How to start your 2020 quality and risk adjustment efforts on the right foot

How to start your 2020 quality and risk adjustment efforts on the right foot

The start of a new year means several things for Medicare Advantage plans—one of which is the need to get members into the doctor so members can close their care gaps and health plans can capture all of a member’s hierarchical condition codes (HCCs) for purposes of accurate risk adjustment.

One commonly overlooked but highly effective way to tackle quality and risk adjustment goals is the Annual Wellness Visit (AWV). It’s a key opportunity to strengthen the patient/provider relationship and pave the way for completion of other high-value healthcare activities. And it’s also an opportunity for members to have a face-to-face visit with a diagnosing physician who can identify HCCs.

Pro engagement tip: Prioritize and incentivize the AWV early in the year to help improve the accuracy and efficacy of quality and risk adjustment efforts.

According to a recent study, just 18.8% of eligible Medicare beneficiaries receive an AWV—which is surprising given the positive impact on quality, risk adjustment and member satisfaction. As a health plan, if you’re not actively encouraging members to complete their AWV, you could be missing a big opportunity.

Download the guide for the latest data that demonstrates why the AWV is so critical, and get 5 proven strategies for motivating more members to complete their AWV.

DOWNLOAD THE GUIDE  <https://www.novu.com/corporate/resources/the-untapped-potential-of-annual-wellness-visits-to-improve-quality-and-capture-risk/>

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served nearly 15 million consumers across all 50 states. Learn more at novuhealth.com.

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2020 Star ratings are out! Here’s your step-by-step guide to improving or maintaining your score

2020 Star ratings are out! Here’s your step-by-step guide to improving or maintaining your score

Last week, CMS released its 2020 Star ratings for Medicare Advantage health plans. And, if it wasn’t clear before, it certainly is now: the industry is only growing more and more competitive.

Earning 4 Stars and above is no longer outstanding—it’s average. But that doesn’t mean it’s easy. These days, it takes more than just high performance in HEDIS measures to achieve and maintain a stellar Star rating—you have to focus on improving CAHPS and HOS as well.

So whether you fell back, maintained, or improved your 2020 Star rating, there are simple steps you can take now to help ensure successful outcomes next year.

If your score dropped or is below your goal, you can’t wait until next year to turn things around. Download our guide: 3 Proven Tips for Boosting Your Star Rating.

DOWNLOAD THE GUIDE <https://www.novu.com/corporate/resources/your-guide-to-a-stellar-star-rating-proven-tips-for-boosting-your-score/>

And if your Star rating improved or is already strong, you can’t afford to take your foot off the gas. Download our guide: 3 Proven Tips for Maintaining Your Stellar Star Rating.

DOWNLOAD THE GUIDE <https://www.novu.com/corporate/resources/your-guide-to-a-stellar-star-rating-proven-tips-for-maintaining-your-score/>

Looking for more strategies to improve your Star rating? Let’s chat about how NovuHealth can help.


About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served nearly 15 million consumers across all 50 states. Learn more at novuhealth.com.

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How to impact HOS measures and build stronger relationships with members

How to impact HOS measures and build stronger relationships with members

Though the next Health Outcomes Survey (HOS) won’t occur until April 2020, it’s never too early for health plans to think about strategies for impacting the hard-to-influence HOS measures.

One common approach we see plans using is a mock HOS survey to get an indication of the results they can expect from the actual survey. While mock surveys may provide a preview of your results, they don’t do anything to actually impact HOS measures.

NovuHealth’s Healthy Connections for HOS solution is different. It focuses first on driving meaningful improvements in members’ perceptions of their mental and physical health. And the results are dramatic.

The vast majority of members who participate in the program rate their physical and mental health as improved by the end of the program. For the few members who don’t, plans can identify them and connect them to additional care. The program is also a great way for plans to engage with members and build a stronger relationship with them.

Pro engagement tip: Q4/Q1 is a great time to deploy a solution like Healthy Connections for HOS because it can not only impact key HOS measures, it also reminds members you care about their well-being.

Plus, an overwhelming percentage of members who participate in the program say they would recommend it to others, which is a positive indicator of member satisfaction according to the Net Promoter Score (NPS) methodology.

Read the case study to see the impressive improvement in members’ perception of their mental and physical health by the end of the program.

READ THE CASE STUDY  <https://www.novu.com/corporate/resources/how-novuhealth-helps-medicare-plans-improve-key-hos-measures/>

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served nearly 15 million consumers across all 50 states. Learn more at novuhealth.com.

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5 warning signs your rewards & engagement program may be delivering negative ROI

5 warning signs your rewards & engagement program may be delivering negative ROI

Engaging members in their own healthcare is paramount today, and your plan likely already has a rewards and engagement program to motivate them. You recognize that members want a simple, seamless, personalized, and rewarding experience—and that’s an essential insight for your plan’s success.

But simply checking the box and investing in a rewards and engagement program isn’t enough if it isn’t effectively and efficiently driving results.

In fact, if you’re not measuring your program’s success or including the right measures and members—you could be actively throwing money away.

Here are 5 warning signs your rewards program may be delivering negative ROI—failing to boost performance and improve member health in a measurable, attributable, cost-efficient way.

#1: You include as many measures as possible.

When choosing measures for a rewards program, many plans take a “kitchen sink” approach, focusing on every possible rewardable measure. “Why not try to improve on as many measures as possible,” you may think.

In this case, more isn’t always better. The problem with taking a broad approach is that you may be wasting money on low-priority measures rather than zeroing in on the measures that matter most and focusing your investment there.

Instead of rewarding too many measures, we suggest aligning program activities with plan and program objectives, such as improving quality and connecting members to plan programs and services to help improve their satisfaction. Identify which measures should be included to achieve those objectives, and set a strategy to improve or progress each measure to the next cutpoint—or maintain its current cutpoint position.

By focusing solely on the measures that will have the biggest impact on quality and member satisfaction, your program can deliver better results more cost effectively.

#2: You passively reward members for closing their care gaps.

In many cases, plans automatically enroll their members into a rewards program and mail out a gift card three months after members complete an activity. The problem with this “opt-out” strategy is that members often aren’t aware they’re even eligible for a reward, nor are they able to make the positive connection between behavior and reward.

While plans must invite all members to participate in a rewards program, a better, more cost-efficient approach is using an “opt-in” strategy that communicates more robustly and frequently to the members most in need of care, and then rewarding the members who choose to participate—helping to build the connection between behavior and reward that can lead to lasting change.

#3: You think personalizing communications means including each member’s name in the salutation.

We often see plans using mail merge to add members’ names into the salutations of otherwise generic communications and calling it a day on personalization. Or, plans sometimes take it a step further, and use member personas developed by marketing to personalize content.

Truthfully, neither of these tactics is enough to personalize your communications and reach members where they are. Different members have different open care gaps. Different members prefer different channels. And those preferences might change throughout the program.

It’s important to prioritize and communicate a member’s open care gaps depending on what is most important to their individual health and your plan’s performance.

In addition, a highly personalized and seamless member experience across multiple channels allows members to interact in whichever channel works best for them, at whatever time they choose.

Finally, personalized, relevant content—based on personas as well as third-party consumer data—is far more likely to resonate with members, prompting them to take the right action at the right time. This translates to measurable improvements in quality, as well as increases in member engagement and satisfaction.

#4: You offer a $25 reward for every activity.

A consistent reward value for all activities might seem like a reasonable way to motivate members to take action while simplifying program logistics on the back end. However, based on our experience with nearly 15 million members, we know there is an optimal reward value for each healthcare activity and the amounts vary.

To avoid overpaying or underpaying, it’s important to consider the ask you’re making of the member, and any barriers they might face in completing that activity. For example, for a colorectal cancer screening, which is more invasive and time-consuming, you should offer a larger reward than you would for a flu shot.

It’s also important to consider the value of that measure to your plan, and its ability to impact results, so you’re investing most in the high-value measures and spending every dollar as efficiently as possible.

#5: You don’t manage and adjust your program daily.

Once a rewards program has launched, a lot of plans simply let it run by rewarding members as claims data rolls in. In other words, they “set it and forget it.” However, actively monitoring, measuring, and adjusting your rewards strategy based on performance will yield far better and more cost-effective results.

Keeping an eye on how your program is doing on a daily basis allows you to be nimble and adapt so you can be sure your program is as successful as possible. Adjusting factors—such as which measures and members you’re focusing on, how many communications members are receiving (in what channels), and what reward amounts you’re offering—can help ensure you stay on track to meet program and plan objectives.

5 best practices for delivering positive R&I ROI

Now that we’ve summarized the 5 warning signs your R&I program could be delivering negative ROI, here are 5 best practices you can use to ensure your R&I program is on the positive side of the ROI equation.

Prioritize: Unlike programs that include every measure, align program activities with plan and program objectives, identifying and focusing on the measures and activities that can directly improve quality, enhance satisfaction, increase enrollment, and optimize costs.

Segment: Instead of passively rewarding members for closing their care gaps, consider using a strategy that requires members to affirmatively opt in, and rewarding those who choose to participate. In addition, use analytics and modeling capabilities to help you understand which members are most likely to take action. This will help your efforts to optimize plan performance.

Personalize: Some plans think personalization amounts to using the member’s name in the salutation. A better approach is to dynamically provide relevant activities and content in the member’s preferred channel, prompting them to take the right action at the right time as their healthcare journey changes.

Motivate: Different healthcare activities require different levels of member effort. Intelligent R&I programs align the reward value with the ask, and couple that with identified barriers, value to the plan and budgetary constraints, to ensure every dollar drives a positive ROI.

Optimize: Evaluating and adjusting your engagement efforts real-time based on member activities is the best way to ensure you’re creating a meaningful member experience and making progress toward your goals.

We follow these five best practices at NovuHealth, and they produce a measurable difference, including lower costs and positive vs. negative ROI, as you can see in the charts from one client program below.

This client’s current R&I program was costing nearly $8 million to run yet was delivering a negative 7.8% ROI. A more strategic program designed by NovuHealth was projected to only cost $1.9 million while delivering a positive ROI of more than 262%.

The moral of the story is just because you have a rewards program in place doesn’t mean it’s delivering on your objectives and using your dollars effectively. A better approach is designing a strategic rewards and engagement program that follows our five best practices (and avoids the warning signs) to deliver measurable, positive ROI.

Looking for more guidance on building a rewards program that’s attributable, measurable and truly moves the needle on performance? Contact us here with any questions.

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served nearly 15 million consumers across all 50 states. Learn more at novuhealth.com.

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Helping AvMed Health Plans improve quality by activating the unengaged

Helping AvMed Health Plans improve quality by activating the unengaged

AvMed is one of Florida’s oldest and largest not-for-profit health plans, serving approximately 230,000 members across 30 counties. Since 2014, AvMed Medicare has received a 4-Star (or higher) overall quality rating, demonstrating their ongoing commitment to quality and member satisfaction.

Like many successful Medicare plans, AvMed knew that maintaining their 4-Star rating would be crucial but increasingly difficult, so they partnered with leading consumer engagement company NovuHealth to help ensure they stayed at or above the 4-Star threshold without falling back.

Download the case study to see how NovuHealth helped AvMed improve program participation, close more care gaps and increase digital engagement year-over-year since 2016.

DOWNLOAD THE CASE STUDY  <https://www.novu.com/corporate/resources/how-novuhealth-helped-avmed-health-plans-improve-quality-by-activating-the-unengaged/>

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 25 million consumers across all 50 states. Learn more at novuhealth.com.

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