For plans looking to build out a rewards and incentive program, choosing which healthy behaviors to reward is an important first step. Ensuring that your rewards program doesn’t live in a vacuum, but instead has a direct and meaningful impact on quality measures like HEDIS and Medicare Star Ratings, boils down to four main stages:

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1) Start with your business objectives – just like the best loyalty programs in other industries have for decades

What is the main goal driving the creation of your rewards and incentives program? Perhaps your objective is to improve Star Ratings and create additional revenue, or to impact Commercial Risk Adjustment through HCC identification.

The best loyalty programs in the non-health care commercial space begin by identifying concrete business objectives and correlating KPIs. For example: a percentage of your population that has activated vs. redeemed, or a percentage of the total activities that you wish your population to complete.

2) Consider compliance

CMS only recently expanded its guidance on rewards and incentives programs for Medicare Advantage plans, allowing programs to reward enrollees for activities that promote improved health, prevent injuries and illness, and encourage efficient use of health care resources. The goal, states CMS, is to help members “improve and sustain their overall health and well-being.”

Unsure if your program will fit under current guidelines? Read the latest here or contact us.

3) Identify your population and their care gaps

Medicare Stars and HEDIS each have specific measures that they look at when scoring plans, and closing gaps in care is a substantial part of the equation. Of the gaps that need closing, identify which populations are the highest risk and will therefore have the largest impact on your scores (and bottom line) if you can move the needle through a rewards and incentives program. For Medicare plans, this is often a non-compliant diabetic population and corresponding diabetes preventive care visits. For Medicaid, healthy behaviors for pregnant females often are measures of focus.

4) Create deeper engagement with wellness rewards

The initial positioning of your rewards program should lead naturally into deeper engagement—with the plan, and with the member’s own health.

Take a non-compliant diabetic member, for example. Their first set of healthy behaviors can center on the preventive visits that most closely align with plan ROI and member health: Diabetic Eye Exams, Kidney Screenings, and quarterly A1C tests. Once a rewards program is consistently getting your diabetic member to the doctor for these important preventive screenings, you can introduce a new set of behaviors that, through incremental healthy living steps, will ultimately have an impact on those doctor visits and screenings: a Diabetes Management program (which can also help you achieve NCQA certification), for example, or a support group.

Choosing your rewardable behaviors is an important step in building an effective rewards and incentives program—but it’s only one part of the puzzle. Get our complete guide when you download the white paper: “Driving Healthy Behaviors through Rewards and Incentives Programs.”

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About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, offering rewards and incentive programs that improve consumer health and plan performance. NovuHealth applies proven loyalty and data science strategies and leverages its deep industry and regulatory expertise to motivate high-value consumer activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 15 million consumers across all 50 states. Learn more at

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