How GoHealth is Using Member Care Assessments to Create Personalized Care Journeys and Drive Better Health Outcomes

PR Newswire

CHICAGO, Oct. 18, 2021 /PRNewswire/ -- GoHealth, Inc. (GoHealth) (NASDAQ: GOCO), a leading health insurance marketplace and Medicare-focused digital health company, recently conducted an analysis of Member Care Assessments (MCAs), health-related surveys administered to a member of a health plan. Data from MCAs can inform when members require support scheduling appointments, finding specialist care partners, addressing social determinants of health needs, and effectively selecting and utilizing a pharmacy—all critical components to a member's overall health and wellness.

The analysis revealed that MCAs play a significant role in supporting health equity attainment, as well as highlighting areas that health plans and insurance brokers should evaluate when enhancing plan benefits to meet population health needs.

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' healthcare journey. MCAs were born to identify these unmet needs.

MCAs are often administered to Medicare and Medicaid enrollees. They can be an effective tool for helping the Centers for Medicare & Medicaid Services (CMS) and the healthcare ecosystem identify gaps in health equity early so they can be addressed. Through MCAs, GoHealth has identified the following critical needs:

-       Most transportation benefits do not comprehensively meet member needs. They often only offer transportation to and from a specified number of doctors' appointments, when members need help getting to the grocery store, pharmacy, and around town.
-       55% of GoHealth members need major dental procedures in the next 6-12 months, while only 33% of members have seen their dentist in the past 12 months, highlighting a clear need for more preventative care.
-       At GoHealth, while only ~28% of members are on Medicaid, over 63% of members have used food assistance programs in the past year. Meal needs span from lacking access to healthy food to the inability to pay for it.

MCAs yield powerful data, however, in order to unearth such insights, intentional and strategic forethought is required:

Design MCAs with member and strategic healthcare priorities in mind.
Establish partnerships to effectively leverage MCA data.
Weigh cost, timeliness, and completion rates when selecting an administration method.
Conduct MCAs regularly, to ensure up-to-date awareness of member needs.
Develop robust MCA data governance tools.

GoHealth Responds to MCA Needs

In response to MCA needs, GoHealth has established exclusive Medicare agreements and partnerships with major organizations like online prescription pharmacy GoodRx and social services agency Aunt Bertha to address these important health issues. On a daily basis, GoHealth TeleCare agents connect members to valuable community-based resources to maximize their health through Encompass, a one-stop solution that empowers members with the tools they need to lead heathier lives.

Forging strategic partnerships with key organizations will continue to be at the forefront of GoHealth's efforts. Ongoing enhancements to our Encompass offerings will continue to be a major focus to ensure members' needs are effectively addressed at all levels as part of our mission to improve access to healthcare in America.

About GoHealth, Inc.:

As a leading health insurance marketplace and Medicare-focused digital health company, GoHealth's mission is to improve access to healthcare in America. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science and deep industry expertise to match customers with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit https://www.gohealth.com.

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