Health plan 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.