GoHealth: How GoHealth Uses Member Care Ratings to Create Personalized Care Pathways and Achieve Better Health Outcomes


CHICAGO, October 18, 2021 – GoHealth, Inc. (GoHealth) (NASDAQ: GOCO), a leading medicare market and a medicare-focused digital health company, recently conducted a Member Care Assessments (MCA) analysis, health-related surveys administered to a member of a health plan. Data from CAMs can indicate when members need help scheduling appointments, finding specialized care partners, addressing the social determinants of health needs, and effectively selecting and using a pharmacy, all of which are critical components of health care. the overall health and well-being of a member.

The analysis found that ACMs play an important role in supporting the achievement of health equity, as well as in highlighting areas that health plans and insurance brokers should assess when making decisions. improving the plan’s benefits to meet the health needs of the population.

Over the past decade, healthcare organizations have faced a lack of cost-effective and timely means to identify clinical and social needs early in the care journey of their members. MCAs were born to identify these unmet needs.

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

  • Most transportation services do not fully meet members’ needs. They often only offer transportation to and from a specified number of doctor’s appointments, when members need help getting to the grocery store, drug store, and around town.

  • 55% of GoHealth members will need major dental procedures within the next 6-12 months, while only 33% of members have seen their dentist in the past 12 months, underscoring a clear need for more preventive care .

  • At GoHealth, while only about 28% of members receive Medicaid, over 63% of members have used food assistance programs in the past year. Meal needs range from lack of access to healthy foods to inability to pay for them.

MCAs provide powerful data, however, in order to uncover such information, intentional and strategic thinking is required:

  1. Design ACMs with strategic membership and healthcare priorities in mind.

  2. Establish partnerships to effectively leverage MCA data.

  3. Weigh the cost, speed and completion rates when selecting an administration method.

  4. Regularly conduct ACMs to ensure up-to-date knowledge of member needs.

  5. Develop robust MCA data governance tools.

Read more: Discover Medicare Needs Through Member Care Assessments

GoHealth meets the needs of the MCA

In response to the needs of the MCA, GoHealth has established exclusive Medicare agreements and partnerships with major organizations such as the Online Prescribing Pharmacy. BonRx and social service agency Aunt Berthe to solve these important health problems. Daily, GoHealth TeleCare agents connect members to valuable community resources to maximize their health through Encompass, a one-stop-shop solution that gives members the tools they need to lead healthier lives.

Establishing strategic partnerships with key organizations will continue to be at the forefront of GoHealth’s efforts. Continuous improvements to our Encompass offerings will continue to be a major goal in ensuring that member needs are addressed effectively at all levels as part of our mission to improve access to healthcare in America.


Media Relations, [email protected]h.com

Investor Relations, [email protected]

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