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Care Coordination Pathways

A data-driven holistic member experience

Personalized healthcare solutions

Our Care Coordination team plays a vital role in connecting health plan members to providers and other healthcare resources. This team is equipped with diverse skills and expertise to ensure seamless coordination of care and optimal patient outcomes. We focus on delivering personalized care plans based on comprehensive In-Home Health Evaluations, effectively addressing the unique clinical and social needs of each member.

Data-driven member engagement

Based on what our Signify Health clinician documents during the In-Home Health Evaluation, pathway engagement logic is activated by the health plan to match the appropriate next best action with the right members.

Next best action plan for members

Signify Health Care Coordination Services creates a personalized plan for each member. We collaborate with you to activate relevant, modular pathways that map to your desired results for the member and your organization.

Comprehensive care coordination

Our care coordination services connect members with resources and providers to support closing gaps called out in their plan. Based on the trust our clinician is able to earn with members during the In-Home Health Evaluation, we've found members are receptive to our call 80% of the time, where our goal is to engage members to educate, assist, and activate them into relevant resources and care.

What is care coordination?

Care coordination is the process of organizing healthcare services to ensure patients receive the right care at the right time. It involves connecting providers, managing treatments, and ensuring follow-ups happen as planned to meet patients’ needs and achieve more effective care. 

Care coordination services may be needed, for example, to ensure medication adherence or to manage chronic diseases like osteoporosis. In any of these cases, a patient might require specialist referrals, medication adjustments, or ongoing monitoring from different providers. However, without a structured plan, these steps can be overlooked, leading to gaps in care or medical errors. Coordinated care ensures this doesn’t happen by helping patients navigate health outcomes, keeping providers informed, and making access to the necessary resources more efficient 

At Signify Health, care coordination starts with insights from our In-Home Health Evaluations. These assessments give us a deeper understanding of a member’s health, living environment, and overall needs, allowing us to match each individual with the right services and support.  

 

Benefits of care coordination services

It’s been shown that disconnected care leads to unnecessary obstacles, such as duplicate lab tests, missed follow-ups, unclear treatment plans, and more. Coordinated care keeps everything aligned by proactively organizing follow-up care, allowing the members to get the most out of their healthcare benefits and receive treatment without delays.

Some of the benefits of coordinated care management may include:

  • Improve Stars performance
  • Improve health outcomes and member safety
  • Better medication management
  • Reduced healthcare costs
  • Improved medication adherence
  • Streamlined access to care
  • More consistent follow-ups
  • Increased patient engagement
  • Stronger provider collaboration

What is the role of primary care providers?

Primary care providers play a central role in a member’s long-term health, and care coordination services strengthen that connection. With real-time insights from our In-Home Health Evaluations, primary care providers can fully understand their patients’ needs. 

At Signify Health, we work with primary care providers to:

  • Share essential health findings from in-home visits
  • Align recommended care plans with ongoing treatments
  • Manage follow-ups, referrals, and specialist care
The close collaboration between primary care providers and Signify Health keeps care organized and helps make sure members receive the support they need at every step of their journey.