Delivering 242% ROI for a National Medicare Advantage Plan by Improving Access to Care

ReferWell demonstrates the effectiveness of a targeted access to care strategy, showcasing not only significant financial returns, but also successfully getting members to go to their PCP. All validated by claims.

The health plan faced a significant challenge with a portion of its Medicare Advantage member base—many had not visited a primary care physician (PCP) in over 18 months. This lack of engagement posed a risk to both health outcomes and overall plan performance. Members who do not receive regular preventive care are more likely to experience unmanaged chronic conditions, higher healthcare costs, and reduced satisfaction with their health plan.

Primary barriers:

• un-engaged member base
• getting those members scheduled for care