CMS Regulatory change

A new J.D. Power study reveals a gap between how health plans communicate with members and what members expect, especially during the pandemic. In its 2020 analysis of consumer attitudes toward health plans, the customer research firm found that:

  • 60% of plan members say they were never contacted by their plan with COVID-19 information; and
  • 48% said they feel their plan has not shown concern for their health since the pandemic reached the U.S.

The research illustrates that members expect more communication from their plans. But for many plans, effective member engagement remains elusive.

New CMS guidance could help plans increase member engagement

Last week, CMS released new guidance that gives health plans a powerful new tool to engage Medicare Advantage (MA) members and get them the care they need.

CMS now allows plans to add new rewards and incentive (R&I) programs in 2020 in response to COVID-19. Plans typically include these programs in their bids submitted the prior year. And if you currently have an R&I program, but want to expand it or increase the budget in response to the pandemic, CMS is providing the flexibility to do so.

This new guidance illustrates CMS’s willingness to provide plans more flexibility to engage members and motivate them to seek the care they need. And it paves the way for plans to significantly ramp up their member engagement efforts for the remainder of 2020.

Increasing backlog of deferred care carries risk for members and plans

That’s imperative, because the amount of health care that Americans have deferred due to the pandemic is growing at an alarming rate. According to NPR, more than half of Americans 70 or older put off medical treatment in the first month of the pandemic alone—everything from vaccinations to cancer screenings to even emergency care.

All those deferred services not only mean that members aren’t getting the care they need, it could also create medical loss ratio (MLR) challenges for plans later this year. Medicare Advantage and Medicaid MCO plans are required to spend 85% of revenue on medical expenses. But with so many services deferred, some plans are reporting unexpectedly high profits. The good news is that many plans are already waiving co-pays and paying premium rebates in anticipation of being upside down on their MLR. But those waivers are dependent on getting members the care they need.

Engaging members proactively and strategically

Proactively engaging members—and offering rewards and incentives to motivate them to get needed care—can also help plans balance out the MLR. As you know, R&I programs for Medicare Advantage members qualify as part of clinical spend, not administrative spend, so R&I investments go toward your MLR.

What’s more, with recently relaxed CMS and NCQA regulations making telehealth a viable option for more than 80 health care services, plans don’t have to wait for stay-at-home orders to be lifted—they can encourage members to get the care they need now. Yet based on the J.D. Power study, plans need to focus more on telehealth: 75% of consumers are aware of telehealth, but 54% don’t understand if their plan covers such benefits.

Several of NovuHealth’s leading health plan clients have initiated proactive member engagement programs, and we’re helping them do so strategically. For example, our engagement programs promote telehealth as a viable option for many services including annual wellness visits, musculoskeletal condition management and remote monitoring of physiologic markers like BMI, blood pressure and HbA1c. We’re also helping plans prioritize the most critical health care activities for members who are most at risk, such as mom and baby populations and those with chronic conditions. Those members can’t wait behind the wave of people who will soon be seeking appointments.

In the end, these leading plans recognize that reengaging their members now is in the best interest of both the plan and the members. Plans can create a competitive advantage by moving quickly and thoughtfully, and they can ensure their members get the care they need.

Want to learn more about how NovuHealth can help you thoughtfully engage your members and get them the care they need?

Want to learn more about how NovuHealth can help you thoughtfully engage your members and get them the care they need?

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.