Summary
A guided digital experience helps members complete advance care plans on their own, and makes sure their wishes are understood across care settings. The result after six months: higher satisfaction, stronger retention, and measurable savings.
How Cigna improved member retention with advance care planning
A guided digital experience helps members complete advance care plans on their own, and makes sure their wishes are understood across care settings. The result after six months: higher satisfaction, stronger retention, and measurable savings.
Members facing serious illness had no tools to make informed care decisions
Cigna wanted to improve engagement among MA members, reduce avoidable hospitalizations, and strengthen loyalty through a more personal member experience. Two forces made that hard.
First, spend is concentrated at the end of life. A quarter of Medicare dollars are spent in a member’s final year, the single most expensive period for any plan managing total cost of care under risk. Second, the members who feel unsupported during serious illness are the ones most likely to leave: 15.6% of MA enrollees switch plans within a year and 49.2% switch within five. Perceived support is a recognized driver of retention, and it shows up in CAHPS and Stars along with caregiver strain.
The gap is wide. Roughly 80% of patients say they want to discuss advance care planning, while only about 7% are actually engaged by their providers.
Hospice is carved out of Medicare Advantage and paid by traditional Medicare, so the levers a plan controls sit upstream of hospice election: avoidable terminal admissions, intensive care use in the final months, and how often seriously ill members complete structured advance care planning before a crisis.
A guided digital experience, with clinicians behind it
Koda helps members define their care preferences, name a medical decision maker, and document state-compliant advance directives in a simple guided flow. Licensed social workers and nurses stand behind the platform for members who need more support, and documented wishes flow into care management workflows rather than sitting in a file.
Koda Compass surfaces the highest-risk, most seriously ill members in the panel.
A guided experience walks each member through their directive, with clinicians available throughout.
Documented wishes reach the care team, so members receive goal concordant care.
“It was like having a virtual assistant guiding me. I answered the questions and then they would say, do you have any comment or want to add anything else, and there was space and time for me to comment.”
Cigna member, 2024
Honoring what quality of life means to a member
“I have lived a good life. I don’t want to be laying up in a bed and somebody has to change me, turn me. That’s not quality of life. The orthopedic doctor only wants to do surgery on me, but I don’t want any more surgery. I think it’s hard for him to understand that.”
After completing her plan through Koda, this member documented her preference to avoid surgery and life-sustaining interventions and received a POLST for her physician to sign, so her wishes travel with her into any care setting. When goals are documented and honored, unwanted interventions, surgeries, ICU stays, and ventilator use are avoided.
Better clinical quality, less acute utilization, real savings
In the first six months, 2,947 members completed an advance care plan. 88% chose a medical decision maker and 10% were identified as candidates for an out-of-hospital DNR or POLST.
| Measure | Koda members vs. matched controls |
|---|---|
| Total cost of care in the last year of life | $11,237 lower |
| Terminal admissions | 79% fewer |
| ICU admissions | 38% fewer |
| Hospice use | 51% increase |
| Member retention | 23% higher |
| Length of enrollment | 13% longer |
| Average patient NPS | 83 |
Why this rolls up to Stars
A plan’s most complex members receive the most care and feel the most friction from prior authorizations and denials. Their experience weighs most heavily on CAHPS, so understanding their goals and values is one of the highest-leverage ways to lift a rating.
A quality ACP experience, rooted in a member’s own goals and backed by RN and LCSW support, drives the CAHPS inputs plans are measured on: care coordination, getting needed care and access, and overall plan rating. Those in turn feed measures tied to readmissions (C15), care coordination (C24), and member retention (C26).
“I’m really so blessed that Cigna provides Koda and Koda provides this service, because I thought I was going to have to hire a lawyer and go through all those channels, and I didn’t want to.”
Cigna member, 2024
An underused capability that supports MA performance
For MA leaders focused on Stars, retention, and cost management, advance care planning is powerful and often overlooked. Done well, it strengthens the member experience while helping plans manage utilization. What that looks like in practice:
Client Feedback
"For our population in Medicare – where they tend to have multiple chronic conditions it's even more important that these people have these plans in place and that they discuss them with their caregivers before something critical happens and not during some critical illness.
We're looking to expand broadly across all of our Cigna Medicare customers. So that's where we're focused, and we're focused on remaining a partner with Koda for that reason."
J.B. Sobel, MD, MPH MBA Former CMO, Cigna Medicare Advantage
