by Jon Rogers, Sr. Consultant, Risk Adjustment

As we reach the midpoint of 2024, managed care organizations (MCOs) must take a close look at their In-Home Health Assessment (IHHA) programs, which play a critical role in managing the health of Medicare Advantage and Affordable Care Act populations. These assessments, running from January 1 to December 31, provide valuable insights into the health status of members, and enable proactive care and accurate risk adjustment. Read on as we delve into best practices to keep your IHHA program compliant and high-performing.

Evaluate Year-Over-Year Performance

In measuring the effectiveness of your IHHA program, it’s essential to conduct a thorough year-over-year performance analysis. This includes reviewing your outreach and engagement strategies and determining the total volume of completions on a monthly basis compared to previous years. A significant increase or decrease in completions can indicate areas for improvement or success. Your data collection methods should be robust and accurate, capturing all relevant information to make informed decisions.

Completion rates offer a clear picture of how many members are participating in assessments and are crucial for evaluating the success of your engagement strategies. Calculate the completion rates by determining the percentage of total members in scope who have completed assessments, which will help you understand how effectively you’re engaging members. Compare completion rates between in-home visits and telehealth services to determine if one method is more effective than the other. This analysis can inform future outreach efforts to allocate resources more efficiently.

Geographical analysis identifies areas that are excelling or struggling. High-performing regions can serve as models for best practices, while underperforming areas may require targeted interventions or additional resource allocation. Identify ZIP codes, counties or cities that are outperforming or underperforming. Understanding the specific challenges and opportunities within different geographies, including socioeconomic factors, can guide your program’s strategy and improve overall performance.

Tracking the program’s month-by-month performance will identify any seasonal trends or anomalies. For instance, certain times of the year may show higher completion rates due to favorable weather conditions, or there may be a dip during holidays. Recognizing these patterns assists in planning and scheduling assessments more effectively.

Enhance Member Engagement

Effective member engagement is pivotal to the success of IHHA programs. Begin by analyzing member contact rates, then calculate the percentage of members who have received an outbound contact attempt vs. those successfully reached. This data highlights the efficiency of your outreach efforts and can maximize member engagement. Additionally, analyze contact rates based on the number of outreach attempts to avoid member abrasion.

Member declination vs. acceptance rates offer further insights. Compare these rates to prior years to determine if more members are declining participation and explore potential reasons behind trends. Factors such as outreach methods, call scripts, communication clarity, and perceived benefits of the assessment can influence these rates. Addressing or modifying these elements may help increase acceptance rates and improve overall program performance.

Incorporate feedback from case managers who interact directly with members, as their perspectives can provide valuable insights into member concerns and satisfaction levels. Regular check-ins with case managers can identify common barriers and inform strategies to enhance member engagement. This also provides an opportunity to align case manager feedback with quantitative data, ensuring a holistic approach to member engagement.

Additionally, consider implementing member satisfaction surveys to gather direct feedback. Surveys can provide insights into how members perceive the value of the IHHA program, the effectiveness of communication, and any barriers they faced in completing the assessment.

Ensure Compliance and Quality

Adherence to CMS guidelines is non-negotiable for IHHA programs. Conduct a thorough review to ensure your program complies with all relevant guidance, including evaluating scheduling, and conducting and documenting assessments. Regular internal audits and staff training are essential to maintaining compliance and improving program integrity.

Listening to a random sampling of recorded calls can provide qualitative insights into the member experience. Pay attention to the tone, clarity, and effectiveness of communication. Identify issues related to call scripting, frequency, or agent performance that may impact member satisfaction. Address these issues promptly and effectively to maintain a high standard of service and compliance.

Review all program complaints or escalations meticulously. Classify them by category and identify any significant trends. Common issues could stem from call scripting, call frequency, specific call agents, or the providers rendering services. Addressing these issues will spur your MCO to achieve a high standard of service and compliance. Regularly update your scripts and outreach strategies based on this feedback to continually improve member interactions.

Additionally, all team members should be well-trained and updated on the latest CMS guidelines and best practices. Education and training sessions support high standards of compliance and service quality. Implementing a robust quality assurance program can also help monitor and improve the performance of your IHHA program.

Meet CMS Requirements

CMS requirements for IHHA programs are comprehensive; to comply with requirements, focus on several key areas:

  • Medication Reconciliation. All medications need to be reviewed and reconciled during the assessment in order to identify potential medication errors and improve medication management.
  • Annual Wellness Exam. Incorporate a thorough wellness exam in the IHHA, assessing the overall health status of the member.
  • Assess Home Safety. Evaluate the safety of the member’s home environment to identify any risks that could lead to falls or other injuries. This can include checking for proper lighting, secure rugs, and accessible pathways.
  • Emergent Care Referral Program. Establish a system for referring members to emergent care services if urgent health issues are identified during the assessment.
  • Referral to Disease Management Programs. If chronic conditions are identified, refer members to the plan’s disease management or case management programs. These programs provide ongoing support and resources to manage chronic diseases effectively.
  • Providing Health Information Summaries. After each assessment, provide members with a summary of their health information, including any identified health issues, recommended follow-up actions, and health tips.
  • Assistance to Schedule Follow-up Appointments. Assist members to schedule necessary follow-up appointments with primary care providers (PCP) or specialists to guarantee continuity of care and address any health issues identified during the IHHA.
  • Establish a Structured Follow-up Care Process. A structured process includes setting up reminders, tracking appointments, and ensuring that follow-up actions are completed.
  • Care Coordination With PCP. Coordinate care with the member’s PCP, sharing assessment findings and any recommended interventions. This leads to creating a unified care plan that addresses all aspects of the member’s health.
  • Update Contact Information. Update the member’s PCP and contact information regularly. Accurate contact information is necessary for effective communication and coordination of care.

Leverage Technology and Innovation

Incorporating advanced technology and innovative solutions can significantly enhance the performance and compliance of your IHHA program. Use data analytics tools to track and analyze key performance metrics such as completion rates, member contact rates, and geographical performance. These tools can provide real-time insights and enable data-driven decision-making.

Telehealth has emerged as a vital component of IHHA programs, especially during times when in-home visits may not be feasible. Compare the effectiveness of in-home visits vs. telehealth services in terms of completion rates and member satisfaction. Telehealth can offer greater flexibility and convenience for members, potentially increasing engagement and completion rates. However, it’s crucial to ensure that telehealth services comply with CMS guidelines and maintain high standards of care.

Additionally, consider implementing automated outreach systems to improve member contact rates. Automated calls, texts, and emails create timely and consistent communication with members, reducing the chances of missed appointments and increasing the likelihood of successful contact attempts. These systems can also streamline the scheduling process, making it easier for members to book and complete assessments.

Foster Collaboration

Collaborating with community organizations, healthcare providers, and other stakeholders can help address social determinants of health that may impact member engagement and completion rates. These partnerships can provide additional resources and support to members, making it easier for them to participate in the IHHA program.

Health plans seeking to improve their IHHA and general risk adjustment programs partner with ATTAC Consulting Group for the guidance and support necessary to implement best practices, address challenges, and ensure IHHA programs deliver the best possible outcomes for members.

Contact ATTAC today to learn more about how we can support your efforts in executing a compliant, high-performing IHHA program