In-Home Assessments: How Health Plans Can Improve Star Ratings and Achieve Excellent Health Outcomes for All

In-home assessments (IHAs) are an essential tool for improving healthcare delivery, especially for individuals with complex needs or barriers to accessing traditional healthcare. IHAs offer several benefits, including a more in-depth view of members’ needs, better access to care, and a way to close care gaps. During Minority Health Month this April, it’s important to highlight how these assessments help address this year’s theme of “Advancing Commitments to Eliminate Health Disparities.”

The Centers for Medicare & Medicaid Services (CMS) plans to update the Health Equity Index (HEI) reward, renaming it the Excellent Health Outcomes for All (EHO4all) reward beginning with the 2027 Star Ratings. The enrollees included in this initiative—those who are dually eligible, receive a low-income subsidy, or are disabled—have been shown to be at greater risk for poor health outcomes. CMS Star Ratings data reveal significant gaps in the quality of care for these groups. Here are three ways IHAs can play a critical role in closing these gaps and supporting the goals of the EHO4all reward:

1. A More Accurate View of Your Members’ Needs

In-home assessments can be used to collect accurate clinical data that may be missing from a member’s claims or electronic health records. IHAs can improve risk adjustment scores, which help healthcare providers secure proper reimbursement from CMS. This is especially crucial for underserved populations who may face underdiagnosis, ensuring they receive the care they need while ensuring that providers have the resources needed to do so.

An IHA can also uncover social determinants of health (SDOH) issues such as food insecurity, housing needs, or heating challenges, and connect members to appropriate resources. According to the CDC, SDOH has a bigger impact on health than genetics or access to healthcare services.¹

2. Increasing Access to Care for Those Not Engaged in Their Healthcare

For many underserved populations, access to healthcare is a challenge due to transportation barriers, living in medically underserved areas, or limited mobility. For instance, 21% of U.S. adults without access to a car or public transportation skipped medical care in the last year.² IHAs break down these barriers by bringing care directly to members’ homes. This improves member engagement and positively affects the Medicare Stars Rating “Access to Care” measure.

Offering in-home assessments ensures that marginalized communities get timely care, ultimately improving health outcomes and supporting CMS’s commitment to reducing gaps in care.

3. Closing Gaps in Care

Many individuals in underserved communities miss out on preventive tests and screenings, which can lead to poorer health outcomes. For example, the mortality rate for diabetes is twice as high in Black and African Americans populations compared to white populations.³ IHAs provide a vital opportunity for providers to administer key tests such as the HbA1c, Retina Eye Exam, or Bone Density Test. Providers can also distribute diagnostic tools like FIT (fecal immunochemical test) kits for at-home colorectal cancer screening—eliminating the need for travel or invasive preparation.

Additionally, during IHAs, providers can help schedule follow-up appointments for other outstanding care needs. These proactive steps help close preventive care gaps and reduce long-term health risks.

Results

Engagys has helped regional and national health plans achieve significant improvements in their in-home assessment initiatives, including:

• 44% increase in completed IHAs in a single month
• 750% increase in care gaps scheduled year-over-year due to IHAs
• 22% reduction in cancelled IHA visits

Conclusion

In-home assessments are a powerful tool in reducing gaps in care for underserved populations. This Minority Health Month, consider how refining your in-home assessment strategy can align with CMS’s evolving focus - now reflected in the EHO4all reward - to ensure excellent health outcomes for all. By reaching members where they are, health plans can promote equity, improve care quality, and drive better health outcomes for those who need it most.

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1. https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important/
2. https://www.rwjf.org/en/insights/our-research/2023/04/more-than-one-in-five-adults-with-limited-public-transit-access-forgo-healthcare-because-of-transportation-barriers.html
3. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/