InSight®

Bringing Unseen Opportunity into Full View
AN IN-HOME ASSESSMENT THAT ACCURATELY DOCUMENTS HCC’S AND CLOSES CARE GAPS

Many of your members are living with chronic conditions and not seeing their physician regularly. With an In Home Assessment, you can extend care beyond the clinical setting to identify medical issues and ensure you are providing the right care for your members.

InSight helps with accurately documenting member disease burden, observing Social Determinants of Health, closing care gaps and recommending health plan support programs to the member. Accurate HCC documentation ensures appropriate reimbursement from CMS/HHS and our point of care testing closes HEDIS and Medicare Advantage Star gaps to improve over quality ratings.

72
net promoter score
4.5:1
average ROI
$1,400
Incremental HCC revenue per member per year
125k+ completed IHAs
WHAT WE DO

InSight is a comprehensive in-home assessment (IHA) solution. Our licensed Advanced Practice Providers visit members in their homes in-person or via telehealth and conduct a comprehensive health assessment, documenting all health conditions, and providing a detailed report with action plan to members, their primary care physician and the health plans. Our assessment includes clinical, behavioral and social determinants that contribute to the risk of the member’s health.

InSight can help you:

  • Uncover worsening and previously undiagnosed conditions
  • Ensure documentation of previously known conditions
  • Close open care gaps– directly address 9 and support 23 HEDIS/Star measures
  • Engage member with health plan support programs
  • Identify and coordinate timely follow-up care for urgent and emergent issues
  • Enhance member engagement and retention by providing services in the home
  • Connect with socially isolated members

"We’re very grateful we’re able to offer PopHealthCare’s IHA program to our members and we’re proud to be part of this team!"

Renee Parrish-Moorefield Sr. Director, Risk Adjustment Strategic Solutions, Florida Blue Medicare

WHAT’S INCLUDED

Our IHA facilitates gap closure, improves quality performance, and positively impacts risk adjustment accuracy. All existing and new conditions are appropriately documented and coded to facilitate proper reimbursement from CMS/HHS.

The demand for virtual health services is growing exponentially, especially for higher-risk populations. In response, CMS has recently provided guidance that IHAs conducted via telehealth will be accepted for risk adjustment calculation.

Our virtual health assessments offer a safe and convenient way to deliver support to vulnerable populations, while still capturing over 95% of the value generated by our in-person assessments (based on 2020 results).

Additional InSight Offerings:
Point-of-Care Tests

During the in-home assessment, clinicians can also administer additional point-of-care tests and screenings to close quality gaps. Tests include:

  • Bone density scans
  • Flu and pneumococcal vaccinations
  • Diabetes and cancer screenings
  • Statin use in heart disease and diabetes
  • Spirometry for COPD
  • Peripheral artery disease
identify

IDENTIFY

PopHealthCare uses labs, medical history, pharmacy, demographics and socio-economic factors to identify appropriate members for IHAs.

engage

ENGAGE

Using best practices of behavioral economics, our engagement materials help you build relationships with your members. Our Engagement team contacts identified members through multiple channels and schedules an IHA with a PopHealthCare clinician from our national provider network.

assess & plan

ASSESS

During the in-home assessment, our licensed providers verify and renew diagnosis codes from the previous year, assess for worsening conditions and uncover new, undiagnosed conditions. If any urgent or emergent issues are revealed, the clinician is able to quickly refer the member to appropriate care.

document

DOCUMENT

Documentation and coding is completed using PopHealthCare’s proprietary HCC coding platform. Our in-house team of coders consistently achieves 97+% accuracy, eclipsing the industry standard of 95%.

report

REPORT

Detailed assessment reporting is shared with the health plan and member’s PCP.

WHY INSIGHT?
  • Concierge account management support focuses on helping regional and community-based plans succeed in a highly-competitive market
  • Deep experience in delivering in-home assessments across all lines of business, including Medicare, Commercial ACA and Medicaid plans
  • In-house team of experienced risk adjustment experts with over 40 years combined expertise working with large health plans
  • Experienced and certified in-house coding team consistently achieves 97+% coding accuracy
  • Our rapid implementation is tailored to your goals, to facilitate accurate, complete and timely capture of HCCs

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