Health, our mission is to build trusted relationships to make people healthier. Our national network of more than 12,000 clinicians works to help people gain a more comprehensive view of their health by conducting In-home Health Evaluations (IHEs). During an IHE, clinicians identify chronic conditions, close gaps in care, and address social determinants of health, making it possible for health plan members to get connected to the right care for their unique needs. 

At Signify Health,  our mission is to build trusted relationships to make people healthier. Our national network of more than 12,000 clinicians works to help people gain a more comprehensive view of their health by conducting In-home Health Evaluations (IHEs). During an IHE, clinicians identify chronic conditions, close gaps in care, and address social determinants of health, making it possible for health plan members to get connected to the right care for their unique needs.

February is American Heart Month when everyone is encouraged 
to focus on their cardiovascular (heart) health.

Social isolation and loneliness are contributing to a growing public health crisis. TheU.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community found that social isolation and loneliness increase the risk of premature death as much as smoking 15 cigarettes daily. They can also increase the risk of conditions like heart disease, stroke, dementia, anxiety, and depression.

Career dreams don’t always work out the we imagine. Luckily for our health plan members, Susan McGinnis’ second act brought her to nursing and to Signify Health.

On Monday, December 18, Signify Health leaders Dana Lynch, Director of Network Services, Alex Blackstock, Vice President of Product Management, and Peter Yates, Vice President of Care Coordination Products from Signify Health, shared exciting findings from two recent research projects that illustrated that beyond providing members, health plans and members’ PCP a holistic view of a members health, the IHE positively impacts members’ experiences, diabetes care, and their connection to the care continuum. 

In-home Evaluations (IHEs) are a comprehensive evaluation of the health status of MA members that help identify potential risks and tailor appropriate care plans. Signify Health Clinicians perform the IHE in the member’s home or virtually. 

We proudly support the many of our provider partners across the country who are providing essential care to those serving rural and underserved communities. McKenzie Health System is one such partner whose innovation in preventive health and wellness is making a meaningful impact in the lives of those they serve in Sanilac County, Michigan.  Here, McKenzie’s President and CEO, Steve Barnett, offers insights from his team's experience as an Accountable Care Organization -- and shares some strategies for success in rural communities.

Accountable care organizations (ACOs) have proven to help position providers, hospitals, and health systems enhance the patient experience, improve patient care outcomes, and lower or contain costs while generating new revenue. The success of value-based care has been so significant that in 2021, the Centers for Medicare & Medicaid Services (CMS) established a goal to have 100% of Original Medicare beneficiaries and the vast majority of Medicaid beneficiaries enrolled in ACOs by 2030. 

In this first part of a two-part series, we identify financial opportunities that can lead to improved patient care outcomes. In the second part of the series, we will weigh the considerations of developing an effective return on investment (ROI) plan and the components necessary for success.

October is Health Literacy Month, which was established to highlight health literacy's vital role in improving patient care outcomes. In a recent whitepaper, Signify Health’s Chief Medical Officer, Value-based Care, Ashok Roy, MD, MPH, MBA, acknowledged the importance of health literacy and the fact that nine out of 10 American adults lack the skills required to effectively manage their health and prevent disease.

October is Health Literacy Month to help establish and celebrate the importance of making health information easy for patients to understand and to help make the healthcare system easier to navigate. 

Recently,  Ashok Roy, MD, MPH, MBA Chief Medical Officer, Value-based Care at Signify Health, released a comprehensive, four-part white paper that addresses the importance and relevance of health literacy and its correlation to improved healthcare. In ‘Addressing Health Literacy to Improve Patient Care Outcomes,’ Dr. Roy demonstrates the relationship between the social determinants of health and how these factors can result in health disparities. Dr. Roy also presents opportunities in value-based healthcare that employs population health methodologies that can help providers provide support for their patients. 

We recently talked with Dr. Roy to learn more about health literacy.

The transition to value-based care is imperative for improving patient care outcomes and lowering costs. To help ensure a successful and sustainable transition to accountable care, providers, health systems, and hospital administrators must ask and answer a fundamental question:

What key steps can healthcare organizations take to make this shift successfully? 

Every day, Signify Health physicians, nurse practitioners, and physician assistants engage with thousands of health plan members – wherever they call home – to get a true understanding of members’ health status – and for members to get connected to the right care for their unique needs. Here is Kurt's experience with his recent In-home Health Evaluation (IHE).

The COVID-19 pandemic caused significant care delays, which disproportionately impacted those with poor health or chronic conditions. In the first three months of 2020, 41% of U.S. adults delayed or avoided medical care. Multiple studies show regular visits with primary care reduce hospitalizations and costs. Yet many Americans lack a primary care provider (PCP).

Americans are living longer than ever, thanks to advances in healthcare and improved public health initiatives. In fact, there are nearly 90 thousand people 100 years or older in the United States today, nearly double the number from 20 years ago. By 2030, all Baby Boomers will be 65 or older. 

But it’s not just about aging – it’s about aging well. To stay healthy with each birthday celebration, we need to pay closer attention to our bodies and minds, and make sure our lifestyles and behaviors support healthy aging. It may not always be easy, but it is important. Savvy seniors are taking the right steps to live their best lives, and you can too. 

The good news is, it’s never too late to take control of your health. Online resources and tools that encourage simple lifestyle changes to lead a longer, healthier, and more independent life are just a keystroke away. 

In celebration of Healthy Aging Month, we’re sharing five tips from Signify Health providers, Elizabeth Dugan, MD and Elissa Greene, NP, to help you improve your health, and age with grace, joy, and dignity.

1. Get Moving

Build movement into every single day. Research tells us that sitting for too long is as bad for our health as smoking. Physical activity is critical to healthy aging. It’s essential to heart, lung, brain, and joint health. Cardiologists recommend walking for 30 minutes, five days a week to strengthen the heart and boost circulation, but even stretching for a few minutes every day can ensure the musculoskeletal system is getting the attention it needs to function better. 

Balancing exercises and basic yoga practices (there’s even chair yoga for those who need it!)  are other ways to move your body and reduce your risk of falling. Grab a friend and hold each other accountable to walk and stretch a few times every week. 

2. Eat healthy, whole food

A healthy diet is key to living a healthier life. How we fuel our bodies affects more than our weight; it impacts immunity, strength, and energy. The foods, drinks, medications, and supplements we consume affect every function of our bodies and minds. 

As we age, it becomes increasingly important to understand what you’re putting in your body. While fresh fruits, vegetables, meats, and whole grains will always prevail when it comes to maintaining a healthy diet, it can be difficult (and expensive) to shop and prepare for every meal. 

Look for low-sodium foods. Many foods, even canned and frozen, may have a lot of sodium. It is important to look at nutritional labels and reduce your sodium intake.   

Health-supporting supplements are popular, however, be sure to consult your healthcare provider before consuming any non-prescribed supplements. It’s important to know how that supplement will interact with prescription medications you may take. Many over-the-counter supplements, for example, can cause dizziness or thin the blood. If you have doubts, always ask a healthcare professional. 

3. Be social and have fun! 

The older we get, the more loss, grief, and isolation we tend to experience. For older adults who have trouble moving around, loneliness can be more acute – especially if family and friends don’t live nearby. 

Social isolation and loneliness are health hazards, and not only to our minds. Yes, they put us at high risk of depression, anxiety, and cognitive decline. But recent studies have found that social isolation also reinforces unhealthy habits that can have a harmful impact on our physical health. 

We can live longer, more joyful lives by seeking and staying connected to others, whether it be by staying in touch with friends and family in person, digitally, or over the phone, by volunteering for a local organization, or by finding a community of people with shared interests and values.

As we age, social interaction should become a priority – even if it’s difficult or uncomfortable. Experts have even suggested scheduling time to develop strong social connections that help combat loneliness. 

4. Your mind matters, too

For some people, the aging experience can be frightening. It is completely normal to be worried about ourselves and our families as we age, but those fears and anxieties can impact our health. We don’t get the restful sleep we need, we experience an unhealthy amount of stress throughout the day, and we can find ourselves adopting a more cynical or negative emotional state of mind. 

These experiences put the cognitive health of older adults at risk, impacting memory, decision-making, and mood. These are completely natural feelings and behaviors, but that doesn’t mean we need to let our anxieties control us. 

Mindfulness exercises and meditation may be effective in combating fear and anxiety. It may feel impossible sometimes to learn how to relax and find calm, but luckily there are more resources available now than ever before. Try downloading an app that walks you through breathing exercises when you’re feeling anxious, or leads you through a guided meditation when you’re having trouble sleeping.

5. Be an active participant in your own health

When it comes to healthy aging, proactivity is the name of the game. We want to be one step ahead of the needs of our bodies and minds, and that means staying engaged with our healthcare.  

In-home health evaluations are one of the best prevention tools available to older adults. Beyond the screenings that tell us what’s going on with our physical health, these preventive services provide you with the opportunity to make use of the time you have with your care team to talk about any concerns you have about your health – whether that be your medications, your environment, or your mood. Think of preventive services such as the annual wellness visit and In-home Health Evaluation as an opportunity to take action – to provide your whole person with what you need to age healthily. 

Get started now by making an appointment with your PCP for your annual wellness visit and see if your health plan covers an in-home assessment with Signify Health.  Schedule your In-home Health Evaluation through Signify Health now! 

Today’s aging experience is much different than generations of the past. People lead active and fulfilling lives well into their eighties and beyond. Take these steps to ensure you too will live your best life now and in the future.

It may be hard to imagine, but one in five Americans will be 65 or older by 2030. The reality is our nation is aging quickly, living longer, and developing needs that exceed our healthcare system’s capacity. As the average age of Americans steadily increases, so too does the country’s chronic disease burden. Consumer expectations for healthcare are changing. If we can shop, bank, and stream our favorite shows from the comfort of our living rooms, why can’t managing our health be just as convenient? 

As a company focused on the health of older Americans, we welcome Healthy Aging Month as a time to explore what we can do to make care more responsive to the needs of those over age 65. 

The Future of Healthy Aging, a report released by CVS Health, identifies strategies that can help the healthcare system perform at its very best. Among them is improving home-based care. With four out of five people 65 and older saying they are interested in receiving healthcare services at home, according to a survey conducted by Harris Poll and CVS Health, it is easy to see why making more services available in the home makes sense. 

At Signify Health, we see firsthand the value of being able to have diagnostic and preventive health screenings performed from the comfort and convenience of home. Beyond that, the home also offers a unique vantage point from which to learn more about a person’s true health – and the social determinants that influence it. 

For example, we find that staying on track with medications can be challenging for those managing multiple chronic conditions. They are often prescribed medications by different providers, who may not know the full spectrum of medications and supplements someone is taking or the challenges someone is having complying with their regimen. When you consider that the average person over 50 is prescribed more than 13 medications, it is easy to see how being able to review someone’s medicines with them at their kitchen table can make an impact on their ability to manage their health.

As our nation continues to age, the need to reinvent care and rethink where – and how – care is delivered grows ever more important. From our experience performing health assessments in millions of homes each year, we believe that helping people do more in the home to manage their health is one important way we can help older Americans age well. We envision a new landscape for the delivery of care that includes the home as part of a continuum of touchpoints with those 65 and older. We look forward to hearing and learning from others who share their strategies to promote Healthy Aging this month and beyond as we continue to serve older Americans in new ways.

The transition is happening. Across the nation, rural providers are successfully implementing value-based care models to improve patient care outcomes. By participating in Signify Health Accountable Care Organizations (ACOs), providers who care for the underserved generate new revenue, earn shared savings, and expand on the primary care services they offer their communities. Below are five ways they are making it happen.

Located in rural Peterborough, New Hampshire, Monadnock Community Hospital (MCH) is a critical access hospital that offers comprehensive inpatient and outpatient services and is celebrating its 100th anniversary. MCH joined a Signify Health Accountable Care Organization (ACO) in 2023 to align with the Centers for Medicare & Medicaid Services’ goal of having all Medicare beneficiaries in an accountable care relationship by 2030. Like many of their rural-based peers, they have transitioned from fee-for-service healthcare to value-based care using Signify’s proven population health methodologies and award-winning technology to improve patient care outcomes.

At Signify Health, we believe achieving excellence in patient health and the operations to support it are important to recognize and celebrate. During the first annual Signify Health Symposium in May, hundreds of leading accountable care health professionals came together to learn and share strategies and best practices.

Although Peter Drucker wasn’t talking specifically about healthcare when he said, “you can’t manage what you can’t measure,” those managing outcomes-based payment models can absolutely relate. Finding a better way to track and measure the multiple dimensions of health has been one of the biggest challenges to the value-based care movement. 

On May 24-25, 2023, Signify Health held its first annual symposium in San Antonio, Texas, themed Transforming Value-based Care. The event was held at La Cantera Resort and Spa, offering 11 keynote sessions and eight breakout sessions. More than 300 participants attended.

A webinar recap; Payers, Providers, & Patients The Impact of ACOs on Accelerating Clinical Integration

Tamara J. Cadet, PhD, LICSW, MPH, is an Associate Professor at Penn Dental Medicine at the University of Pennsylvania and a Senior Fellow at the Leonard Davis Institute. Dr. Cadet specializes in health social work, health literacy, and advocating for underserved and vulnerable populations to have equal and equitable access to healthcare services.

More than 10 years have passed since Dana Lynch, a nurse practitioner (NP), took a daring career leap that put her on the path to becoming a corporate healthcare leader.

When I was welcomed into the medical community at the White Coat Ceremony on my first day of orientation at the New York University School of Medicine, a single piece of advice stood out and I remember it to this day: always listen to the nurses! It was some of the most sound professional guidance I’ve ever received, and I’ve followed it my entire career.

The month of May has historically celebrated nurses and their collective commitment to their patients and their profession. This year, rather than one week culminating on the May 12 birthday of Florence Nightingale, the founder of modern nursing, nurses week has expanded to National Nurses Month.

Exactly 90 years ago, the people of Winder, Georgia came together to observe the very first “Doctors Day” – a day to show thanks to the local physicians who cared for members of their rural community. Over the next few decades, Doctors Day spread to communities across the country, and in 1990, it was formally recognized as a national holiday. Just as the roles of physicians have expanded and diversified as medicine has evolved, so, too, has the holiday. This week, the nation recognizes the more than one million physicians across the country who have dedicated their lives to keeping us healthy.

Older people are a rapidly growing proportion of the population in the United States, and people’s expectations for care are evolving in tandem with their needs as aging adults. Today, there are more than 55 million people over age 65 – the majority of whom are living with more than one chronic condition – who require vital preventive services in order to get and stay healthy. Tomorrow, there will be more.

Sue Hubbard, NP-C, has been conducting In-home Health Evaluations (IHEs) for Signify Health for more than eight years. Sue’s healthcare experience is impressive and includes performing outreach and delivering home care for 19 years. She hails from Iowa and travels much of the northeastern part of the state serving health plan members in the privacy and convenience of their homes.

As the industry moves further into value-based care, nurse practitioners are playing an increasingly important role in driving outcomes by improving both quality and efficiency. From primary care offices to hospitals and urgent care clinics to long-term care facilities to the home, NPs are improving health and well-being across settings. 

Nearly one in five Americans live in a rural community. That’s 60 million Americans – myself included – who live, work, and play in small towns, farming communities, tribal lands, and sparsely populated frontier areas across the country. Though they manifest in ways that are unique to our geography, rural communities like mine in West Virginia often struggle with many of the same healthcare challenges as people who live in suburban and urban communities. 

More than 50 years ago, the first nurse practitioner training program was developed at the University of Colorado. Upon completing advanced clinical training, registered nurses – who also have completed a master’s or doctoral degree program – assess patients, order and interpret diagnostic tests, make diagnoses, prescribe medications, and manage treatment plans. A half-century later, NPs have become an integral part of healthcare, expanding access to high-quality medical treatment in communities across the country.

Over the last ten years, financial and staffing issues have caused too many hospitals to close, especially those in rural areas and serving vulnerable communities. These closures threaten access to care for millions of Americans. The 340B drug discount program has helped safety net providers to stretch scarce federal resources by offering significantly reduced prices on prescription drugs. By participating in 340B, safety net providers can reach more eligible patients and provide more comprehensive population health services. This important program must be preserved and protected.

Our new paper explains the importance of 340B and accountable care, as well as our ideas for improving the program to make it more sustainable. The paper “Caravan Health and 340B – A pillar of support for safety net hospitals” is available here.

When it comes to hospital discharges, going home ought to mean staying home. As a geriatrician, I’ve learned that the largest gaps in care often occur in those first few days and weeks after being discharged from a hospital or rehabilitation facility. Too often, providers lose track of patients once they are discharged from a hospital, only to see them back there within a month or two.  

Taking a small step toward better health can be as simple as answering the phone. As part of our in-home health evaluation program, Signify Health partners with leading health plans to offer their plan members a no-cost visit by a licensed Signify Health clinician.

For example, a Medicare Advantage plan will identify members who might benefit most from an in-home visit. Once they are identified, Signify Health team members contact them to schedule an appointment.

These no-cost annual check-ins function as a supplement to a person’s annual primary care check-up and happen in the comfort of their home. According to a recent Signify Health survey, these in-home visits are well-received by the people we serve, with results showing:

Signify Health clinicians meet people where they want to be: at home. As part of our in-home health evaluation program, health plan members are eligible to receive a no-cost, in-home visit from a licensed, highly trained clinician. During these visits, a physician, nurse practitioner, or physician assistant examines the member’s whole health, including mental well-being, and identifies potential barriers to care. We partner with many leading Medicare Advantage plans, as well as provide services to certain Medicaid and commercial plan members.

Opening up a new office is always a cause for celebration. It’s a time to recognize the accomplishments that led to the expansion, a time to welcome new colleagues, and a time to establish new connections within your community. The official opening of Signify Health’s new regional service center in Oklahoma City was just such an occasion – and one I was honored to recently host. 

It's no secret that primary care providers are stretched increasingly thin.  They're being asked to do more - see more patients, manage more conditions, do more charting - all with limited resources and for less money.  The constant pressures of reaching RVU goals by churning through more patients weighs continuously on both provider and patient satisfaction, and as a result, the norm is too often an abrupt ten-minute patient visit.  

When President John F. Kennedy established Older Americans Month in 1963 there were just 17 million Americans over the age of 65. Today, that number is 54 million, and growing rapidly. Then as now, the needs of older Americans are too often not fully appreciated or acted upon.

Diversity, equity, and inclusion (DE&I) are critical to Signify Health’s continued success as an organization. We thrive on inclusivity and diverse voices to solve hard problems and act as one team. As Signify Health’s new Head of DE&I, I want to ensure that we continue our commitment to building DE&I awareness and employee engagement throughout our organization. We want to make it fundamental to the way we do business each and every day. That requires a steadfast and consistent effort to elevate awareness, increase education and encourage honest conversations about the issues and daily realities of DE&I.

While it’s no secret preventive measures are essential to keeping people healthy, many seniors wait for their annual wellness visit to gain updates on their health status. For individuals with chronic conditions like diabetes, preventive and diagnostic screenings and services provided as part of an in-home health evaluation (IHE) can help fill the gap between office visits and serve as a hub for the continuum of care.

The high cost of healthcare is a burden on families across the country, and that burden is only getting heavier. A recent Lown Institute Report shines a light on an under-discussed driver of healthcare spending: the extraordinarily high volume of low-value procedures and services perpetuated by the fee-for-service payment system. 

A company’s values — and how they are lived by every employee, every day – are fundamental to achieving financial performance and sustained success. Our values at Signify Health – accountable, compassionate, inclusive and adaptive – guide us as a company that has been entrusted to support the health of millions of Americans, and they underpin all that we do to have a positive impact on the well-being of communities and society.

To fulfill its vision to achieve the highest level of health and well-being and to eliminate disparities in health care quality and access for all they serve, the Centers for Medicare & Medicaid Services’ (CMS) supports a range of initiatives designed to provide equitable, cost-effective, and person-centered care. This vision is ambitious, but achievable if all within the extended care team – and the organizations that support them – collectively embrace initiatives that meet the medical and nonmedical needs of beneficiaries in cost-effective ways. 

Signify Health, a leader in accountable care and the 340B drug discount program, has announced its new success-based pricing model for 2022. ACOs have faced tremendous uncertainties throughout the COVID-19 pandemic, and Signify Health is supporting providers by eliminating all service fees and start-up costs to join its ACO program. By freeing providers from these costs and allowing them to collect a percentage of shared savings earned, Signify is positioning providers to better deliver high-value care. Signify Health works with providers to minimize their downside financial risk in the Medicare Shared Savings Program.

Signify Health’s success-based pricing model also extends to its 340B service line, where Signify Health helps ACO participants maximize their use of the 340B drug discount program with new value-based contract data and workflows. The service line can potentially enable ACO participants to earn more 340B discounts while helping hospitals and physicians expand primary care services for underserved patients with minimal risk.

"As Medicare and other payors are asking healthcare providers to take financial risk related to patient outcomes, it is critical that accountable care enablers not only provide the guidance, technology, and methodologies necessary for success, but also walk the walk, in terms of sharing financial risk,” said Rachelle Schultz, President & CEO of Winona Health. “Signify Health is that enabling partner. Their success-based pricing and shared risk model ensure they're invested in our organization's success. That is the type of confidence and assurance we need.”

Signify Health’s ACO participants consistently rank among the national leaders in performance measures. In 2019 and 2020, all Signify Health collaborative ACO participants earned near-perfect Merit-based Incentive Payment System (MIPS) scores, and in 2020, 100% of provider participants in the collaborative ACO model received shared savings. These strong results, combined with Signify Health ACOs actively managing the care of more than 500,000 Medicare beneficiaries, have led to the company’s management of one of the largest and most successful accountable care organizations in the nation.

Signify Health pioneered its collaborative ACO model based on statistical analyses that demonstrated the importance of having a viable number of beneficiaries being managed. Having more beneficiaries in an ACO results in less random variation, creating more stable and predictable financial results – results linked to actual improvements in care rather than the “luck of the draw”. In Signify Health-supported ACOs, independent providers band together to build a model that positions them to mitigate risk, achieve collective success, and improve patient outcomes. Providers, who would otherwise be too small to make total costs of care risk viable on their own, maintain their independence in a collaborative ACO, while benefiting from safety in numbers.

"A successful ACO requires joining forces with other healthcare systems, making investments in systems and staff, and adopting strong population health management. It can be difficult for providers to effectively line the pieces up, especially as the COVID public health emergency continues,” said Tim Gronniger, Chief Value-Based Solutions Officer for Signify Health. “Our model lowers the barrier to ACO participation while providing a sustainable path forward to earn savings and lower total costs.”

“Foodie Friday” has become a tradition here at Signify Health, with colleagues from across the country exchanging recipes with a couple thousand taste testers! In celebration of Black History Month, Signify Health’s BEALE (Black Employee Association for Leadership & Engagement) team shared some of their favorite African recipes throughout February. The four-part “Foodie Friday” series brought us a rich selection of foods, from authentic coastal dishes like New Orleans style gumbo to West African staples such as classic Nigerian Jollof rice.

One year ago today, we rang the opening bell of the New York Stock Exchange – and rang in a new era for Signify Health as a public company. I could not think of a better way to mark this milestone than by announcing our acquisition of Caravan Health.

In its recent Strategy Refresh, the Center for Medicare and Medicaid Services’ Innovation Center performs a needed introspection of the work done to-date with the alternative payment models piloted and fully implemented, and lays out a clear agenda for continuing its work and meeting important objectives. This report, which is the focus of the virtual Value-Based Payment Summit, has elicited many reactions from health policy experts and, in some cases, raised questions about the potential negative impact of these models on Medicare beneficiaries and the enrichment of model participants at the expense of the Medicare Trust Fund.

New CMS rule supports standardization of data to better understand drivers of health

As we close out 2021 and look forward to a new year, Signify Health is poised to redefine how healthcare is delivered and paid for so we can advance the transformation to value-based care and help people enjoy more healthy, happy days at home. In 2021, our Board of Directors recognized an urgency to accelerate these changes and focus the company on unlocking solutions to make them happen.

Time has a special meaning in geriatrics, for both patients and the geriatricians like me that treat them. Older patients are focused on maintaining their function and independence so they can enjoy every day-week-month as happily and healthily as they can. Geriatricians know that to achieve those goals, we need time to connect with patients on both a personal and professional level. Doctors have traditionally been lucky to spend even 15 minutes with their patients — just enough time to cover the chief complaint and maybe some chronic disease basics. 

As the healthcare industry continues its transformation from the costly pay-as-you-go, fee-for-service model to paying for those services that actually make you better, all eyes are on health technologists. The transformation to “value-based care” requires a seismic shift of all market forces happening simultaneously and requiring a new level of interoperability, connectivity, scalability and usability. 

In a recent blog post examining what it will take to restore patient confidence in a fair and equitable delivery system, Dr. Daniel Wolfson, EVP and COO of the American Board of Internal Medicine Foundation, and I expose the significant challenges to establishing trust when money gets in the way. And money gets in the way when it drives both parties away from each other rather than towards each other. That happens all too often today, and here’s how.

Signify Health accountable care organizations (ACOs) are leading health care organizations nationwide in the Medicare Shared Savings Program performance for another year, according to results released this week. Signify Health ACOs earned total savings for Medicare of $160 million, showing that Signify's collaborative approach continues to generate a return for population health investments.

All of Signify Health’s collaborative ACO clients, predominantly safety net and community hospitals, will receive shared savings, demonstrating the strength of our collaborative model. Between 2018 and 2020, Signify consolidated smaller ACOs into 12 larger ACOs to minimize statistical noise and variation that comes from small size – scale allows superior performance to shine through. Participating hospitals typically have fewer than 50 primary care physicians serving between 2,500 and 5,000 attributed Medicare patients which means they will struggle to generate shared savings revenue on their own.

Despite the enormous challenges of the COVID-19 public health emergency, quality performance was a strong point in 2020, with Signify ACOs earning scores averaging 97%. Following Signify's nearly perfect Merit-Based Incentive Payment System (MIPS) scores, these providers are well-positioned to excel in the coming move to the streamlined ACO Performance Pathways (APP) program.

"During 2020 and the onset of the COVID-19 pandemic, our clients showed ingenuity in serving their patients – using technology but more importantly grit and perseverance in making sure the most at-risk patients still had access to care when they needed it,” said Tim Gronniger, Executive Vice President, Accountable Care for Signify Health.

“There is no way to compassion; compassion is the way.” -- Chinese proverb.

June 2021 was a meaningful month for inclusion. We celebrated Pride Month with our LGBTQ+ colleagues and this year, Juneteenth became a national holiday. As I reflect on the past month, I’m encouraged by the progress Signify Health has made to become a more inclusive company by helping colleagues across the company become stronger, more committed and understanding allies.

May is Older Americans Month, and this year we should use it as a time to think big about changes we can make for how seniors receive their health care. Coming out of the pandemic, we have an opportunity to embrace the lessons we learned about what is possible. Millions experienced their first home visit, their first doctor’s appointment by telemedicine, their first sharing of biometric data remotely to improve care management or even their first admission to the “hospital” at home.

When you work at a company whose mission is to help people live more healthy, happy days at home, you have the opportunity to see the magic of nursing in practice in many different ways.

Pregnancy is a journey. Through each trimester, the investments expectant moms make in their health — from prenatal vitamins to clinical check-ups — culminate into what is (hopefully) a healthy, complication-free birth and adjustment of mom and baby to their new world.

Roberto and Dora Hernandez were thrilled when they delivered a healthy, 9-pound baby boy. He was meeting all of the developmental milestones — he was sitting, crawling and walking at the right time. But he wasn't babbling and talking like other children. More concerning, he wouldn’t make eye contact with them, didn't respond to their smiles, and wouldn’t return his parents’ hugs and kisses. Roberto and Dora thought there might be something wrong with their son, and were concerned when their pediatrician said he should be evaluated for autism. They didn't know where to turn or what to do next.

One of the many lessons we learned this past year is that the world is a dynamic and fragile health and environmental ecosystem — closely connected and constantly evolving. We all have a role — sometimes big, sometimes small — in caring for our home, our living world.

Health plans and employers are increasingly contracting directly with Accountable Care Organizations (ACOs) in hopes of lowering the cost of care provided to plan members and improving health outcomes. Unfortunately, ACOs have a problem: Although they have proved to be a vital component in the movement toward value-based care, ACOs rely extensively on their primary care members to drive value improvement, and primary care physicians can only influence a portion of the health plan spend — estimated to be 40%. The challenge ACOs share across all their risk arrangements is how to create tighter incentive alignment between the ACO and its PCPs -- and the downstream medical/surgical sub-specialists they rely on — to achieve increasingly more value, and assume increasing amounts of risk on both an upside and downside basis.

Those working in public health are familiar with the statistic that social factors influence 60% of a person’s health. As the broader healthcare community has begun to consider social determinants of health (SDOH) at a systems level, the main challenge before us today is less about what to address or why, but how. Specifically, how do we go about identifying and coordinating social care so that it is integrated with medical care within what is a largely fragmented healthcare system?

Medical school barely teaches physicians how to open practices, balance the books and staff appropriately, let alone how to mitigate the challenges of running a small business and stay afloat in a pandemic. This past year has turned the practice of medicine — and by extension, many physicians’ lives — upside down; and so, during National Physicians Week, we want to recognize the contributions that physicians make to the lives of their patients and the communities they serve.

Twelve-year-old Sophia’s life changed dramatically when she suffered a traumatic brain injury and stroke after a horrible car accident. She spent 109 days in the hospital, fighting for her life. When she was finally released to go home, she and her family faced a long, difficult recovery journey —Sophia had to relearn the basic skills necessary to help her reclaim her life.

Believe it or not, only 5% of the total $3.8 trillion spent on healthcare every year in the U.S. goes towards primary care. That makes primary care one of the specialties we spend the least on, despite being our first-stop in care and wholly focused on disease prevention and our overall health.

As the saying goes, “home is where the heart is.” Those working in healthcare also know this to be true, “home is where the health is.” Today marks an important milestone towards making the home a viable health hub for more people with the launch of the Moving Health Home coalition.

This year Black History Month was especially significant for me. The 2020 social justice events—particularly those relating to Black Lives Matters--motivated so many of us to listen more closely to the personal stories of colleagues, friends and neighbors from diverse backgrounds. It opened the eyes of many people and made diversity, equity and inclusion personal.

Each February, the healthcare community rallies to raise awareness around heart healthy behaviors and the importance of regular screenings. When there isn’t a pandemic, we are doing heart walks, wearing red to work, and volunteering at screenings in our communities. Despite the strides forward in prevention and treatment, heart disease remains the leading cause of death (outside of COVID-19) among high-income countries, and is projected to be the leading cause of death worldwide by 2030.

A decade after its creation, it’s time to take stock of the Center for Medicare and Medicaid Innovation’s (CMMI) progress and challenges.

To enjoy more healthy, happy days at home. This is something I want for myself, for my children and for my family and friends. This is why I chose a career in healthcare and it is our mission at Signify Health. While the pandemic has made our collective work more challenging in many ways, it also has put the importance and the urgency of our work into sharper focus.  Today, as Signify Health becomes a publicly-traded company listed on the New York Stock Exchange, we are positioning ourselves to achieve this mission for our company, our customers and partners and the people in our care.  

Inclusion requires more than words stating a company’s commitment. It needs clear purpose, actionable goals and measurable progress. It is one of our core values at Signify Health and a key driver behind many of our internal initiatives and training programs. While our Inclusion Value recognizes the need to support our entire universe of diverse populations, today, I want to share what we are doing to uplift our women colleagues.

Today, we celebrate Martin Luther King Day. Today honors a great man—a once in a generation visionary—who inspires us to transcend race, come together, celebrate diversity and improve the lives of everyone.  

When the Medicare Bundled Payment for Care Improvement (BPCI) program was launched in 2013, it was the first national alternative payment model that put providers at financial risk (for any losses incurred on the patients they manage) from day one of the program. In 2018, BPCI was replaced by BPCI-Advanced. By then, it had grown substantially from its early roots to representing over $10 billion in at-risk contracts per year with providers in all but one state. And it’s still going strong today.

This Summer, when Signify Health announced our new set of Core Values, I was delighted by the positive team response. I had just joined the company as Chief Human Resources Officer, and I expected the normal uptick in excitement and enthusiasm during and immediately following the event. But, I was surprised it didn’t end there. 

Earlier this year, I was asked to help lead our Corporate commitment to living our value “Inclusive, be one team” in a meaningful way by going beyond the expected and inspiring real change in the way we work. Between the Covid-19 pandemic, the Black Lives Matter movement and the country’s polarization over the November election, I thought this would be a challenging goal. But, as an African-American woman, I am passionate about Diversity & Inclusion and was honored that leadership gave me this opportunity.

It hasn’t been easy. There is so much to do, and we’ve just begun tackling this issue; however, I quickly realized that my colleagues truly want Signify Health to be a diverse and inclusive company. From Kyle Armbrester, our CEO, and the Executive Leadership Team to our entry-level new hires, everyone has been encouraging, they are eager to learn, and most importantly, they want change. They are adamant that a diverse and inclusive culture is a core strategic advantage. I had to help make it happen.

When you delve into diversity and inclusion, sticky questions pop up. What does diversity and inclusion mean in our daily work? Who needs to change and how? How do we monitor and enforce change? Where do we start? These are not easy questions to answer, but we always returned to our value, “Inclusive, be one team.”

This year we implemented a series of Diversity & Inclusion training programs for the entire company, including critical topics like unconscious bias. We also began hosting roundtable discussions, starting with one on allyship. In addition, we launched two Employee Resource Groups (ERGs):

For decades now, employers have been at the forefront of health care transformation, continuously pushing for greater price and quality transparency, demanding better value from the delivery system, and encouraging plan members to be better consumers. Despite their efforts, progress has been slow. Employers continue to see health care prices increase, crowding out other investments and stifling pay raises. Quality improvements have been modest and, in some cases (like maternity), have worsened. Pricing transparency remains elusive.

Two new posts (1 and 2) on the Medicare Shared Savings Program for Accountable Care Organizations (ACOs) show the importance of taking a rigorous lens to the evaluation of any alternative payment program and continuously working to improve them. Importantly, the posts remind us of the significant impact these models have had on the healthcare system.

In 2017, the Iowa Department of Public Health (IDPH) asked, “How can we help our people, specifically women and children?” While the question was simple, the answer was complicated.

As we’ve radically rethought care delivery over the past 15 years, we’ve found a way forward in value-based care. This is an opportunity that transcends political parties. Both the current administration and the prospective one have discussed policies that will help accelerate the movement to value. 

On October 5, 2020 Theresa West, Vice President Community Solutions at Signify Health, and Donna Wilson, Community Health Manager and Traci Spillman, Community Network Program Manager at Mosaic Life Care participated in a panel discussion at The Root Cause—Fifth National Summit on the Social Determinants of Health. They were joined by Linda Judah, Executive Director at Social Welfare Board for the presentation “The Elephant in the Room Preventing Collaboratives from Achieving SDoH Outcomes: Privacy. What It Takes to Build a Safe-Sharing Community Network.” Their presentation, summarized here, gives an insider’s look at what it takes to build a community network optimized for outcomes. 

François de Brantes, Senior Vice President, Episodes of Care, was invited to participate in a panel discussion at this year’s HLTH VTRL, a trend-setting conference that brings together payers, providers, employers, investors, startups, pharma, policymakers, and the patient community to help solve some of the industry’s largest problems and to bring to life some of the most promising opportunities to improve health. 

Frustrated by continued health plan inflation and point solutions that keep piling up and sometimes fail to live up to their promise, employers are looking for more comprehensive approaches that deliver measurable value today—and tomorrow. 

Today, Signify Health and Independence Blue Cross announced CommunityLink™, a new network of community-based organizations designed to break down the traditional barriers between social and clinical care and improve health outcomes for at-risk individuals in the Philadelphia region. 

Each September, the health and mental health communities come together during National Recovery Month to reflect and discuss where we are and where we need to go to help those with substance use disorders achieve lasting recovery. This September, the discussion has taken on a whole new level of complexity with COVID-19 constraining access to services and limiting the in-person support that is a vital part of 

September is Healthy Aging month, and anyone with older friends or family members wants them to be able to live their healthiest life, in the place where they are most comfortable and around the people they care about the most. 

One of the country’s largest surgical practices is teaming up with Regence BlueShield and Signify Health to transform healthcare for providers, employers, individuals and families in Washington state.

As a Black woman in Corporate America I know what it’s like to be supported, mentored and sponsored, and just how important these dynamics are in growing and advancing in your career. However, while I am so grateful for these experiences, they do not outnumber nor erase the other experiences I’ve had of discrimination, racism, stereotyping, implicit bias, both macro- and micro-aggressions, as well as the underlying stress that comes with trying to fit-in when I am the only one or “token” African-American in the room.

The COVID-19 pandemic is affecting most aspects of American life—and housing is no exception.

Three weeks ago, Signify Health leadership shared with our colleagues a new set of corporate values. Having recently joined the company as Chief Human Resources Officer, I was looking forward to being a part of this discussion. I’ve been in human resource management for more than twenty years and have announced a number of corporate vision and mission statements, and their supporting values and behaviors, so I usually know what to expect. But, this time I was surprised. 

In the course of a few months, all of our lives changed in profound ways we couldn’t have possibly imagined. Suddenly, nothing was taken for granted: a trip to the grocery store, spending time with family and friends, and receiving services from a healthcare system that’s overwhelmed.

This uncertainty was particularly felt by those already struggling to obtain basic necessities and social support. Seniors for example, many of whom grapple with feelings of loneliness, have been further isolated in a time of social distancing. Many had trouble accessing food, transportation to run errands, financial resources to afford their medications, and other social determinants of health (SDOH) that impacted their outcomes and quality of life.

As a healthcare community, we must continue to find ways to build a system that’s value-based and human-centered—one that takes care of people’s full spectrum of clinical, social, and behavioral health needs. While this crisis has exposed and exacerbated just how many people need help, it also has the power to mobilize change and inspire action.

Change Starts with a Recognition of the Problem
Providing care and support to vulnerable populations is a moral imperative. It also has financial and economic implications for our healthcare systems and country at large. A recent study found that a lack of social connection is as harmful as smoking 15 cigarettes a day or having an alcohol use disorder. Loneliness also appears to be twice as harmful to physical and mental health as obesity. When these issues are unaddressed, they end up in the emergency room.

I have the honor of leading an organization that oversees the nation’s largest network of mobile clinicians, who go into the homes of Medicare beneficiaries to identify and address their clinical and social needs. During the COVID-19 pandemic, our team conducted these visits by phone and video. From April 1 to May 5, 2020 our health risk assessment data showed that 1 in 3 Medicare Advantage patients live alone, 17% have trouble getting around the house, and 22% struggle with everyday shopping or errands.

Social issues like these are far too often the root cause of costly and unnecessary emergency room visits. We must think of healthcare beyond clinical procedures and prescription drugs, to address the very issues that drive these clinical events in the first place.

Breaking Down the Barriers Between Clinical and Social Care
While SDOH has quickly gone from a buzzword to the boardroom, these issues have always existed. We’re fortunate to live in a country with thousands of amazing community-based organizations (CBOs), each with the knowledge and trust of their local communities.

Those of us in the healthcare community must recognize that we cannot do what CBOs do. If we want to create a more equitable system focused on holistic, whole-person care, it’s imperative that healthcare and social service providers work together more effectively in addressing the SDOH that put outcomes at risk.

This isn’t easy. It requires partnership and collaboration across sectors, as well as a steadfast commitment to privacy and patient confidentiality. But when done correctly, the benefits on access and quality of care is immense.

At Signify Health, we have the unique privilege of helping build cross-sector collaborations across all constituencies that touch a person’s life: CBOs, providers, insurers, government agencies, and employers. From Arizona to Texas, Michigan to Iowa, these connected communities are helping residents access vital support services and community programs like never before.

To accelerate an era where each person’s needs are met once they leave the four walls of the hospital or facility, we must acknowledge our limitations. Partnering with community providers, and building safe and collaborative alliances, is the only way to tackle these deeply entrenched and interrelated social issues.

In the wake of COVID-19, we’re starting to see more and more discussion about the need to support people outside of the traditional health care setting. Setting aside the challenges of social distancing, this makes sense. You only need to think about yourself and those you care about to know that people recuperate and convalesce best in their home. That’s where we have the best chance to be comfortable and happy. That’s where health is won—or lost.

Building a community network isn’t easy. As communities form social service networks to collaboratively address social determinants of health, it’s important to recognize the trusted messengers that bring people together.

Will COVID-19 permanently reshape U.S. healthcare? Many experts seem to believe that’s the case. For Signify Health, reshaping healthcare starts with redesigning the way healthcare providers are paid.

Today, on International Nurses Day, we salute those who care for others so selflessly—especially during a time when doing so may put their own health at risk.

More than 6 million women will become pregnant this year, and, of those, more than 1 million will be facing the unknown as first-time mothers. A little over two years ago, one of those first-time mothers was Serena Williams. The story of her complications after delivery shed a light on what health care services and public health experts have known for well over a decade—that complications of delivery, including death, have been going up in the United States. What should be a time of rejoicing can quickly turn to tragedy.

Promoting Long-Term Recovery in a Short-Term, Misaligned Delivery System

Today, over 20 million Americans are suffering from some form of addiction. Unlike many other chronic conditions — where “standards of excellence” inform consumers, health systems, and payers about best practices and services that should be available — today’s addiction recovery services are delivered through system that lacks alignment or integrated economic structures that incentivize long-term recovery.

Insights on Employer Demand for Episodes of Care and Centers of Excellence: An Interview with Willis Tower Watson

It’s not every day the phone rings and it’s the White House on the other end. Then again, it’s not every day we are faced with a global pandemic. 

This podcast series is brought to you by Signify Health, the market leader in transforming the quality, delivery and cost of care.

Last week, Forbes published an article listing the top 8 predictions that will disrupt healthcare in 2020 according to Frost & Sullivan's Transformational Healthcare Group.

The eHealth Initiative & Foundation (eHI) recently released a set of tools to help promote the use of ICD-10-CM Z codes in capturing social determinants of health (SDOH) data. As the transition from volume to value accelerates, having a unified approach to funding social care gaps is imperative to ensure hospitals and health systems can track needs, identify community-based solutions, and improve the health of their communities.

Last week, JAMA published a study that found few physician practices and hospitals screen patients for key social needs. Specifically, the researchers found that only about 24% of hospitals and 16% of physician practices reported screening for the five key social determinants of health outlined by CMS' Accountable Health Communities model: food insecurity, housing instability, utility needs, transportation needs and interpersonal violence.

Even as the summer winds down, the topic of using supplemental benefits to address social determinants of health (SDOH) in Medicare Advantage is getting hotter.

Care management and social determinants of health (SDOH) programs must work together to address a more comprehensive picture of member health. Currently, more than 40% of the most substantial impacts on members’ health are social and economic factors. The idea of care is changing with the shift from service-based care to value-based care, especially for Medicare Advantage members with multiple chronic conditions. 

Last month, several hundred people congregated in Washington DC for RISE’s National Summit on Social Determinants. It proved to be a rich, dynamic conference, jam-packed with education, discussion, and debate from diverse set of cross-sector attendees. 

Many health plans experience vendor challenges when leaning on multiple vendors for their risk adjustment programs in the home or primary care setting. From inconsistent data, potential member overlap in programs, and more, all which cause several negative effects on your risk adjustment and quality programs resulting in less desirable overall results. 

Medicare Advantage (MA) is abuzz about Supplemental Benefits.

The month of May, National Osteoporosis Month, served as a reminder that osteoporosis is an important part of taking care of members. This condition impacts approximately 10 million Americans (roughly 80% being women) and another 44 million have low bone mass, placing them at increased risk.

Approximately 8.5 million people in the United States have Peripheral Artery Disease  (PAD), including 20% of individuals older than 55 years old¹. 

The first service platform to formally integrate social and clinical care plans

Medicare Advantage (MA) plans are evolving to address their growing market—10,000 baby boomers are now retiring every day, and Medicare Advantage health plans are set to become 50% of the Medicare market by 2025—increasing programs for care management and bringing services to the home to improve care and reduce utilization in their high-risk members.

In 2016, 23 of Signify Health's Track 1 ACOs increased net patient revenue by 17 percent and saw an improvement in 14 of 17 quality measures. These successes were dependent on Signify's data-driven model.

Signify's approach draws upon our Enterprise Data Warehouse analytics to support care coordination and ACO Quality Reporting under the Group Practice Reporting Option. By merging standardized information with care management strategies, our ACOs can identify gaps in care and make necessary adjustments to workflow barriers for continuous improvement.

Signify Health analytics aggregates data into actionable reports, giving providers a deeper insight into their patients. Quality and practice managers can then analyze the reports to drill down changes at the patient level and identify improvements across all levels of the organization.

One Signify Health partner, Margaret Mary Health, has found success in proactively managing high-cost patients through data analysis. The health system can clearly pinpoint patients with high risk scores and excessive ED visits allowing them to implement new models of care delivery that will minimize inappropriate or unnecessary utilization.

Adults age 65 and older are at higher risk for contracting contagious illnesses and diseases such as the flu, and can have a more difficult time rebounding. That’s why it’s especially important to communicate to health plan members ways they can stay happy and healthy during the busy holiday season.

Anyone age 65 and older can experience greater severity in symptoms and complications from influenza—and according to the Centers for Disease Control and Prevention, older adults accounted for roughly 60-80 percent of flu-related deaths in recent years. 

The table is set, and the turkey is carved. Your family is all at the table—for most of us, that’s a rarity. So what will be the topic of conversation with the multiple generations sitting at your table for Thanksgiving Dinner? In honor of National Family Health History Day, consider using this opportunity to discuss the chronic conditions that affect or have affected your loved ones and relatives.

Diabetes impacts approximately 30 million people in the United States. More than a quarter of those individuals are 65 and older, making this a serious health concern for the elderly population. World Diabetes Day 2016 is meant to bring awareness to the vulnerable populations worldwide who battle diabetes every day.

In honor of Veterans Day, Signify Health salutes veterans of our armed forces and the commitment and sacrifices they’ve made to protect our nation.
 

Simple steps you can take to reduce your risk of cognitive decline and Alzheimer’s.
There are more than 47 million people worldwide suffering from Alzheimer’s and other dementias. The month of November is dedicated to raising awareness and inspiring action. Knowing the early signs of dementia and taking a proactive role in keeping your brain healthy can help you reduce your risk.

The American Geriatrics Society (AGS) added benzodiazepines, commonly prescribed to treat insomnia and sleeplessness, as potentially inappropriate medication (PIM) according to the Beers Criteria in 2015. Older adults have increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents; in general, all benzodiazepines increase risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults.