For too long, health plans serving dual-eligible and complex Medicare Advantage populations have faced the same equation: the members with the costliest and most challenging health situations are also the members who care models are least likely to reach. As a result, the healthcare industry has normalized 20 to 30 percent engagement as the standard for these populations, and the 70 to 80 percent left behind continue to face costly and complicated health challenges. Ultimately, the value-based care math does not add up.

Accompany Health set out to rebuild the equation, throwing out the industry standard for engagement and adopting a deliberately rigorous definition. As a result, Accompany Health engages 55 percent of attributed patients, sustains those relationships year over year, and delivers measurable performance across the metrics plans track most closely: a CMS Star Rating shift from 1.7 to 4.5 and medical loss ratio down 18 percentage points. All of this is enabled by Accompany's care management program for high-cost populations, which consistently reduces medical spend by 36 percent and inpatient admissions down 49 percent.

The report that follows will introduce the new definition of engagement and pull the curtain back on how it helps Medicare Advantage health plans change the value equation for dual eligible and complex populations.

Most organizations count engagement when a patient picks up a phone call or checks a consent box. Accompany Health believes that is attribution, not engagement. When this type of light touch is counted as engagement, ultimately only 20-30 percent of patients are engaged, numbers the health care industry considers the standard for dual-eligible and complex populations. The standard is leaving 70-80 percent of the most complex patients with the highest-cost problems untouched.

To address this problem, Accompany Health is redefining engagement, setting a deliberately rigorous standard. Engagement means a completed in-home visit conducted jointly by an Advanced Practice Clinician (APC) and a Health Advocate, a unique role Accompany Health has pioneered. Our health advocates close the last-mile gap between benefits access and health outcomes, building a sustained connection with our patients and walking with them through every stage of care.

This combination of clinical excellence and individualized support enables our patients’ active, sustained participation in longitudinal, multidisciplinary care. No checkbox. No single call. A real relationship, built in person, with a care team that includes physicians, nurses, pharmacists, behavioral health clinicians, and psychiatrists.

This standard is intentionally demanding because we serve the patients most programs deprioritize: Medicare and Medicaid dual-eligible individuals and Medicare Advantage members with complex medical, behavioral, and social needs.

Against this definition, Accompany Health consistently engages 55 percent of attributed patients — against industry norms that sit in the 20–30 percent range for comparable complex-care programs. Retention is where the model shows its structural difference. Of patients engaged in 2024 who remained attributed, 99 percent were still actively engaged with our care team throughout 2025. Of the initial cohort who were attributed in 2023, 63 percent are engaged today. That is not a small lift over the industry. It reflects a structural difference in the systems we've built and the discipline with which our teams run them.

Reaching the hardest patients requires more than good intentions. It requires a system that learns what works for each individual across every dimension that shapes their relationship with care. That learning depends on signal, and in healthcare signal is fragmented by design. Claims lag. EHRs sit in walled gardens. Pharmacy fills, ED visits, behavioral health encounters, and field-team notes accumulate in different systems on different cadences. Accompany Health's proprietary AI-enabled models unify this landscape and synthesize signal across intersecting domains for every patient: medical complexity and clinical risk, behavioral health status and history, social circumstances and unmet needs, and persona of engagement. This multi-dimensional profile is not a one-time intake. It is continuously refreshed as the patient's circumstances evolve.

We distinguish between clinical segmentation (i.e., what a patient needs clinically) and their engagement persona (i.e., how they actually respond to outreach, what builds trust, and what barriers have historically kept them from connecting with care). Most programs optimize only for the former. Accompany Health optimizes for both, because a patient with the right diagnosis and the wrong engagement approach still doesn't get better.

Example engagement persona profiles

These personas are not static. Clinical conditions progress, behavioral health crises emerge, social circumstances shift. Accompany Health's system is built to detect those changes and adapt in real time because the patient who needed validation six months ago may be a solution-seeker today, and treating them the same way produces worse outcomes for both.

Sustained relationships are harder to manufacture than a care model, and the numbers show it. Of the members who were attributed to Accompany Health and engaged in 2024, 99% continued to engage through 2025 across multiple channels that include SMS, calls, and in-home visits with our extended care team.

The average Medicare beneficiary has around 3 primary care visits per year, and national data show non-visit patient-clinician contact — patient- and clinician-initiated portal messages plus telephone encounters — averaged 10.4 interactions per patient annually across U.S. health systems in 2025. By contrast, Accompany Health’s care model generates over 70 patient- and provider-initiated interactions per patient per year on average, rising to over 100 for high-risk patients — reflecting a fundamentally different design: proactive, team-based outreach across primary care, behavioral health, and care navigation, purpose-built for a medically complex, dual-eligible population with far higher contact needs than the general primary care population captured in national benchmarks.

Rigorous engagement is not an end in itself. It is the mechanism through which care becomes effective. A patient who completes an in-home psychosocial and physical health assessment each year, builds a relationship with a consistent multidisciplinary care team, and stays connected between visits is a fundamentally different patient from one marked as attributed after a phone call. The first has care gaps closed, an evidence-based plan built around guideline-directed medical therapy (GDMT), and a real chance at better outcomes. The second is a marketing statistic.

When Accompany Health engages a patient at our standard, that patient receives a comprehensive in-home assessment covering behavioral health, cognitive and functional status, social care and benefits needs, medication reconciliation, chronic condition review, and risk factor screening. AI-enabled diagnostics detect cardiac and pulmonary abnormalities on the spot. The care plan that follows is AI-generated and personalized, drawing on the unified signal our models maintain across claims, EHR, pharmacy, behavioral health, and social data to prioritize the interventions most likely to change this specific patient's trajectory. Much as a tumor board convenes medical, radiation, and surgical oncology to drive coordinated action against the complexity of cancer, our models convene signal from across a fragmented data landscape to drive coordinated action against the complexity these patients actually live with multi morbid chronic conditions, behavioral health conditions, and social risk in the same person, at the same time. Care plans are carried forward by a multidisciplinary care team, supported by a 24/7 engagement hub.

Each of those closed clinical loops translates directly into quality performance that health plan partners can measure: HEDIS measures, Star ratings, avoidable utilization. Engagement at 55%, with our definition of engagement, is what drives those numbers. That is the Accompany Health guarantee.

In Detroit, Accompany Health delivered one of the most dramatic quality turnarounds in recent value-based care, with a Medicare Advantage D-SNP population, dual-eligible patients with the most complex medical, behavioral, and social needs in the system.

In Detroit, Accompany Health turned an ambitious vision into a remarkable healthcare transformation, lifting their dual eligible (Medicare-Medicaid) patient population’s Star rating for quality of care from 1.7 to 4.5. This feat was accomplished in record time, in a period when value-based care organizations struggle to maintain or improve Star ratings in partnership with health plans. Accompany Health accomplished this within its very first year of operation, which makes the achievement all the more remarkable. To achieve this milestone took more than just closing care gaps. It required rethinking how care is delivered, where we prioritize trust-building, teamwork, data-powered precision, and relentless persistence. Click here to read the full white paper.

Star ratings measure quality. Total cost of care is what health plans must watch closely. Accompany Health's engagement model is designed to move both. The data shows it does.

These are not marginal improvements. On the members Accompany engaged, medical loss ratio dropped 18 percentage points, the metric that most directly determines whether a value-based partnership works for the plan. Within that population, a 36% reduction in medical spend for patients enrolled in our high cost care program, in a single year of engagement, shows where the largest dollars come from and how quickly they move.

To see how these results emerge in practice, consider the patients who first engaged with Accompany Health in the second half of 2024 and maintained continuous enrollment through 2025. Within that group, we examined the highest-cost 20 percent, the patients whose spending most directly drives plan financial performance, and compared their 2024 baseline to their 2025 outcomes.

These are not marginal improvements. Within this population, medical spend fell 36% in a single year of engagement, showing where the largest dollars come from and how quickly they move.

The inpatient figure is particularly notable. Cutting admissions nearly in half for patients who entered the program with the highest clinical complexity. This reflects what happens when engagement is real: care gaps close before they become hospitalizations, and patients have a team to call before a crisis sends them to the ER.

Accompany Health's results are repeatable and designed to scale, fueled by the people and technology that make them possible. Each new contracted population presents its own mix of clinical, behavioral, and social complexity. Accompany's AI-enabled models build a population-specific engagement map from the ground up: not a generic playbook applied uniformly, but a continuously refined understanding of who each patient is and what it takes to reach them.

We hire only 1% of applicants, because alignment with our values and with the job to be done is what makes this model succeed. Health Advocates, Advanced Practice Clinicians, Behavioral Health Clinicians, Pharmacists, Nurses, Physicians, Psychiatrist, Social Workers and Navigators show up and build the kind of trust that no algorithm alone can establish. Technology and human commitment working together is what makes this model both scalable and irreplaceable.

For health plan partners, the promise is straightforward: bring us your hardest problems. Accompany Health is purpose built to care for populations at scale who who have the highest cost, the most complex needs, and the longest history of falling through the cracks. We will engage them at a level the industry has not seen and deliver the high quality, excellent care, with the results to prove it.