Engaging members to identify risk: how NovuHealth
optimizes risk adjustment

A NOVUHEALTH CASE STUDY

Challenge

It goes without saying, understanding your members’ risk is as crucial to delivering high-quality care as it is to your plan’s financial success. Under the Hierarchical Condition Categories (HCC) reimbursement system, health plans must identify high-risk members to receive the payments necessary to cover that risk. But, assessing members’ risk status can be a challenge, especially if they are not actively engaged in their heath or with the health care system.

Solution

In this case study, we partnered with a large health plan to implement a targeted HCC identification and risk adjustment strategy. Our approach? A first-class engagement program.

As our first step, we identified high-risk members through propensity modeling and analytics. With this data in hand, we drilled down to yet another layer of detail, segmenting these members further based on risk score and propensity to activate. This allowed us to establish marketing focus, developing unique communication and activation strategies per segment to drive either health risk assessment (HRA) completion or a primary care visit to assess risk. Not only does such a targeted approach make our solutions more effective at driving members to complete desired activities, it also makes them far more cost-effective as well.

Finally, as a key part of the process, we leveraged rewards and incentives to motivate members to engage and complete their HRA or visit their doctor. And, as always, we’re never content to rest on our solution’s laurels: we continuously learn and improve our engagement efforts based on how members do (or don’t) engage and the program results. As a program continues into its second year, we rely on data to inform any revisions to the model, further optimizing our communications and rewards strategy.

Results

Insights

For an engagement program that successfully identifies risk, determine the most effective activation approach based on the member’s risk score and activation propensity—and invest accordingly. Continuously learn from member activity and non-activity, refining and adapting your approach to drive high-value activities, like HRA completion.

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NovuHealth is the leading healthcare consumer engagement company, offering rewards and incentive programs that improve consumer health and plan performance. NovuHealth applies proven loyalty and data science strategies and leverages its deep industry and regulatory expertise to motivate high-value consumer activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 15 million consumers across all 50 states.

When time is
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increase incentives,
communications
and audience focus
to deliver business
results.