Modernize Health Assessments to Address Medicare Advantage Quality Goals


Mobilizing members to receive preventive screenings, self-manage chronic conditions and reduce the risk of developing illnesses and injuries has long been a priority for the Star Ratings program. With each iteration of the program, the Centers for Medicare & Medicaid Services (CMS) highlights the importance of preventive and chronic care programs through several high-value quality measures.

Paving a path to four or more Star Ratings must include identifying where members are in their health journeys and delivering the appropriate interventions to help them adopt healthy behaviors. For Medicare Advantage plans, the most powerful tool for surfacing these insights is the health risk assessment.

What is a Health Risk Assessment?

A health risk assessment evaluates a member’s health and identifies risks that could contribute to injuries and diseases. Assessments are conducted by providers once a year during routine health screenings or via comprehensive questionnaires submitted directly to members through the mail or digitally. During these screenings, members are asked a series of questions that evaluate their medical history, physical activity, mental health, lifestyle and risk factors. Plans may also ask questions to measure a member’s willingness to engage in their health.

While there is no fixed format for health risk assessments, the Centers for Disease Control and Prevention encourages providers, health plans and vendors to use an evidence-informed framework. This format analyzes a member’s health status, facilitates the creation of a personalized care plan and provides follow-up care. Members should also receive assessment summaries that highlight specific medical conditions, risk factors and activities that can improve their overall health.

Why Does Medicare Require a Health Risk Assessment?

Health risk assessments were originally optional for most health plans, but under the Affordable Care Act, Medicare Advantage plans are required to conduct appraisals of all members as part of annual wellness visits within 12 months of enrollment and each year afterwards. In addition, Special Needs Plans and Dual-Eligible Special Needs Plans are required to conduct health risk assessments within 90 days of enrollment and must include social risk factor questions related to housing, food and transportation insecurities.

For populations supported by these types of plans, keeping on top of member health status is vital. One in five adults 65 or older report having fair to poor health. Adults with disabilities are five times as likely to experience mental distress when compared to adults without disabilities. Both populations contend with chronic diseases like diabetes and heart disease at nearly double the rate as other populations. Annual health assessments allow plans to monitor and address high risk factors within senior and disabled populations to improve health outcomes.

Benefits of Health Assessments

Annual health appraisals lay the groundwork for powerful preventive and coordinative care programs. These comprehensive questionnaires give plans insight into where members are in their health journeys and help identify opportunities to support members in improving their health. Plans may determine members are due for important screenings, would benefit from chronic disease management programs or need assistance addressing social determinants of health.

Member responses can be used to:

  • Close care gaps by helping members schedule and complete health screenings with high-touch outreach
  • Enroll members in chronic disease management, care coordination and substance use programs
  • Design personalized care plans that help members get needed care before risk factors escalate
  • Address health disparities by referring members to appropriate supplemental plan benefits, community resources and social programs
  • Collect demographic data around race, ethnicity, preferred language, sexual orientation and gender identity to support health equity improvements
  • Evaluate quality measure performance and member engagement
  • Calculate and validate risk scores for population health programs and CMS compliance

At the member-level, a health assessment can set them on the path to a healthier life. These questionnaires give them the opportunity to review their health conditions, discuss risk factors with providers and receive guidance to help them reach goals. Relaying these benefits to members is important for encouraging them to complete questionnaires and receive follow-up care.

The Role of Health Assessments in Plan Performance

Health assessments are one of the best steps to bolstering quality scores and improving plan performance. These screenings lay the foundations for comprehensive member profiles, coordinated care and outreach, and stronger Star Ratings.

Plans that make health risk assessment completion a priority set themselves up for success in several areas:

  • Operational efficiency: The wealth of data captured in health assessments can fuel risk adjustment documentation, chronic condition and care management enrollments, quality measure reporting and provider engagement strategies. By centralizing member responses within a single platform, staff and stakeholders can seamlessly funnel this data into interventions. Increasing the speed to action informs leaner, smarter and more effective quality care programs.
  • Plan expenses: Without routine preventive screenings and care, healthy members may move from low to high-risk statuses. This upward movement increases utilization and overall costs of care. Appraising a member’s risk status each year allows health plans to monitor risk status movement and implement countermeasures to reduce expenses.
  • Bonus payments: Most Star Ratings measures are addressed through preventive care services and chronic disease management programs, including screening rates, immunizations, age-related risk factors and medication adherence. Annual assessments identify care gaps and verify measure performance through self-reported data. Responses can guide gap closure initiatives to accelerate Star Ratings scores and empower a plan to secure quality bonus payments.
  • Member experiences: Health assessments create a clearer picture of which areas members need assistance in to improve their health. Through whole-person views of members, plans can build trust by communicating in preferred languages, sharing relevant resources, coordinating follow-up outreach and addressing barriers to care. These enhanced member experiences translate into stronger retention rates and positive feedback in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

Advantages to Digital Health Risk Assessments

Resolving the current and emerging quality challenges facing Medicare Advantage plans means strengthening every process, tool and program with comprehensive data.

The traditional approach to health appraisal hampers quality improvement strategies by limiting plans to resource-heavy and costly physical outreach. For every survey administered over the phone or through the mail, there is an associated cost to staffing, cost to time and cost to efficiency that could be avoided. This slow, manual process of administering questionnaires also divides data collection, analytics and member engagement into isolated systems that hinder operational efficiency. 

Plans can quickly mobilize coordinated, impactful and cost-effective member engagement strategies when they adopt digital health risk assessments that:

Expand Touchpoints with Omnichannel Outreach

Incorporate multiple channels into a health assessment campaign to increase the likelihood a member will complete a questionnaire. Seniors are more digitally-savvy than previous generations and are accustomed to engaging digitally with health plans through smart phones, tablets and computers. Plans that leverage emails, text messages and in-app notifications for administering questionnaires multiply the opportunities for members to complete assessments.

Centralize Assessment Administration

A digital-first approach to health assessment administration enables plans to minimize the number of platforms they rely on to distribute, review and action assessments. Comprehensive platforms allow staff to seamlessly move from administering assessments to members to monitoring response rates and initiating risk summary analysis. Simplifying administration and analysis to one platform minimizes the cost of relying on multiple solutions while bolstering operational efficiencies.

Present Real-time Analytics

Rather than devoting staff and resources towards manually processing and coding physical questionnaires, digital health risk assessments support real-time tracking and analytics when ingested into a central platform. Staff can instantly monitor completion rates, distribute reminder messages and review responses without the lag time that comes with physical distribution. This data is also more mobile and easier to synchronize with quality performance tracking, risk adjustment analysis and spending reports.

Meet Your Quality Goals with Healthmine

Moving from administering physical health assessments to a digital format does not have to be a painful process. Healthmine’s digital health risk assessment can be implemented in just 60 days and empowers you to do more than just survey members. Our all-in-one platform seamlessly ingests member responses into comprehensive records that can immediately be leveraged to coordinate targeted and meaningful member engagement. Throughout the process, our team will provide dedicated support to ensure your quality and financial priorities are incorporated into all decisions.

Optimize your health assessment capabilities to address your Star Ratings and organizational pain points with Healthmine. Contact us for a demo.

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