How NovuHealth helped 1 health plan significantly improve their Mom & Baby Medicaid engagement

How NovuHealth helped 1 health plan significantly improve their Mom & Baby Medicaid engagement

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO) in Houston that serves 400,000 members across Southeast Texas—many of whom are Medicaid-eligible pregnant women and their newborn children, who face challenges related to social determinants of health.

Recognizing the importance of prenatal, postpartum and well-child visits to the health of mothers and their babies, as well as a health plan’s bottom line, Community wanted to create a member engagement program to encourage more moms to complete those all-important healthcare activities.

Download the case study to see how NovuHealth helped Community engage and motivate more than 1/3 of program participants to complete their prenatal and/or postpartum care visits.

DOWNLOAD THE CASE STUDY  <https://www.novu.com/corporate/resources/how-novuhealth-helped-1-health-plan-significantly-improve-their-mom-baby-medicaid-engagement data-recalc-dims="/>

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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The quality paradox: Improving performance by motivating the unengaged

The quality paradox: Improving performance by motivating the unengaged

Most consumer loyalty programs—think Starbucks, Delta and American Express—reward their best, most engaged customers. The frequent fliers. The twice-daily mocha drinkers. The big spenders. For these brands, 20 percent of customers drive 80 percent of revenue, so it makes sense to focus on those who are most loyal.

For health plans, it’s a different story. 20 percent of members drive 80 percent of costs. And generally, these members are the unengaged and non-compliant. If your plan is only reaching the members who are already engaged in their care, you’re not addressing the members who are costing you the most.

To meaningfully impact performance, health plans must engage and motivate the unengaged. So, where can you start? First, make sure you’re focusing on the right populations. Don’t just reward those who are already engaged; focus on the members who aren’t engaged and aren’t compliant with their care gaps.

Then, customize your program design and communications. Most plans use a one-size-fits-all approach to member outreach and engagement, sending everyone the same postcard with the same generic message and reward.

A better approach is a segmented, targeted and personalized approach at the measure and member level. Identify the quality measures where you need to boost performance, focus on the non-compliant population and figure out exactly how many care gaps you need to close to reach the next cut point. Then, design and deliver your rewards program accordingly.

Download our co-presentation with AvMed Health Plans from RISE Qualipalooza to learn 5 strategies for motivating unengaged members to take action, and to find out how we helped AvMed improve performance by doing just that.

DOWNLOAD THE PRESENTATION  <https://www.novu.com/corporate/resources/the-quality-paradox-improving-performance-by-motivating-the-unengaged data-recalc-dims="/>

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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The benefits of integrating risk & quality functions within health plans

The benefits of integrating risk & quality functions within health plans

Forward-thinking plans are integrating their risk adjustment and quality functions—is your plan among them?

While risk adjustment has always been a significant performance lever for government plans, in recent years, quality has become an equally important business driver, especially with the rise of value-based care.

In this value-driven climate, plans have naturally begun to gravitate toward increased collaboration, recognizing—and capitalizing on—the natural synergy that exists between quality and risk.

With so much alignment between the two functions, including shared goals like getting more members the care they need and capturing accurate member risk, the old model of operating within distinct department silos just doesn’t add up anymore.

If your plan is considering building more collaboration between your risk and quality functions, here are a few things to keep in mind—including potential benefits, challenges, and advice on getting started.

The benefits of combining quality and risk adjustment

With so many goals in common—such as getting more members to visit their primary care providers—quality and risk are perfectly positioned to join forces.

And as you might assume, such synergistic efforts lead to better performance—as well as operational efficiencies. Not only can plans align cross functionally to drive quality ratings and eliminate unknown risk, they can also avoid the duplicate efforts and fragmented member experience that can come with independently operating departments.

By aligning quality and risk, plans are able to optimize budget and resources across departments. Take for example Community Health Choice—a non-profit managed care organization (MCO) that serves 400,000 members across Southeast Texas. Recognizing overlapping objectives between departments, as well as where their staff’s strengths aligned, Community chose to house risk adjustment within their quality function.

“When we looked at RADV (risk adjustment data validation), it started to look like what we were already doing with HEDIS,” said Pam Hellstrom, Chief Compliance and Quality Officer at Community Health Choice. “It just made sense to move risk into the quality department.”

By bringing the knowledge of the quality department to its risk function, Community has strengthened the performance of both teams, while eliminating duplication and increasing efficiencies.

At WellCare, one of the 10 largest health plans in the U.S. that serves roughly 6.3 million Medicaid and Medicare members, developing a partnership between risk and quality was a natural choice that happened quite organically. “At WellCare, there’s a strong culture of teamwork,” said Anthony Allegretta, Director of Quality Improvement, WellCare Health Plans. While WellCare’s risk and quality teams have remained independent, they consistently collaborate on joint initiatives, reducing member and provider abrasion through streamlined, interdepartmental processes.

Likewise, AvMed, which serves more than 200,000 members across the state of Florida, has adopted a collaborative approach to quality and risk, capitalizing on the operational efficiencies that come with it. By developing an organized, cross-departmental method for collecting records—then sharing quality and risk data in a universal location that everyone has access to—they have streamlined their provider requests, said Cynthia Weiss, Director of Quality, Accreditation and Wellness at AvMed. Ultimately, this adds up to cost and time savings.

Challenges to building better collaboration

When it comes to developing an integrated approach, it’s no surprise that one of the biggest obstacles facing plans is simply breaking down departmental silos. Not only can it be challenging to make changes to longstanding processes and structures—but it can be hard to shift established habits and attitudes. Developing a more collaborative culture within an organization can take time. And getting buy-in from key internal stakeholders—from departmental leaders all the way up the executive chain—is crucial.

For Community Health Choice, an organization with a strong culture of collaboration already in place, their current challenges are more tactical in nature—for example, syncing up quality and risk data repositories. This is a common challenge for plans that store large amounts of data but lack the systems to integrate it. In Community’s case, an initiative is currently in place to better align their data and strengthen collaboration.

Other hurdles for Community Health Choice have centered around the provider relationship, including provider abrasion, medical record retrieval, and educating providers about appropriate coding, which plans need for both HCC and HEDIS documentation. Accurate coding and timely information are key to both risk and quality efforts, and can have a big impact on how successful risk/quality collaboration can be.

However, oftentimes, plans think of risk adjustment as just a finance or a data issue—which isn’t seeing the full picture. Efforts to accurately capture risk revenue are largely dependent on getting members to the doctor, closing care gaps, and accurately documenting member health needs. For the most successful HCC documentation, you also need to be thinking about HEDIS measures—something the plan leaders at AvMed understood when creating their current member assessment.

Recognizing that both their risk and quality teams could benefit from making Annual Wellness Visits more productive, they created an assessment that would capture more than just the HCCs needed for risk adjustment.

“Risk and quality designed the assessment collaboratively, so it captures certain HEDIS requirements as well,” said Weiss. “Now, the assessments can also be used as medical records, streamlining record collection, and providing valuable data to both departments.”

WellCare also recognized that key encounters, like the AWV, could benefit risk and quality efforts alike if members and providers were effectively engaged.

“We have teams that work with providers to help members make and keep appointments with their assigned Primary Care Provider,” said Allegretta. “From there, we also work with the provider and the provider’s staff to help close all the member’s care gaps and have provider reps in the physician offices to talk directly with the member about what steps are needed.”

Not only are WellCare’s AWVs more productive, offering valuable data to both risk and quality teams, but they provide members with a more holistic healthcare experience, addressing current and preventive care needs.

5 keys to successful collaboration between quality and risk

So how should your plan get started with creating a collaborative relationship between quality and risk? Here are a few proven tips from our forward-thinking plan leaders:

1. Enable cross-functional communication

Whether it’s setting up regular interdepartmental meetings or co-locating departments, fostering open, consistent communication between teams makes collaboration easier, especially at larger plans with thousands of employees.

“Having our risk and quality teams in the same building helps build upon our already great teamwork,” said WellCare’s Allegretta. “Just being able to walk over to someone’s desk and have a conversation about what we’re working on is invaluable.”

2. Share (and even centralize) your data

For better cross-functional performance, integrated analytics and reporting are essential. When analysts and other team members are given wider access to plan data—and can approach it with an understanding of both quality and risk—that data becomes far more useful.

For Community Health Choice, giving team members access to interdepartmental data has been a game changer. “It has broadened our impact on the company and allowed us to give more time and attention to the quality and outputs of our data,” said Nicole Lievsay, Director of Quality Validation at Community Health Choice.

3. Build a team of shared resources

To increase operational efficiencies and create a unified member experience, consider where your risk and quality programs share objectives—and where they might be able to share resources as well. After all, with so many shared interests between risk adjustment and quality, it often makes sense to align budget and staff to streamline processes and develop stronger teams.

Consider examining where your staff’s skills and knowledge overlap. “Look at your staff strengths and see if their strengths help risk and quality more naturally align,” suggested Hellstrom from Community.

For example, Community Health Choice has nurses on staff who are knowledgeable about both quality and risk, so depending on the time of year, they can focus on HEDIS or shift to risk. “A couple of times last year when we were up against deadlines, we were able to flex our nurses, and they both became pretty active in HEDIS,” Hellstrom explained.

With such an approach, you can not only streamline your team, but also help them work more effectively and efficiently across functions.

4. Start with small-scale pilots

Pilot projects can be a great way to test and validate cross-functional collaboration. For larger plans, especially, completely integrating two departments that have previously been in silos can feel like trying to boil the ocean. Instead, by starting with smaller pilot initiatives that you can stand up quickly, building collaboration can be far less overwhelming.

Plus, you have the opportunity to demonstrate a project’s value before rolling it out on a larger scale.

Case in point, AvMed’s member assessment, mentioned above, started out as a pilot. WellCare has also seen success with starting small, currently running two new cross-functional pilots: one to engage members to have more productive AWVs, and another to leverage quality efforts to impact RAPS.

“You don’t have to do it all,” said Allegretta. “Figure out the pilot that’s going to give you the most return.”

5. Focus on member engagement to drive performance

Getting members to the doctor is key for both quality and risk—and that interaction (or lack thereof) can have a huge effect on your performance across programs, as well as the health of your members.

A member engagement program designed to motivate members to complete the high-value activities that will have the biggest impact on both their health and plan performance can help. NovuHealth partners with Community Health Choice, AvMed and WellCare to design highly successful member engagement programs, offering members incentives to attend recommended appointments and empowering them with information about what to expect at their visits.

The future of integration

As innovative plans continue to become more collaborative and value-based care continues to drive the market, integrating quality and risk is essential for any plan that wants to take (or keep) its place at the forefront of the industry.

And while it can be challenging to break down departmental silos, the benefits for member health, performance, and operational efficiencies are undeniable. As you’re working to build more collaboration within your organization, start by keeping an eye out for aligned interests, and joining efforts where there are shared objectives.

And remember, in a high-performing plan, no department can function in isolation.

“Risk adjustment happens to be in the quality department, but it doesn’t function in a vacuum,” said Hellstrom. “It also overlaps with analytics, finance and IT—so it’s very much an interdepartmental program regardless of where it resides.”

AvMed’s Weiss added, “We don’t think of it as a single initiative. When one department sees another doing something beneficial, they work together so everyone can benefit.”

A collaborative mindset like this will become industry standard in time, so get started now and stay ahead of the curve. And if you need any help developing member engagement solutions that integrate quality and risk in your organization, don’t hesitate to get in touch.

 

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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TAKE THE QUIZ: How does your member engagement strategy stack up?

TAKE THE QUIZ: How does your member engagement strategy stack up?

Member engagement is a top imperative for health plans, and for good reason. Unengaged members can threaten quality ratings, hurt retention, limit accurate risk adjustment and hinder growth. When members are actively engaged, on the other hand, they can drive plan performance, satisfaction and retention—giving you a competitive edge.

How you reach and motivate members is critically important. To see how your strategy stacks up (and where you need to improve), take this short quiz.

TAKE THE SHORT QUIZ <https://novuhealth.outgrow.us/engagement_quiz data-recalc-dims="/>

Wondering just how much unengaged members can impact your plan’s performance (and your bottom line)? Check out our blog post on the high price of low member engagement. To see how leading plans approach member engagement, read up on the 7 habits of high-performing health plans.

 

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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The potentially high price of low member engagement

The potentially high price of low member engagement

Consumer engagement is currently one of the most talked-about topics in healthcare, and not just among marketing or member retention teams. Financial decision-makers are making it a priority as well.

In fact, a recent survey from the Deloitte Center for Health Solutions found that consumer engagement is the top priority risk among healthcare CFOs, with 58 percent ranking it above other key concerns such as cybersecurity and the transition to value-based care.

While this focus from the CFO may seem somewhat surprising, it actually makes sense considering that poor member engagement can significantly impact an organization’s bottom line.

4 key ways unengaged members impact a health plan’s bottom line

For Medicare Advantage plans, unengaged members threaten Star ratings—and the plan’s financial health.

Based on our work with more than 40 plans and nearly 15 million members, we find that if even a fraction of members are unengaged, it can mean the difference between a plan maintaining a high Star rating and falling back to a level that doesn’t earn quality bonus payments from CMS. Depending on the plan, that could translate to millions of dollars.

Unengaged members limit accurate risk adjustment.

On average, one in five plan members is not accurately risk adjusted. Unengaged members who don’t visit the doctor have not had the opportunity to be fully evaluated for all of their chronic health conditions, and may be coded incompletely or inaccurately. That means members aren’t getting the care they need, and it can also cost millions in risk adjustment revenue for the plan.

Unengaged members negatively impact retention.

Based on data from the Medicare plans we worked with in 2018, actively engaged members churned at a rate of just 2.5% compared to an 8.3% churn rate for non-engaged members. Put another way, unengaged members were more than 3X more likely to churn than engaged members. And as financial decision-makers know all too well, member churn hurts profitability.

Similarly, unengaged members can hamper growth.

The “big five” health plans (UnitedHealth Group, Anthem, Aetna, Cigna and Humana) hold a 60% share of Medicare Advantage enrollment nationwide, while accounting for 86% of total net enrollment growth from 2015 to 2018. This makes it harder and harder for other plans to attract new members. In this scenario, successfully engaging members means giving them fewer reasons to shop around.

Given the significant impact consumer engagement can have on a health plan’s bottom line, it’s no wonder CFOs are taking notice. And beyond the CFO, plan leaders in many departments are taking notice—recognizing that using the same one-size-fits-all member engagement strategy isn’t going to cut it any longer.

To effectively address consumer engagement, high-performing health plans are leveraging several proven consumer marketing best practices, including:

– Focusing on the member populations that will deliver the biggest impact

– Prioritizing the healthcare activities that improve member health and align with plan business objectives

– Personalizing the approach to deliver the right message at the right time in the right channel to each member

– Using optimized rewards and incentives to inspire action and build trust

– Measuring engagement program performance regularly and adjusting as needed

Taking a page from the consumer brand playbook

Other consumer brands, such as Starbucks, Target and Zappos, have already figured this out. They approach consumer engagement with these loyalty marketing and behavioral science best practices—using meaningful incentives and personalized experiences to build lasting relationships.

But the rise of the consumer no longer only applies to only industries such as retail or services—it now includes healthcare as well. It’s been said for years that health plans need to start seeing members as consumers, and as each day passes it becomes more and more true.

In order for plans to win and be successful under today’s new consumer-driven paradigm, they need to take a page from the retail industry’s consumer marketing playbook and build member engagement strategies around best practices. Only then will they be in a position to see consumer engagement as a strategic business advantage rather than an organizational 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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