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Transforming Dual-Eligible Outcomes, Star Ratings, and MLR at Scale

ohog5 by ohog5
August 18, 2026
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Transforming Dual-Eligible Outcomes, Star Ratings, and MLR at Scale
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What You Ought to Know

  • New data from Accompany Health rejects trade norms that depend passive cellphone calls or consent checkboxes as engagement (which generally yields solely 20–30% attain), setting a typical outlined by a accomplished in-home go to performed collectively by an Superior Apply Clinician (APC) and a devoted Well being Advocate.
  • Accompany Well being achieves a 55% engagement charge amongst attributed dual-eligible and sophisticated Medicare Benefit members, with 99% of engaged sufferers in 2024 remaining actively engaged all through 2025.
  • Whereas nationwide Medicare benchmarks common ~13 complete annual touches (visits and non-visit interactions), Accompany Well being generates over 70 patient- and provider-initiated interactions per affected person yearly, exceeding 100 interactions per 12 months for high-risk cohorts.
  • In a Detroit Medicare Benefit D-SNP deployment, the care mannequin elevated the affected person inhabitants’s CMS Star Ranking from 1.7 to 4.5 in Yr One.
  • Throughout engaged populations, Medical Loss Ratio (MLR) dropped by 18 share factors; for the highest 20% highest-cost members, common medical spend decreased 36% (from $3,230 to $2,075 PMPM), and inpatient admissions fell 49% (from 86 to 44 per 1,000 member months).

Redefining Twin-Eligible Engagement

Accompany Health has presented a care supply framework for Twin-Eligible Particular Wants Plan (D-SNP) and sophisticated Medicare Benefit populations, demonstrating that deep in-person scientific relationships supported by AI-driven segmentation can tackle engagement limitations. By redefining member engagement from passive contact to intensive, in-home multidisciplinary care, the group has demonstrated measurable scientific, high quality, and financial positive aspects throughout high-cost cohorts.

Conventional government-sponsored care administration fashions typically settle for a 20% to 30% engagement charge, counting people as “engaged” merely for answering a cellphone name or finishing an preliminary consent type. This low-touch attribution leaves the overwhelming majority of high-need people unmanaged, contributing to widening care gaps and excessive emergency division utilization.

Accompany Well being replaces superficial attribution with a full-risk, high-touch care mannequin:

  • Twin AI Segmentation (Medical + Engagement Personas): Evaluates scientific danger alongside behavioral “engagement personas” to grasp communication limitations, trust-building wants, and private priorities earlier than outreach begins.
  • Pre-Assembled Chart Intelligence: Unifies medical claims, EHR feeds, pharmacy knowledge, and social wants to offer care groups with pre-populated charts and prioritized subsequent greatest actions earlier than they arrive on the affected person’s dwelling.
  • Multidisciplinary In-House Care: Delivers complete major care, behavioral well being, scientific pharmacy, and social care navigation within the affected person’s dwelling, supported by a 24/7 engagement hub.
  • Excessive-Frequency Touchpoints: Averages over 70 multi-channel interactions per 12 months per member (surpassing 100 annual touches for the highest-risk tier), in comparison with the nationwide common of 10–13 touchpoints.

Validated High quality and Monetary Benchmarks

  • 55% Member Engagement: Engages 55% of attributed dual-eligible members de novo, surpassing typical trade averages.
  • 99% Longitudinal Retention: Retains 99% of engaged sufferers year-over-year (from 2024 to 2025).
  • CMS Star Ranking Transformation: Lifted its attributed Medicare Benefit inhabitants throughout Detroit and Denver from a baseline 1.8 CMS Star composite score to 4.5 Stars.
  • 36% Medical Spend Discount: Decreased medical spend by 36% amongst high-cost dual-eligible cohorts.
  • Inpatient Admission Reductions: Minimize inpatient hospital admissions by 49% (from 86 to 44 per 1,000 member months) within the highest-cost tier.
  • 18% Medical Loss Ratio (MLR) Enchancment: Harvested operational financial savings by lowering pointless acute utilization underneath a full-risk cost construction.

“We’re a risk-taking supplier. We take full danger for outcomes and for the price of care of the populations that we serve. And the magic of that is that by retaining folks out of the hospital, out of the emergency room unnecessarily, we harvest these financial savings and we use it to energy the mannequin. And it’s the intensive care that we offer that enables us to try this.”

— Dr. Rahul Rajkumar, MD, JD, Co-Founder and CEO, Accompany Well being



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