Blog

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).

In-home services help Medicare Advantage (MA) plans comprehensively assess members’ status and reconnect them to their primary care physicians (PCPs) when needed. These improved connections help to promote healthier lifestyles, appropriate healthcare use, and lower costs while helping to enhance and positively impact plans’ quality and Star ratings.

The Impact of Chronic Illness

With more than 60% of Americans experiencing at least one chronic disease and chronic conditions holding fast as the leading cause of death in the U.S., early identification, including annual well visits, is critical. In-home evaluations enable whole-person assessments to uncover care gaps and encourage PCP engagement and the development or continuation of the patient-provider relationship. These services are vital, with CMS doubling patient experience weighting for 2023 Star ratings.

The Member Experience Advantage

Exceptional member experiences boost health plan growth and retention. A consumer experience study conducted by McKinsey & Company and sponsored by Signify Health revealed that exceptional member experience can lead to health plan growth and retention. In that study, data demonstrated that members who are highly satisfied with their In-home Health Evaluation are:

• 61% more likely to renew coverage
• 26 times more likely to recommend their health plan
• Six times more likely to say it improved their health
• 74% more likely to consider additional in-home services

By guiding and supporting members’ healthcare journeys through personalized solutions, MA plans can enhance member health, reconnect them to care, address cost and quality metrics, and foster loyal relationships. A primary objective of Signify Health’s in-home evaluation, is to reconnect members with their PCPs when needed. Regular visits with a PCP and management of chronic health conditions result in healthier members with lower medical costs.

High-touch + High-tech

The key to improving outcomes is to make members feel genuinely seen, heard, and cared for. This requires understanding individuals’ unique needs and perspectives and not just claims data. Supplementing traditional models with in-home engagement provides insights into whole-person health while building brand affinity. 

Personalized, human-centered solutions do not necessitate advanced technology. Simple outreach reminding members of upcoming appointments makes a difference. Smart digital tools can strengthen connections if the tools are thoughtfully designed with considerations as to how people live, access care, and prefer communicating.

To effectively achieve these goals, an emphasis ought to be placed on building human relationships and enabling informed, shared decision-making rather than fully automated interactions. Plans that position healthcare teams to listen to member priorities can tailor solutions to have a meaningful impact. This begins with aggregating clinical, claims, and social data to identify high-need individuals. However, quantitative insights must blend with qualitative understanding. Key questions that can be posed to ensure plans are on the right track include:

• Who is the member beyond the data? 
• What matters most to them? 
• What challenges are they facing? 
• How can we best support their health journey?

Responding to these questions and providing solutions requires nuanced approaches combining data analytics with human connections. By genuinely knowing members, plans can deliver personalized support, improving satisfaction and outcomes. The recipe for success contains equal parts high-tech and high-touch.