Top member engagement mistakes and how to fix them — Part 2 of 5: Member segmentation

Top member engagement mistakes and how to fix them — Part 2 of 5: Member segmentation

Welcome back to the second of our 5-part series where we explore the top member engagement mistakes health plans tend to make, and provide proven strategies for designing more effective programs. In our last post, we discussed how to prioritize the right health care measures to improve both member health and plan performance. Next time, we’ll dig into program personalization—and how serving up relevant content in a member’s preferred channels prompts stronger engagement. Stay tuned!

Part 2 of 5: Strategically segmenting your member population

It’s no secret that one of the biggest challenges facing plans in 2020 is the tremendous backlog of deferred care. Not only are members not getting the care they need, plans are way behind on their quality measures, hierarchical condition category (HCC) capture, and even their medical loss ratio (MLR).

And with just 6 months left in the year, plans are under pressure to get care to their members—especially at-risk members who simply can’t afford to postpone essential care any longer.

That’s why a thoughtful segmentation strategy is more important than ever. With the current backlog and competition for appointments, now’s the time to prioritize your outreach and communications to your at-risk populations, including:

  • those requiring cancer screenings and those with chronic conditions like diabetes and hypertension, who may not be actively managing their conditions
  • your mom and baby population, whose members could be behind on vital vaccinations
  • members in need of mental health support, particularly those facing added stress and isolation during the pandemic.

So how should you segment your population and tailor your communications with your members? Here are three of the most common mistakes to watch out for, plus expert advice for successful segmentation in 2020.

Mistake #1: Sending the same communications to every member

We often see plans engaging with every member using the exact same communications, channels and cadence.

At NovuHealth, we use proprietary predictive analytics to identify at-risk populations—such as those with critical open care gaps, or those most likely to leave a plan. Then, we focus on those members with a robust communication strategy, promoting telehealth in particular as a virtual option for members during the pandemic.

We can even identify a member’s preferred channel of communication (email, phone, SMS, etc.) and determine how often to communicate with that individual to motivate action. This enables us to reach the right member at the right time in the right place, optimizing program performance and ensuring members get the care they need.

Mistake #2: Passively rewarding members for taking action

Plans that passively reward members for completing any and all activities—even ones they didn’t know they were eligible for—effectively use an “opt-out” strategy that fails to cost-effectively deliver results. It’s inefficient, it doesn’t allow you to focus on the at-risk members you most need to engage, and it doesn’t build valuable member affinity for your health plan.

A more effective approach is to use an “opt-in” strategy that gives all members an opportunity to participate but communicates more robustly and frequently to the members most in need of care and then rewards those who choose to participate.

With this strategy, plans can be sure they’re spending program dollars wisely and effectively, and driving high-value care as efficiently as possible.

Mistake #3: Failing to leverage data fully to prioritize member communications

Often, plans use only behavior data—or data on open care gaps—to determine which members to focus on in their engagement program. However, with such limited data, it’s hard to account for all of the variables that may influence a member’s propensity to act.

With NovuHealth’s approach to propensity modeling, we take into account not only member behavior data, but additional information, such as third-party consumer data, that helps us build a comprehensive, 360-degree view of members and what motivates them to act.

Want more tips on how to segment members to drive high-value care in 2020? 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 novu.com.

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Concerned about deferred care? Annual Wellness Visits can boost quality scores and risk adjustment code capture

Concerned about deferred care? Annual Wellness Visits can boost quality scores and risk adjustment code capture

Health plans face a host of compounding challenges this year. As the pandemic continues, members are deferring care in record numbers:

  • 30% of members have missed a wellness visit
  • Cancer screenings are down by 95%
  • Vital vaccinations have dropped by up to 73%
  • Chronic conditions have been left unmanaged: HbA1c, cholesterol and lipid tests are down 65%
  • Even emergency room visits have dropped by half

All these deferred visits impact members, providers and plans dramatically. Members aren’t getting the care they need. Providers aren’t generating revenue. And plans are way behind on their medical loss ratio (MLR) and hierarchical condition category (HCC) capture, which could lead to millions of dollars in lost revenue.

What’s more, as we stand at the midway point of the year, you may be running out of time to address these challenges.

Luckily, there’s a quick and effective way to engage your members, drive care, and capture more HCCs before the year is over.

The key lies in driving Annual Wellness Visits (AWVs).

Why AWVs are critical for member care and plan revenue

AWVs offer a key opportunity to identify the HCCs that determine CMS risk adjustment payments. And CMS has said they can now be conducted via telehealth—and that plans can leverage new rewards and incentive programs in 2020 to expand member engagement.

In addition, members who complete a wellness visit are up to 10X more likely to complete other health care activities as part of an ongoing engagement program. This, of course, impacts overall quality scores—and has been shown to boost member satisfaction as well.

NovuHealth’s Annual Wellness Visit Solution

At NovuHealth, we can quickly deploy a focused and efficient engagement program specifically designed to motivate members to complete wellness visits.

Whether you choose to focus on new and high-risk members, or engage your full population, we can educate your members about the value of the AWV and motivate them to complete this important activity. Best of all, our program is quick to launch—it can be ready to launch in days, not months.

Plus, we can customize the program to fit your plan’s coverage, promoting options to complete the visit in-person, via telehealth, and/or with an in-home visit.

With our AWV engagement program, you can feel confident that you’re helping your members get the care they need safely, leading to better health outcomes and stronger member trust. And at the same time, you’re also identifying more HCCs for appropriate risk revenue capture and driving revenue for your provider network.

Want to learn more about our Annual Wellness Visit solutions and how to overcome the impact of deferred care during the pandemic? Click the button below to book a meeting with one of our engagement experts.

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 novu.com.

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CMS raises the stakes on CAHPS—learn why it matters, why it’s so elusive, and how to impact it

CMS raises the stakes on CAHPS—learn why it matters, why it’s so elusive, and how to impact it

The Centers for Medicare and Medicaid Services (CMS) doubled down on CAHPS recently, increasing measure weights for patient experience and access from 2 to 4. As a result, improving CAHPS and member satisfaction has become an urgent priority for health plans nationwide.

However, that goal remains elusive. According to a recent J.D. Power study of commercial health plans, only 36% of members say their health plan acts in their best interest “always” or “most of the time.”

What’s more, given the challenges of the current pandemic, members will likely have higher expectations and may be more critical of their plan this year. Clearly, to stay competitive, plans today need to take a proactive and holistic approach to CAHPS and member satisfaction.

Download our new e-book to learn more about the high stakes of low member satisfaction, and the 5 steps plans should take to improve member experience and positively impact CAHPS measures.

The Quest for Member Satisfaction: Why Member Satisfaction is both a Priority and a Puzzle for Health Plans

The Quest for Member Satisfaction: Why Member Satisfaction is both a Priority and a Puzzle for Health Plans

Ready to proactively address the most common sources of member dissatisfaction—and the Part C measures that plans can address directly? NovuHealth’s Member Satisfaction Solution zeros in on members who are unhappy or unengaged, then we proactively connect with them to keep them informed and engaged. The result? An improved member experience, enhanced member satisfaction, and a positive impact on your CAHPS measures.

Read more: The proactive way to improve member satisfaction and impact CAHPS

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 novu.com.

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The 2020 HOS survey is delayed—you now have a chance to impact scores, even during the pandemic

The 2020 HOS survey is delayed—you now have a chance to impact scores, even during the pandemic

One of CMS’s many regulatory changes in response to COVID-19 was postponing the HOS survey to late summer (and, at this point, it is still expected to occur).

Here’s the good news: This presents a new window of opportunity for your plan.

In a normal year, the HOS survey would already be underway. But this year’s delay affords you additional time to reach out to and engage members before the survey begins.

And it’s especially crucial that you do so now, when your members may be facing increased isolation—and its mental health effects—during the pandemic. You can support your members and impact HOS scores via telehealth services and NovuHealth’s Healthy Connections for HOS solution.

New telehealth allowances enable 2020 HOS activities

Members who may be struggling with their physical and mental health during this time don’t have to go it alone, thanks to increased access to telehealth.

Many of the Star measures that rely on HOS data for their rating don’t require members to be physically present in a clinical setting. For example, HOS activities like C04 and C05, members’ impressions of their physical and mental health; C06, monitoring physical activity; and C17 and C18, evaluating fall risk and assessing bladder control, can still occur via IVR or through visits conducted via telehealth.

Fortunately, thanks to CMS’s recent expansion of telehealth services and relaxation of technology requirements for those visits—for example, allowing a provider to use FaceTime or Skype with a patient—virtual visits are more accessible than ever during these times.

In fact, a recent survey found that 50% of doctors are now seeing patients via telehealth, up from 18% just 2 years ago. Two other recent surveys suggest seniors are open to using telehealth and give it high marks when they do.

Bottom line: What you do now can still have a significant impact on member health and the upcoming survey—as well as your 2022 Star scores.

NovuHealth’s Healthy Connections for HOS solution helps plans impact HOS scores, even in a small window

Looking for a way to meaningfully engage your members and see a measurable impact on key HOS measures during this short window of opportunity? Our Healthy Connections for HOS solution empowers Medicare Advantage members to improve their health—and perceptions of their health—with an 8-topic series of engaging, podcast-like phone calls.

Featuring uplifting, relatable content on physical and mental well-being, these calls provide an ideal way to connect with your members during this pandemic. With the calls for social distancing and shelter-at-home orders, Medicare members may be more isolated than ever and facing greater mental health risks—especially those who were already feeling isolated before the pandemic. That’s exactly where our HOS solution can help.

And because the program utilizes both outbound and inbound IVR, plan members can engage with the program whenever it’s convenient. If they miss one of the calls, they can call back at a later time or date to receive the information.

Members are rewarded for starting and completing the program, and perceptions of their physical and mental health are measured before and after.

Several leading health plans have leveraged the program to engage members and impact HOS scores. Participation is strong: More than 70% of members who enroll and complete the first topic also complete the final topic. And the results are overwhelmingly positive:

  • 91% of enrolled members rate their physical health as improved
  • 89% of enrolled members rate their emotional health as improved
  • 95% of enrolled members say they would recommend the program to a friend or relative

And when asked, “What did you think of this week’s message?” 96% of enrolled members rate the topics as excellent or good.

In short, Healthy Connections for HOS impacts key HOS measures while building stronger relationships with members—which is especially important during this challenging time, when members may be experiencing higher levels of stress, isolation and dissatisfaction and may be more critical of their plan and.

Want to learn more about our Healthy Connections for HOS solution and how you can impact HOS measures during COVID-19? 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 novu.com.

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CMS final rule for Medicare Advantage and Part D prioritizes member experience and expands telehealth access

CMS final rule for Medicare Advantage and Part D prioritizes member experience and expands telehealth access

The Centers for Medicare & Medicaid Services (CMS) issued a final rule last week that increases the weight of member experience measures, expands access to telehealth, and increases some chronic disease supplemental benefits, among other changes.

Increased weight of patient experience measures

CMS refined the Medicare Advantage Star Ratings system (and Part D Star Ratings) by giving member experience measures more weight in determining ratings. Specifically, CMS increased measure weights for CAHPS patient experience and access measures from 2 to 4. This change takes effect for the 2021 measurement year and will be reflected in the 2023 Star Ratings.

Given this change, which CMS hinted at earlier this year, improving member satisfaction and the overall experience has become a top priority for leading MA plans nationwide.

Telehealth flexibility

As part of what it called “larger efforts to advance telehealth,” CMS encouraged MA plans to increase their telehealth benefits and gave plans more flexibility to count telehealth providers across several specialties toward meeting CMS network adequacy standards.

CMS has been strongly encouraging plans to leverage telehealth as a way to safely get care to members who need it, without waiting for all in-person visits to resume. For example, earlier this year CMS said clinicians can conduct Annual Wellness Visits and other preventative or chronic condition monitoring virtually. Mental health services and substance abuse counseling are now covered through telehealth as well.

MLR expansion

The final rule also expands medical loss ratio (MLR) regulations, allowing MA plans to include all amounts that an MA organization pays for covered services in the incurred claims portion of the MLR numerator. “Incurred claims,” now include payments to individuals and entities that previously did not meet the traditional definition of provider in the MLR statute.

This move is intended to incorporate costs associated with supplemental benefits MA organizations now may offer their members. Supplemental benefits can include items and services that fall well outside the definition of “provider.” This change may also be helpful to plans that have leveraged the flexibilities provided by CMS during COVID-19.

Pandemic accommodations

To address the COVID-related challenges plans are facing, CMS adjusted the 2021 and 2022 Star Ratings calculations, acknowledging that data collection and measure scores will likely be affected by the pandemic.

Finally, CMS retired measure C16: Rheumatoid Arthritis Management, although it’s an area plans may still want to keep an eye on. In addition, the rule makes all Medicare beneficiaries with End Stage Renal Disease (ESRD) eligible for Medicare Advantage, beginning Jan. 1. And it eases rural healthcare policies in order to make more Medicare Advantage options available to rural residents.

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 novu.com.

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