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

GoHealth, Inc., 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.

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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:

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

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