Clinical Insights

In-Home Health Assessments: Benefits Beyond the Doctor’s Office

Written By
Marisa Smith

In 2018, CMS reported that healthcare spending in this country was projected to reach $3.8 trillion. Since then, initiatives to cut costs and improve outcomes have been leaning on preventive care in its many different forms. In-home health assessments (IHAs), especially for those 65 years of age and older, are increasingly utilized to reduce spending by MAOs. Meeting members where they live through these IHA programs allows plans to deliver care and close gaps for members less likely to visit their provider’s office. Through in-home health assessments, less engaged members can be identified and treated more effectively, reducing unnecessary ER admissions and overutilization while also ensuring accurate reimbursement.

IHAs are meant to obtain an in-depth overview of a member’s health, which is often unavailable through doctor’s visits or hospital stays. By implementing these visits, high-risk members can be identified, and communication between them and their providers can be improved. As their focus is largely on documentation, IHAs are an important part of accurate risk adjustment coding. They offer clinical, administrative, and financial advantages, such as improved quality of care, increased member satisfaction, and enhanced data sharing among providers.

The Benefits of In-Home Health Assessments


For Members


IHAs benefit members through personal and coordinated care delivery. A less formal setting allows members to interact with providers comfortably. Members’ literacy and language comprehension are both reviewed during the visit to better accommodate for them on an individual level. Assessments can ensure members understand what’s being explained about their health, without the discomfort and stress of an office setting. Some members experience fewer hospital admissions, lower cost of claims, and a higher level of satisfaction with their health plan when receiving routine in-home care.

Payers and Providers


IHAs are becoming crucial to both risk adjustment and quality performance, as payers can leverage them to ensure the success of their objectives for both programs. These in-home visits may result in more accurate and complete identification of high-risk diagnoses and promote member engagement with a focus on outcomes, which has a notable effect on STAR ratings and additional quality measures. In-home health assessments can help payers to:


Enhance quality of care through patient engagement


Both payers and providers are tasked with improving quality of care while reducing costs. One way to achieve these goals is by increasing patient engagement. By promoting positive health behaviors through in-depth education and care management, IHAs encourage members to become more engaged in decisions about their healthcare. As evidenced in the Deloitte 2018 Health Care Consumer Survey, patients who are informed about their condition and involved in their treatment decisions tend to have better health outcomes, incurring lower costs overall.


Optimize HCC code capture


Outside of education, IHAs also offer more time with patients to make diagnoses, capturing the member’s complete HCC codes and closing gaps. An in-home visit can be essential in highlighting additional health, environmental, and behavioral factors that may not be accurately represented in their current record—such as social determinants of health (SDOH). A more accurate risk score and profile for members is critical to ensuring patients will have the resources available to receive the quality care that they need.


Improve population health management


These assessments can also be a valuable tool in population health management. Payers can obtain and analyze data, including SDOH, to drive proper care interventions and quality improvement. Plus, utilizing risk scores and stratification for population health management allows for a customized approach and better insight. As CMS has opened the door to a broader definition of supplemental benefits, IHA campaigns will be a key follow-up to take advantage of the new opportunities.


Other benefits of IHAs include:


  • Reduced medical expenditures
  • Decreased hospital admissions
  • Increased member retention
  • Lower nursing home admissions
  • Enhanced health education
  • Increased specialist visits  
  • Access to an up-to-date, prioritized list of patients
  • Improved patient care compliance
  • Escalation of members to care management
  • Better view of member SDOH
  • Enhanced support of aging in place

Employing Episource for IHAs


At Episource, our extensive network of nurse practitioners and physicians perform health assessments, including labs and other services, assisted by our proprietary IHA application. We go where your members are to help you improve patient care and optimize member engagement with data-driven IHAs. Learn more about our IHA services and discover how we’re reinventing the way that healthcare organizations manage their member populations.


We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider