New CMS Interim Final Rule offers Star reporting flexibility, affirms importance of member engagement

New CMS Interim Final Rule offers Star reporting flexibility, affirms importance of member engagement

CMS recently released its latest Interim Final Rule, including new guidance on Star measure reporting for Medicare Advantage plans. Despite 2020 being an extraordinary year, CMS is not giving plans a free pass; 2022 Star ratings will still be calculated. However, plans will have greater flexibility in the data they submit to determine those scores and subsequent quality payments.

With new CMS flexibility, plans may see a temporary lift in Star scores in 2022. But it will likely be short-lived without a sustained focus on member engagement.

That flexibility will likely give plan performance a bump across the board, but those changes will only be temporary. Plans without a sustained focus on member engagement will likely find their higher scores to be short-lived and unsustainable.

So what exactly does all this mean for your plan? Here’s everything you need to know, plus strategic insights to optimize the new flexibility and boost performance both this year and beyond.

CMS: Plans granted flexibility in 2020 Star measure reporting

CMS is amending the “uncontrollable circumstances” policies for 2022 rating purposes only. Plans will have their 2022 Star ratings calculated based on data from the current year—or the previous, whichever is better. This gives plans the opportunity to cherry pick, selecting the best data for each individual measure across two years.

In addition, CMS has removed their previous guidance that kept cut points from falling by more than 5% for each measure. The 5% rule will be re-applied in 2021 (affecting 2023 Star ratings. But in the meantime, measures could fall to lower levels and, because CMS grades on a curve, the standard for 4-Star ratings may drop as well.

NovuHealth: Our strategic takeaway on the CMS rule

With this new guidance, many plans may see a temporary lift in Star scores in 2022, and even more plans will achieve a 4-Star rating. But it’s likely this performance will be short-lived.

In other words, the opportunity to choose 2019 or 2020 data shouldn’t be seen as a pass to coast through the rest of the year. What you’re doing right now to engage members, close HEDIS gaps, and impact Star ratings is still incredibly important. If you let up, you face the prospect of a one-year uptick, only to fall back in subsequent years without the benefit of these temporary rule changes.

CMS Star Rating Marathon, not a sprintAs we like to say, member engagement is a marathon, not a sprint. Rather than take your foot off the gas now, continue to accelerate your member engagement efforts, solidifying your performance to achieve the best 2022 Star ratings possible. Not only will this boost your quality bonus payments for 2023, it will also set you up for higher scores and payments in years to come.

You can be assured your competitors will be positioning themselves to take advantage of these new rules and advance their Star scores as well. So if you’re standing still, others will bypass you.

Instead, keep your momentum going through the end of the year and focus on improving specific measures, particularly those that didn’t perform well in 2019. With a NovuHealth program boosting communication and engagement, you have the opportunity to move the needle this year—and play the long game for 2021.

Looking for more insights on how to maximize these temporary rules to boost your results and see long-term performance improvement? Contact us to learn more 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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It’s not too late to meet your plan’s 2020 performance goals

It’s not too late to meet your plan’s 2020 performance goals

It’s no secret that the COVID-19 pandemic has upended the world of healthcare. Due to the significant increase in deferred care, every plan is struggling with gaps in HEDIS measures, lack of HCC capture, and record-low MLRs. What’s more, as a result of these challenges, member satisfaction has taken a hit and increased churn is a serious concern this year.

Now, with the end of the year approaching, you might think it’s too late to make a difference.

If you’re concerned about hitting performance targets for 2020, you’re not alone; we’ve heard concerns from plans across the country. But there’s no reason to fear. With a little last minute focus and these actionable steps, there’s still plenty of opportunity to get back on track.

#1: Closing gaps in HEDIS measures

This year, more than ever, it’s been a struggle to get members in to see their providers for the care they need.

Fewer members with chronic conditions like diabetes, osteoporosis, arthritis, and hypertension have been completing their care plans and maintenance tests this year. And the same pattern holds true with preventive care—whether it’s vaccinations, flu shots, or Mom & Baby wellness visits, members are missing care that could keep them healthy for the long term.

There’s still time, however, to motivate members to complete specific, vital visits and close HEDIS gaps. At NovuHealth, we can quickly deploy a highly personalized engagement program focusing on specific segments of your membership—engaging and rewarding them to close one or more essential care needs.

With this approach, you can rapidly focus in on the highest-value measures, getting members in for essential care, and measurably impacting HEDIS scores before the end of the year.

#2: Accurately capturing HCC codes

With so many members deferring care—or unable to visit their providers due to a backlog of appointments—HCC code capture is also way down.

One quick and effective way to engage members, drive care, and accurately capture HCCs is to drive Annual Wellness Visits (AWVs). These visits offer a prime opportunity for providers to assess overall member health, develop a preventive care plan, and identify any appropriate HCCs. And now that CMS allows AWVs to be conducted via telehealth, there’s just one less barrier between your members and this essential care visit.

In a matter of days, NovuHealth can deploy an engagement program that educates and motivates your members to complete wellness visits. Customized to fit your plan’s coverage, we can promote options to complete the visit in-person, via telehealth, or with an in-home visit. By completing this one visit, members can feel more secure in their health, and you can identify more HCCs for appropriate risk revenue capture.

#3: Boosting member satisfaction and retention

The pandemic has not only disrupted the delivery of care, it’s also had a significant impact on members’ attitudes around their health and their health plans. More than ever, members are feeling isolated, overwhelmed, and dissatisfied. They haven’t engaged with the healthcare system, so they’re not seeing the benefits of having a plan. And as many plans have reduced or suspended non-COVID communications, members simply aren’t feeling as connected to or supported by their plans.

Naturally, as open enrollment approaches, this means plans may see increased churn rates. What’s more, now that CMS has double-weighted CAHPS measures for satisfaction and experience, plans need to act quickly to address member concerns and improve satisfaction.

Many of our clients are deploying NovuHealth’s Member Satisfaction Solution, an engagement program designed to identify and connect with members who are frustrated or confused, and proactively keep them informed and engaged. For example, we send positive messages to remind members that you care about them, and reminders about the valuable benefits you provide, like dental coverage, telehealth services, or access to community resources, all of which improves the member experience, boosts satisfaction, and has a positive impact on your CAHPS measures.

Another way to impact satisfaction and improve members’ perception of your health plan is our Healthy Connections for HOS Solution, an 8-week series of engaging, podcast-like IVR calls. The program offers uplifting, relatable content on physical and mental wellness. Engaging members with positive, supportive content helps them feel better about themselves and their health—especially during these isolating times. In addition, this program allows plans to regularly connect with members, helping them feel cared for and strengthening the affinity they have for your plan. The result? A better relationship with members and improved HOS scores. On average, 85% of members rate their physical health as improved, and 84% rate their emotional health as improved after the program.

Need a quick win for your plan as the clock ticks down on 2020? No matter what you have planned for member engagement the rest of the year, NovuHealth can launch, add, or adjust a solution to quickly move the needle on performance. Contact us to learn more.

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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3 steps to improve member satisfaction and retention as MA open enrollment approaches

3 steps to improve member satisfaction and retention as MA open enrollment approaches

2020 has been a chaotic year both for plans and their members. In the midst of the COVID-19 pandemic, many members aren’t engaged in their health. Throughout the spring, 46% of plans suspended all non-COVID communications. Although member communications have restarted, most members say they still aren’t feeling loved or supported by their plans. In a recent J.D. Power study of commercial health plans, nearly half of members (48%) said their plan has not shown concern for their health during the pandemic.

This enrollment season, members who feel isolated and overwhelmed by the pandemic and dissatisfied with their plans will likely fall into two categories:

  • Members who are unhappy but stay with their current plan because they don’t have the capacity to switch—putting your CAHPS and HOS scores at risk; or
  • Members who are so dissatisfied that they leave their current plan, increasing churn rate and, in turn, impacting the plan’s brand value, risk adjustment and profitability.

Plans already feel the pressure of double-weighted CAHPS measures for satisfaction and experience, and CMS’ guidance that CAHPS will go to a quadruple-weighted set of Star measures only increases their importance. So as we approach open enrollment this year, taking steps to ensure member satisfaction and retention is an even more urgent priority.

Here are 3 steps you can take to engage members, improve member experience, and reduce churn.

Empathize with your members

The J.D. Power survey of members also revealed that only 36% say their health plan acts in their best interest always or most of the time. Now more than ever, plans need to recognize what members are going through and find ways to connect with them. Start with empathy. Put yourself in your members’ shoes and support them with the resources, tools, and information they need and want.

For example, stay-at-home orders have kept people at home—away from their friends, family, and daily routines. Isolation can have profound effects on mental health, especially for seniors. Ahead of open enrollment, your plan has an opportunity to serve as a valuable connection point for members, sharing tips on how to avoid stress and loneliness and reminding them of the mental health services available to them.

If pandemic concerns are preventing members from seeking out needed care, remind them of your telehealth offerings and include clear instructions and a contact number to encourage adoption.

Now is also a great time to remind members about programs like Silver Sneakers to get them active—or medication review services to relieve the stress of prescription management. Show your members you’re committed to more than just their premiums by focusing on health and safety and providing them with tools and information to help them navigate these uncertain times.

Focus on quick wins

With only weeks until open enrollment, you might think there’s little you can do to impact member satisfaction and retention this year. But there are still ways to move the needle and do so quickly.

For example, NovuHealth’s Rapid Response Engagement Solution enables you to share crucial pandemic tips and resources with members and can be launched in a couple of weeks. And our Member Satisfaction Solution can specifically identify those members who are frustrated or confused, then proactively connect with them to keep them informed about and engaged in the benefits you provide, removing unpleasant surprises and reinforcing that your plan cares about them.

Meanwhile, our Healthy Connections for HOS Solution sends members an 8-week series of engaging, podcast-like IVR calls with uplifting, relatable content on physical and mental wellness. Having these consistent touchpoints helps members feel less alone and strengthens their affinity for your plan. It can also improve their perception of their health, impacting key HOS measures. On average, 85% of members rate their physical health as improved, and 84% rate their emotional health as improved after the program.

Optimize your member engagement

According to the J.D Power study, proactive efforts by health plans to engage with members drive significant improvement in overall customer satisfaction. Well-designed engagement programs can develop a more trusted relationship with members, leading to increased brand affinity and loyalty.

Take a look at your member communications to ensure you’re getting members the most relevant information in the channels they prefer. Right now, the right information might be accurate, up-to-date information about COVID-19, or information about the community resources available to them through your plan. The right channels will depend on the member and may range from mail to email to text messages.

Optimizing your communications drives real, measurable results. One plan with a NovuHealth member engagement program cut attrition nearly in half, which drove significant acquisition savings and increased revenue.

Member Retention Results

Remember, now is a key time to focus on member satisfaction and retention. With a meaningful member engagement program, your plan has the opportunity to enhance the member experience, reduce churn, and increase retention. What’s more, an engaged, satisfied member is a lower-cost member likely to not only stay loyal to your plan, but also refer new members and use lower-cost health services.

Looking for more strategies to improve your plan’s relationship with members? Contact us to learn more 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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Top member engagement mistakes and how to fix them — Part 3 of 5: Optimization

Top member engagement mistakes and how to fix them — Part 3 of 5: Optimization

Welcome back to the third of our 5-part series exploring health plans’ top member engagement mistakes and providing proven strategies for designing more effective programs. In our last post, we discussed how to strategically segment your member population to drive high-value care in 2020. 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 3 of 5: Optimizing your program to improve outcomes and ROI

At this point in the year, most plans are heading into the homestretch with their member engagement programs. If they’re behind on key goals, they might think it’s too late to course-correct, but there’s still time to tweak engagement efforts, get members the care they need and optimize engagement program performance.

This year, optimizing your engagement programming is more urgent than ever. With the trough of deferred care caused by COVID-19, members are behind on getting care, and plans are behind on their MLR. Plans should be adapting to the unexpected events of this year and adjust their communication efforts to get back on track in 2020 and beyond.

While many plans have engagement programs in place to boost performance, they may not be evaluating and optimizing their programs for the best results. Here are 4 common mistakes to avoid and what you should be doing instead to successfully optimize your program.

Mistake #1: Taking a “set it and forget it” approach

Once an engagement program has launched, some plans simply let it run, reviewing metrics only on a quarterly or year-end basis. When you “set it and forget it,” however, you miss out on the opportunity to build a measurable, targeted program that allows you to evaluate performance and adjust course as your business and membership base changes.

Plus, in this current climate with COVID-19, a “set it and forget it” approach can come across as tone deaf to your members. If members don’t hear from you during this time—whether you’re sharing information and resources about staying healthy or otherwise providing support—they may think your plan doesn’t care about them, or is more interested in making a profit than member care.

Instead, we recommend plans frequently take the pulse of their programs, adapting and fine-tuning as they go. At NovuHealth, we actively monitor client programs weekly, dynamically adjusting a variety of levers—including which measures and member segments to prioritize, how many communications members receive (and in what channels), and what rewards amounts to offer—to meet program and plan objectives.

In the end, this strategy ensures members get the right information at the right time for the best, most cost-efficient results.

Mistake #2: Not leveraging behavioral science to optimize member engagement

Plans frequently communicate with members, hoping to motivate them to complete needed healthcare activities—but they’re not always taking advantage of behavioral science strategies proven to drive action and optimize member engagement.

For example, with the end of the calendar year approaching, plans have the opportunity to create a sense of urgency among members, capitalizing on the near-universal fear of missing out. Language like, “Hurry up! Rewards end December 31,” can help trigger members to act quickly and schedule any necessary health visits before the year’s end.

In addition, at NovuHealth, we know how to motivate members to be more receptive to our messages—and more likely to engage. For instance, after sending information to a member about getting their annual flu shot, we can then offer them a reward for doing so, which makes them far more likely to complete the activity.

One last behavioral science strategy plans should be taking advantage of is the “present bias.” As people, we tend to value what we have in the present more than what is delayed and distant. As such, by offering members a tangible, immediate reward for completing a healthcare activity—the health benefits of which may be far into the future—plans can negate that present bias, and motivate members to take action now.

Mistake #3: Building an inefficient program using a variety of internal and external resources

We often see plans cobbling together engagement programs from a combination of internal resources, such as marketing teams and call centers, and multiple vendors. And while some plans manage this approach well, it can make it nearly impossible to accurately measure ROI and attribute a program’s success or need for improvement to a specific variable.

Plus, it leaves the door open to the possibility of crossed wires and duplicate efforts, not to mention the difficulty of understanding exactly what’s going on across your program.

That’s why NovuHealth takes a streamlined approach. We handle all engagement efforts on one platform with one dedicated team, delivering a program with clear and measurable ROI. After all, we evaluate your program continually and provide detailed reporting on exactly what’s working, and what’s not, to make laser-focused adjustments in real time. Which brings us to our next mistake…

Mistake #4: Not implementing reporting to track KPIs and measure ROI

Plans that aren’t measuring their programs’ success may be actively throwing money away. They can’t pinpoint what’s responsible for a positive (or negative) ROI and can’t make dynamic, informed decisions to optimize their programs.

At NovuHealth, we design programs that are measurable, attributable, and truly move the needle on performance. That’s because our efforts are driven by data. We know exactly how effective your program is, and how to optimize its effectiveness, because we actively track key performance indicators. By continually evaluating your performance—and adapting to focus on the right measures, member segments and communication channels—we can ensure your program meets objectives and delivers positive ROI.

Looking for more strategies to optimize your engagement program in 2020 and beyond? Get in touch with your NovuHealth representative, or contact us to learn more about how we can help streamline your efforts for the best results.

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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5 steps to engage members and hit your MLR target for 2020

5 steps to engage members and hit your MLR target for 2020

We’ve been talking a lot about deferred care on this blog lately, and for good reason: It represents a significant challenge for health plans this year. And with COVID-19 outbreaks on the rise again—and some states reversing their decisions to reopen—members may again be hesitant to go in to the doctor’s office. Healthcare utilization is unlikely to return to normal levels through the end of the year.

Naturally, as it becomes harder to get members the care they need, plans are also struggling to hit the 80 or 85% medical loss ratio (MLR) required by the Affordable Care Act.

Take for example, UnitedHealthcare (UHC). The nation’s largest health insurer recently reported that its MLR dropped to 70.2% in the quarter ending June 30, compared to 83.1% at the same time last year, due largely to deferred care.

And we’re seeing a similar story at health plans across the country. Many plans have fallen well behind their MLR target. Many are waiving co-pays on certain services, and some are even issuing rebates.

But here’s the good news. There’s a lot you can still do to address deferred care and get members the care they need. For example, since reward and incentive investments count toward your MLR, member engagement programs optimized with rewards offer benefits on multiple fronts.

Download our guide to learn 5 actionable steps you can start today to drive care gap closure and hit your MLR target for 2020.

5 steps to engage members and hit your MLR target for 2020

5 steps to engage members and hit your MLR target for 2020

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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