Advantages for All: Why Contessa Partners with Medicare Advantage Plans

At Contessa, we strive to improve the healthcare process for patients, providers and payers. At the core of this concept is our managed care strategy, which is Contessa’s unique ability to partner with Medicare Advantage (MA) plans to provide home-based clinical services through risk-based arrangements. Our high-touch models rely on a triad of telehealth, in-home clinical visits and other remote patient-monitoring services that enable patients to have better outcomes at lower costs. All of that makes partnering with payers who base their contracts on value – like most MA plans – a no-brainer for us. 

Our hospital care at home model includes treatment for 34 unique episodes and 111 diagnosis-related groups, treating common conditions including pneumonia and urinary tract infections. Many of these conditions disproportionately affect seniors, meaning that Medicare patients make up a significant portion of who Contessa treats. In fact, roughly three of every four patients we treat is covered by an MA plan.  

We continue to show the value we offer these plans. With the Contessa model, each of our three key stakeholders benefits through:  

1. Expanded revenue opportunities for the health system,  
2. Reduced cost and risk for health plans, and  
3. A better experience and outcomes for patients.  

Expanded revenue opportunities for health systems

We want health systems to enjoy a hospital at home program where they facilitate better outcomes for patients while still supporting the financial viability of their system. Working with MA plans allows us to break a 3- to 5-day hospital stay into a 30-day episode, which creates more opportunities for revenue by expanding the scope of services while delivering a more personalized engagement with the patient. 

For 30 days, Contessa acts as the quarterback for patient care, especially with those at high risk for readmission. During that time, our team stays deeply engaged with the patient and with each other – working together so that every transition and touchpoint runs smoothly. Our care coordinators help these patients adhere to their treatment plan and ensure they have access to a trained team of clinicians and support resources. Hospitals benefit from a reduction in readmissions, while also freeing up critical bed space at a time when most health systems need it most. 

Reduced cost and risk for health plans

By partnering with Contessa, MA plans not only benefit from the ability for Contessa to engage members in a unique way, but they also realize upfront savings to their historical spend in addition to capped risk on their patients. Treating a patient at home with Contessa is generally less costly than treating someone in a hospital – and those savings are realized by the patient, the health system and the health plan.  

While working with the health plan to create an agreement that works for both parties, we can build a program that effectively manages risk and ultimately creates long-term financial stability. That stability also depends on managing expectations surrounding fee-for-service waivers. The future of healthcare requires a paradigm shift in how we think about financial structures and how systems can continue to manage costs and mitigate risk as the industry continues to rapidly evolve. 

Contessa’s value to MA plans is apparent upon initial engagement with the patient, through immediate reduction in spend and capped risk. And, as mentioned before, MA members are put in a better position to recover thanks to deep relationships with a care management team, ensuring MA plans also see benefits that last well beyond the first 30 days.  

Improved outcomes and a better experience for patients

Contessa’s model allows for increased engagement and satisfaction between the patient and their care team. This is especially true among patients who were reluctant to engage in the beginning of their journey or in a different care setting. 

Rooted in a close relationship with patients, our in-home assessments allow providers to gain a better perspective on their patients, their environments, and factors that may help or hinder their recovery. As such, the greater visibility these assessments offer helps us tackle issues that traditional methods have historically struggled to address, primarily, social determinants of health. Our providers can better see the whole person and how they live, through pictures on the wall and pills in the medicine cabinet. We believe providing a more vigilant approach helps ensure our patients are on the path to recovery through every step of their journey and our outcomes show that this works.  

Our patients report an outstanding experience with Contessa, marked by 97 percent patient satisfaction in our hospital care at home program. And, 100 percent of our patients experience medication reconciliation and education while in the home, which helps enhance the patient’s overall awareness and helps lead to better recovery outcomes.  

These results help MA plans address some of their most pressing concerns, because they know that they’re factors which have a direct impact on patient health – and their plan’s bottom line. With Contessa, plans can be assured that our well-constructed program will bring these benefits and more.