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GoHealth Uses Member Care Assessments to Create Personalized Care Journeys and Drive Better Health Outcomes

According to a recent GoHealth analysis of Member Care Assessments (MCAs), these health-related surveys represent a powerful tool to drive personalized care journeys and better health outcomes.

Over the past decade, healthcare organizations have been challenged by the lack of a cost-effective and timely means of identifying clinical and social needs early in their members’ health journeys. MCAs were born to identify these unmet needs. MCAs are surveys typically administered by health plans or insurance brokers to learn about members’ health needs and personalize engagement. This survey is often administered to Medicare and Medicaid enrollees. Used to trigger member engagement, MCAs often produce the following types of data:

  • Physical Health-Related Conditions (emergency room admissions, chronic conditions,
    alcohol consumption)
  • Social determinants of health (SDOH) (food insecurity, transportation needs, health literacy)
  • Prescription and Pharmacy Access (pickup preferences, affordability, vaccinations)
  • Extra Benefit Needs & Mental Health (dental, fitness, loneliness, anxiety)

MCAs – What They Aren’t

For the purposes of this whitepaper, the term MCAs describes the questionnaires used to screen members for a variety of SDOH and health preferences, which are used to activate member engagement. That said, the industry is still aligning on verbiage in this space. Specifically, the terms MCAs and health risk assessments (HRAs) are sometimes used interchangeably. GoHealth views HRAs as encounter-focused appointments, executed by a provider, which are often completed well after point of enrollment and can help inform risk adjustment.

Use Cases of MCAs

Primary – Member Engagement

The primary purpose of MCAs is to learn more about the member to inform how to interact and engage with him/her. Data captured from MCAs provides new insight into a member’s health and well-being, which is used to segment membership and drive meaningful, tailored engagement journeys that address the identified needs.

Ways to leverage MCA data to inform how to interact with members:

Scheduling Provider Visits

MCA data reveals which members don’t have a primary care physician (PCP) and those who haven’t visited their PCP recently

Insights and Education for Chronic Disease Management

MCA data informs the need for coordinated specialist support, 90-day pharmacy fills, and in-home support

Identification for Behavioral Health

MCA data helps predict risk of mental health illness to drive intentional, focused outreach

Referrals for SDOH

MCA data effectively captures SDOH needs, which account for excess medical spend of $93B annually

Supporting Pharmacy Needs

MCA data informs members’ preferred pharmacy model

Creating a personalized member journey and outreach plan is essential, as member experience heavily impacts Star Ratings. Star Ratings performance data comes from surveys, administrative data, claims data, and clinical data.

 

Relative Weight of quality measure types in Star Ratings

2020 Weights

32% Member Engagement Measures; 68% Other (Process, Outcome, and Improvement Measures)

2023 Weights

57% Member Engagement Measures; 43% Other (Process, Outcome, and Improvement Measures)

Secondary – Identify Health Inequities

MCAs play a major role in supporting health equity attainment, which is achieved when every person can reach their full health potential. The CMS Equity Plan was developed to provide an action-oriented, results-driven approach for advancing health equity by improving the quality of care provided to minority and other underserved Medicare beneficiaries. MCAs are one of the many tools that can effectively help uncover, address, reduce and prevent health disparities.

Tertiary – Plan Design 

At a population level, MCA data and agent feedback can be used to inform gaps in benefit design. MCAs indicate demand for benefits and help identify the extra benefits that are most desired by members.

In order to leverage these powerful insights, MCAs must be strategically designed and administered, administering organizations must have partnerships in place to act on the member needs, and the MCA data must be stored and managed effectively. Over time, MCA questions and use cases will evolve to meet the ever-changing member demands and to better inform the holistic member journey.

GoHealth remains committed to serving as a trusted advisor to Medicare beneficiaries, helping them navigate the healthcare ecosystem and addressing their individual needs. Its Encompass platform, fueled by MCA data, provides carriers and members with robust member engagement solutions that fill unmet needs across the industry. GoHealth is proud to play a role in improving the health of Medicare beneficiaries in America.

Click here to download GoHealth's full guide, "Uncovering Medicare Needs Through Member Care Assessments."

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Read the full report

https://pdf.gohealth.com/Member-Care-Assessments-wp.pdf

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