Americans spend more per capita on healthcare than any other nation, but are burdened with higher rates of chronic disease, obesity, suicide, maternal mortality, preventable hospitalizations and now a decline in overall life-expectancy for the first time in nearly a century. The coronavirus pandemic illustrated the importance of being able to provide more care in and around the home, and to extend the care team’s reach outside the four walls of institutions and doctors’ offices. Signify supports providers who are committed to practice innovation and care redesign that improve quality, reduce duplicative services, and lower overall costs.

Leading with quality

High quality care is at the core of what we do and enable. Improving the overall health and well being of older adults in the U.S. requires a focus on evidence-based assessment and management of chronic conditions, supporting our nation’s providers, and accountability for quality outcomes.

Quality oversight and outcomes

Signify serves as one of the nation’s largest care teams, with a network of credentialed home-based and virtual-enabled physicians, nurses, nurse practitioners, physician assistants, and social care coordinators that is held to industry-leading standards of clinical quality, documentation, licensure, credentialing, and peer review.

Signify holds NCQA accreditation for credentialing, which ensures a consistent, effective and diligent credentialing process, including verification of practitioner credentials, designated credentialing-committee review of practitioners, and monitoring of practitioner sanctions.

Our nationwide provider network of 10,000+ clinicians is well-trained in identifying clinical, social, cultural and environmental conditions that could indicate or lead to inadequate care. Signify provides education for newly onboarded providers, including modules on cultural competency, language barriers, and implicit bias. All of our providers are required to complete compliance training annually.

We are proud that the NCQA has also certified Signify for Healthcare Effectiveness Data and Information Set (HEDIS^®) measurement. NCQA’s Measure Certification program validated the methodology we use to identify eligible members with open gaps in care to perform certain diagnostic and preventive services during a Signify in-home health evaluation.

Success in achieving Medicare health insurance plan quality ratings (or ‘Star ratings’) and HEDIS quality measures are key for our health plan partners. High quality screenings and assessments are critical drivers of HEDIS measures, especially for those plan members with multiple chronic conditions who may have a hard time accessing local services and whom we are more likely to see at home.

Quality assurance and data integrity

Our tablet-based, in-home clinical workflow provides an evidence-based, holistic view of a given member’s health status. Focusing on a truly comprehensive evaluation with emphasis on chronic, life-long conditions better informs a member’s healthcare team to direct services where gaps or suboptimal care results may occur. Given the impact of the coronavirus pandemic on older adults, we added evidence-based screening tools for suicidality and drug/alcohol dependence to our workflow in 2021.

Signify Health utilizes credentialed, certified, professional medical coders for coding of all evaluations. Each is required to code in accordance with the rules and regulations set forth by CMS and assign all applicable ICD-10 diagnostic codes captured and ensure that they are clinically supported. Following code application, we complete rigorous internal audits to ensure the coding conforms to generally accepted professional standards such as the Official Guidelines for Coding and Reporting approved by the American Hospital Association, the American Health Information Management Association, CMS and the National Center for Health Statistics. Each coder is required to maintain at least 95% accuracy and completeness for audited files. In addition to our internal auditing processes, we perform an annual, external Risk Adjustment Data Validation (RADV) compliance audit to provide additional support for our coding accuracy and completeness.

Reducing unnecessary hospital readmissions

Readmission reduction is a key indicator of quality healthcare, and ensuring patients have the support they need to successfully transition from hospital to home is a critical focus at Signify. In February 2021, we began the implementation of a virtual-first, evidence-based, interdisciplinary transitional care program that now services patients discharged from more than 68 hospitals in 15 states.

In its first year, this Transition to Home (TTH) program has coordinated care for more than 7,000 patients participating in Medicare’s BPCI-A or Accountable Care Organization (ACO) models nationwide. TTH solves for the unmet social and clinical needs that recently discharged patients often have, directs patients back to primary care physicians and specialists, and has meaningfully reduced 30- and 90-day rehospitalization rates.

Managing social determinants of health (SDOH)

Social determinants of health — issues that affect individuals’ abilities to access quality healthcare such as financial concerns, affordable medication, food insecurity, and lack of transportation — pose significant barriers for patients seeking quality healthcare services. We strive to ensure that the people we serve have access to primary care while connecting them to additional resources and programs that address broader health and wellness needs such as those listed below: