The Opportunity
At DUOS, our focus is on supporting the needs of older adults and caregivers. We execute this mission on behalf of and in coordination with our health plan and provider partners, who deeply understand the direct connection between addressing the needs of older adults and the business results they are accountable for achieving. Most commonly, our health plan and provider partners are focused on these four areas of value:
- Improving member retention to drive growth and maximize lifetime
- Driving Annual Wellness Visit closure to optimize risk and adjustment efforts.
- Elevating Stars scores with an increasing focus on CAHPS measures
- Lowering medical costs to drive profitability and future benefit investments
The Insight
A review of our interactions with older adults and their caregivers suggests that social needs are often a barrier to engaging with preventative and condition-related care. Furthermore, solving these blockers for older adults engenders trust and satisfaction, boosting the older adults’ perception of the organization that solves these challenges. DUOS completes a comprehensive care navigation and social needs assessment for each older adult early in our engagement.
A key takeaway from these assessments: the majority of DUOS enrollees that have not completed an AWV (or similar critical care action) also lack reliable transportation, financial resources and struggle with frailty. Not surprisingly, many older adults also suffer from multiple social barriers.
The Impact
A plan’s ability to build a deep connection with older adults, help them navigate care, and drive timely and ongoing engagement with their PCP is foundational to many of the key measures of health plan effectiveness. For example, successful execution in these areas drives improved performance in CAHPS scoring (e.g., Access to Care or Health Plan Rating) and HEDIS scoring (e.g., Preventive Screenings, Medication Review).
Many of our partners focus on risk adjustment and member growth and retention. Our data suggests that solving social barrier issues effectively drives progress on AWVs, a critical step in preventive care for members and a significant contributor to Medicare Advantage revenue. Only 24% of eligible beneficiaries received an AWV in 2017 (Am. Journal of Accountable Care, 2021).
RISK ADJUSTMENT
Performance Indicator: Closure of Annual Wellness Visits in support of RAF scoring
DUOS Impact Measure: 83% AWV & HEDIS conversion for chronically ill non-compliant MA members with 1+ SDOH blocker
In the process of supporting the member and the plan by unblocking AWV engagement, support for addressing social barriers also engenders trust with the older adult. DUOS’ direct engagement with social needs leads to record Net Promoter Score satisfaction rates, which has a carry-on effect for the plan: member surveys consistently suggest that a positive experience with DUOS increases the likelihood of retaining the member.
SATISFACTION & RETENTION
Performance Indicator: Likelihood to renew with health plan
DUOS Impact Measure: 88+ Net Promoter Score (NPS), lifetime average across the book of business
Building a successful Medicare Advantage and Dual Eligible program that serves the needs of members, providers and the health plan is a complicated task. Addressing the social needs of older adults is a foundational element that benefits all parties involved.