Medicare Advantage care gap case study call to action

Leaders at Medicare Advantage (MA) organizations rely on ReferWell to drive efficient care transitions by leveraging the referable momentSM with their members. With an EMR-agnostic technology platform and operational support, ReferWell helps payers covering millions of older adults improve their members’ health with delightful engagement, better access to providers and increased member adherence to recommended care. ReferWell manages the last mile so more members complete appointments, close more care gaps and improve outcomes.

Challenges Solved for Medicare Advantage Plans


A Better Member Experience Accessing and Scheduling Care

ReferWell shortens the average wait time for a member to see a specialist by 25% with point-of-call scheduling and a broad selection of in-network specialists. Email and text appointment reminders and satisfaction surveys further ensure a quality experience and retention.


Achieve Better Member Adherence & Outcomes to Support Reimbursement

ReferWell significantly increases MA member follow through with care by allowing your plan’s provider network and care navigators to schedule care at the referable moment. This not only helps the plan achieve its quality goals, but leads to better outcomes. And when members get the care they need, plans get the data to more accurately code and, where appropriate, increase CMS reimbursement.


More Care Gaps Closed

ReferWell impacts more than one-third of MA members we engage by employing care navigators who meet patients at the referable moment. That includes gaps in care for colorectal and breast cancer screenings, DEXA scans, retinopathies and Annual Wellness Visits.

More Coordinated Care

ReferWell has increased specialists’ loop closure threefold with intuitive technology and an expert operational support team that makes it easy to share clinical notes and improve care coordination.


Reports With Impact

ReferWell reports on member and provider behavior in real-time, giving your plan a detailed view of how you’re progressing toward target thresholds as well as the insights needed to take corrective action.


“ReferWell helps us get members the care they need and give them an exceptional experience they don't expect from their health plan.”

– VP of Stars & Quality Improvement, national Medicare Advantage plan

Close care gaps by next month.

See how a large, national Medicare Advantage plan closed COL, BCS and OMW care gaps and achieved a record 81% show rate at care gap appointments!

Through ReferWell’s care gap closure program and expert care navigators, the plan engaged beneficiaries to schedule member appointments, improve care coordination between network providers and provide comprehensive reporting to the health plan.

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Explore Solutions for Medicare Advantage Plans

Referral Management

Improve member access to specialist care, increase adherence and coordinate care.

Care Gap Closure

Identify, call and schedule members with open care gaps for a better experience and outcomes.

Risk Adjustment Performance

Make the most of in-home evaluations and risk assessments, leading to appropriate follow up care.


Provide nationwide access to behavioral health specialists in the ReferWell Telehealth platform.

About Medicare Advantage Plans

Like Medicaid MCOs and accountable care organizations, Medicare Advantage (MA) plans accept a set (capitated) per member per month payment for the services they provide and are therefore incentivized to provide the most efficient, highest quality care at the lowest cost.

Simplifying access to care and improving the member experience are constant priorities for MA plans, as beneficiaries and national agencies rate plans on these areas and the results affect capitated payments, member retention and even the plan's long-term sustainability.

MA plans are also under increasing requests from the US Department of Health and Human Services to not only charge the government for Health Risk Assessments completed but also prove that plans are providing the appropriate follow-up member care. 

This pressure makes it even more critical for plans to leverage the referable moment to get members to appointments and document the care received.