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Get the Most Out of In-Home Assessments to Retain Members and Improve Health Outcomes

Summary

As health plans evaluate more efficient ways to engage and retain members, they should focus on existing high-touch points to improve healthcare access and the overall experience. Augmenting these efforts can generate more evidence-based patient management thus improving overall health outcomes.

One high-touch example is the in-home assessment (IHA), deploying nurse practitioners to the patient’s home to personally interact and identify gaps in care. Traditionally, an IHA’s primary focus is providing additional information to improve risk-score accuracy and close quality gaps, particularly for those members who have a higher risk of chronic conditions and may require active care management oversight and support. According to Inovalon research, plans using IHAs typically receive a 95.5% member satisfaction rate after the home visit. However, the IHA can be leveraged as a critical engagement point with consumers to fulfill other objectives including improving member satisfaction, retention, engagement and direct access to care with the objective of improving health outcomes.

Here are some ways plans can get the most from an IHA:

  • Create a comprehensive care plan for continued in-home support
  • Discover and address positive and negative experiences with customer service, billing, network access, or financial concerns
  • Identify dissatisfied members who want to leave the plan and address their needs
  • Track and deliver solutions to address social determinants of health including inadequate nutrition, lack of transportation, loneliness, or cost concerns
  • Build continuity of care with the provider network and recommend community-based resources
  • Connect to telehealth services

Currently, the Centers for Medicare and Medicaid Services (CMS) allows a health plan to bill for an IHA in Medicare Advantage, excluding Affordable Care Act members. Generally, CMS has allowed for expanded IHA services and support. Complying with CMS’ requirement to develop a well-executed health risk assessment, health plans can use this typically viewed “check-in-the-box” activity as a way to educate members about benefits and gather useful data for strategic business decisions. Leveraging the IHA can deliver deeper insight into the member’s overall experience and identify real-time issues to increase member satisfaction and retention. Building member confidence fortifies brand loyalty and continuity of care.

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