Delivering services in the home is key to keeping members connected to the care continuum
The COVID-19 pandemic caused a nationwide delay in care. In the first three months of 2020 alone, 41 percent of U.S. adults delayed or avoided medical care. Some delays were inevitable due to the lockdowns and medical office closures. However, initial and ongoing care lapses were greater for those with self-reported poor health or underlying conditions. The majority of people with multiple chronic conditions who postponed or canceled appointments during the pandemic did so more than once. This delay exacerbated their medical issues, worsening their mental and physical states.
Medicare Advantage (MA) health plans and the Centers for Medicare & Medicaid Services (CMS) understand the importance of getting these members back into the care continuum. Peer-reviewed studies show Medicare beneficiaries who see their primary care provider (PCP) regularly, have fewer hospitalizations and lower health care costs. Yet, there remain factors that make it challenging to see a primary care provider (PCP) on a regular basis. Almost 33 percent of Americans do not have a PCP, a higher percentage than in decades past. This group disproportionately includes older Americans.
In-home health evaluations (IHE) and services can help MA health plans gain a more comprehensive understanding of members’ health status and health care practices, including their current connections with a PCP. A primary objective of Signify Health’s in-home service is to reconnect members with their PCPs when needed. Regular visits with a PCP and management of chronic health conditions results in healthier members with lower medical costs. By planning early engagement strategies with members, including in-home engagement, MA health plans can help prevent deteriorating health and promote appropriate health care utilization thereby mitigating unnecessary ER visits and hospital admissions while simultaneously impacting their quality and Star ratings.
Chronic disease in the United States is on the rise
About 60 percent of Americans have at least one chronic disease, and chronic conditions are the leading cause of death in the U.S. Nationally, 40 percent of adults have two or more chronic conditions with more than 66 percent of all deaths caused by one of five chronic conditions. Statistics like these emphasize the importance of early identification and intervention including annual wellness visits.
Providing MA members services in their home, offers health plans a unique opportunity to assess the whole person and address care gaps while simultaneously encouraging members to be engaged with a PCP to ensure they receive the medical care they need.
Adding Stars to the mix
In 2021, CMS doubled the patient experience weighting from 2x to 4x, an adjustment that went into effect for 2023 Star ratings. MA plans still have one more cycle of this higher weighting to consider for plan design and strategy.
It is critically important that health plans consider innovative solutions to improve the overall member experience and connect members back to care when necessary. By supplementing traditional care models with in-home tools and services, health plans can enhance their ability to engage with their members, build brand affinity, and capture ongoing feedback. 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.*
Members highly satisfied with their IHE are:
- 61 percent more likely to renew their coverage with their plan
- 26x more likely to recommend their health plan to a friend or colleague
- 6x more likely to say their IHE has improved their health
- 74 percent more likely to consider additional in-home health services
Conclusion
MA plans should employ the tools necessary to provide personalized member experiences to impact members health, especially those with chronic health care needs and those who are not actively engaged with the health care delivery system. By deploying solutions to guide and support members in their health care journeys, MA plans can improve member health, keep members connected to the health care system, address health care cost and quality metrics all while creating trusting, loyal, and long-term relationships with their membership.
*Signify Health Consumer Experience Study. McKinsey & Company. May 19, 2023.