Alignment Healthcare, a mission-based Medicare Advantage insurance company founded in 2013, today announced plans to double both the footprint of the territories it covers and the number of plans it offers in the 2020 enrollment cycle. As part of its rapid growth in the Medicare Advantage market, Alignment Healthcare will debut Medicare Advantage preferred provider organization (PPO) plans for the first time in its history, giving seniors a broad range of choices to best suit their individual health care needs. Currently serving eight counties with 10 health maintenance organization (HMO) plan products, the company is expanding its coverage to 16 counties with 22 HMO and PPO products in 2020, pending regulatory approval.
Operating on an artificial intelligence (AI)-driven “command center” that serves as the company’s backbone, Alignment Healthcare has grown significantly while upholding high levels of quality care, now serving nearly 50,000 Medicare members through Alignment Health Plan. Specifically, Alignment has:
- Achieved a 42% annual growth rate over the last 5 years
- Earned a 4 out of 5-star rating in overall quality in 2019 from the Centers for Medicare & Medicaid Services
- Achieved consistent recognition for its best-in-class pharmacy benefits by the Pharmacy Quality Alliance
“Alignment’s mission from day 1 has been to shift the focus of health care delivery from payments to people. This model has proven itself to be a win-win, delivering a life-changing level of personalized care to our senior population, while lowering costs and improving outcomes,” said John Kao, CEO, Alignment Healthcare. “We look forward to bringing this unprecedented offering to more seniors in the coming year.”
This growth is a direct result of the company’s distinct approach to care that leverages AI to create the experience of having a “doctor in the family.” To do this, its Alignment Virtual Application (“AVA®”) houses more than 100,000 unique data signals per member that identify changing care needs in real time to provide care when and where seniors need it most. In fact, AVA takes in more data than typical electronic health systems – including real-time vital signs, labs, biometrics, social determinant of health factors, and even unstructured doctor notes. It then uses this data to triage each member every 30 minutes, 24 hours a day – identifying any signs for needed immediate intervention or changes in care – from oxygen deficiencies to lapses in medication pickups. Beyond this, AVA runs 500,000 algorithms to predict potentially deadly medical issues such as risk of hospitalization and worsening of chronic illnesses – smart enough to trigger warnings based on even the most subtle of data patterns.
Via insights from AVA, Alignment has delivered:
- More than 5,000 actionable health alerts, providing members with “in the moment” care interventions
- Informed responses to nearly 1 million inbound calls from members and their caregivers
- Overall hospital admission rates approximately 30% less than that of traditional fee-for-service Medicare in certain counties
- A hospital readmission rate of under 12%
In just one example, an Alignment member visited a Bay Area emergency room (ER), triggering an AVA alert. Alignment’s care team proactively called the ER doctor, who was preparing to send the patient home. Using data from AVA, Alignment caught a flag in the patient’s medication history that indicated a high likelihood of previous blood clots. With this information, the doctor ordered additional tests that, indeed, showed a pulmonary embolism, or a clot in the patient’s lungs, which could have led to her death had she been sent home as planned.
“With AVA, we are as close as health care can get today to having a doctor in your family. We’ve spent the past five years building a robust data engine to enable a level of coordinated care otherwise impossible – with the ability to act on this data in real-time with our 24/7 concierge care team,” said Dr. Arta Bakshandeh, chief medical information officer, Alignment Healthcare. “Without the connected care that AVA enables, seniors are susceptible to falling through the cracks of today’s siloed system. AVA uses rich, real-time data to fill these critical gaps, empowering care teams to make better – often life-saving – decisions.”
To learn more, please visit: www.alignmenthealthcare.com.
About Alignment Healthcare
Alignment Healthcare is redefining the business of health care by shifting the focus from payments to people. We’ve created a new model for health care delivery that cuts costs and improves lives by unraveling the inefficiencies of the current system to drive patients, providers and payers toward a common goal of wellness. Harnessing best practices from Medicare Advantage, our innovative data-management technology allows us to commit to caring for seniors and those who need it most: the chronically ill and frail. With offices and care centers across the country, Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options to California residents through Alignment Health Plan, and partners with select health plans in North Carolina and Florida to help deliver better benefits at lower costs. For more information, please visit www.alignmenthealthcare.com.
1 Pending regulatory approval