Closing gaps in care is a critical challenge for health plans, especially in promoting preventive care and Annual Wellness Visits (AWVs) that can lead to better health outcomes for members. Icario research shows that when members complete their AWV, they are 40% more likely to complete additional health actions that are traditionally hard to close.
| Diabetes Kidney Exam | |
| 2018-2019 Flu Shot | |
| Arthritis Management | |
| 2019-2020 Flu Shot | |
| Diabetes Blood Test (A1C) | |
| Taking Care of Your Overall Health | |
| Colon Cancer Screening | |
| Diabetes Eye Exam | |
| Breast Cancer Screening | |
| Bone Density Test | |
| Total |
*Based on Icario data analysis
While in-person provider visits are returning to comparable 2019 levels, all of the institutional and social barriers to care remain. In many cases, the pandemic has exacerbated these social determinants of health (SDoH). This means millions of Medicare and Medicaid members struggle in a variety of ways to achieve everyday health and wellness due to barriers such as transportation, food insecurity, and much more. These challenges make AWVs even more critical for member health as well as a plan’s Health Risk Assessment (HRA).
In this blog post, we’ll provide actionable insights on the significance of AWVs and preventive care, offering strategies that can help health plan executives address gaps in care and enhance HEDIS measures to support improved health outcomes.
How Do We Motivate Members to Engage in Preventive Care?
As we approach this challenge, we have to get back to basics. It sounds obvious, but it’s important to start with the member in mind to develop programs and outreach from a highly personal perspective to find what motivates different individuals. Let’s look at three innovative ways to engage members and move them to take positive health action and close gaps in care.
Closing Gaps in Care and Breaking SDoH Barriers: 3 Proven Ways
1. Put Members in the Driver’s Seat on Their Journey to Better Health
It’s critical to understand the unique relationship you as a health plan have with your members and how this differs from the role a healthcare provider plays in the same person’s care. However, rather than simply understanding your role, there’s an opportunity to use this knowledge to drive better engagement with your members.
Think of it like this: You’re not just a plan, but a partner. Members look to their healthcare provider for a personal relationship and discussion of their specific health concerns and goals, including highly personal medical details. But they also need your support, transparency, and encouragement to take the steps necessary to maintain or improve their health.
Getting a member in the door for an AWV helps them build a positive relationship with their provider, incentivizes them to complete other high-value health actions, and with plan transparency and support, they know what to expect for additional appointments or screenings.
Providers and plans need to engage members differently because these are different relationships. Members want their health plan to be an active partner in their health journey by giving them the tools that empower them to make the right health decisions.
It’s important to respect these limits and craft member outreach in a way that aligns with these expectations. Take the examples below. A simple copy change can be the difference between gaining or losing your members’ participation. Which of these prompts convinced more members to complete a health risk assessment (HRA)?
Option A
We’re always working to serve you better. You can help us by completing a brief survey about your healthcare experience, so we can better meet your needs and improve your access to no-cost and low-cost services.
Option B
As a valued member, please complete a brief survey about the quality of care you’ve received. We’ll use this information to evaluate your physicians and care staff, and work to provide you with the best care possible.
If you picked Option B, you’re right! Option B resulted in 11% more people completing their HRA than Option A. Icario employs qualitative and quantitative research methods to ensure that our content helps build trust in health plans while meeting the members’ needs and moving them to better health.
Blue Cross Blue Shield of Rhode Island found members who completed an Annual Wellness Visit were 9x more likely to close other healthcare gaps, such as cancer screenings.
2. Develop Capabilities That Address SDoH Barriers and Make Data Actionable
There are many barriers health plans must overcome with their members, including fear of the healthcare system overall, varying levels of understanding about the value of visits and screenings, and a plethora of SDoH challenges.
For 2023, NCQA has added five new HEDIS measures, including one that addresses social needs screening and interventions (SNS-E). SNS-E encourages plans to focus on members’ food, housing, and transportation needs and follow up with a corresponding intervention within one month of identification.
Given the critical nature of supporting social needs, it’s important to broaden your focus beyond screenings to consider the types of assistance and resources that will truly improve member quality of life. We can start by using the power of data and demographics to predict some of the barriers members may be experiencing. These barriers are unique to the member and vary for each targeted health action.
We can also listen to member concerns using Health Risk Assessments, pre-CAHPS surveys, and other interactive vehicles that give plans insight into not only member concerns, but areas of opportunity for plans to intervene.
Survey results can be insightful, but it depends on what you do with the data. We can intervene immediately with resources like Member Action Plans that help improve health outcomes by promoting benefits in one convenient place. Examples that improve SDoH barriers include transportation, housing, and food benefits, but also smoking cessation programs, mental health services, and other counseling tools. Once we know what is most valuable to the member, we can go the extra mile by getting them engaged.
These forms of engagement are important for impacting member health by addressing barriers that prevent them from accessing care, moving them to complete an AWV, and closing additional gaps in care as a result.
The Untapped Potential of Annual Wellness Visits to Improve Quality & Capture Risk
Discover how powerfully personalized health action programs not only boost annual wellness visits, but improve overall quality scores and close gaps in care.
3. Know When To Use Rewards & Incentives
Everyone likes rewards and incentives. But what you, as a healthcare leader, are interested in is likely very different from what members facing SDoH barriers would find valuable. Once again, we have to remember that the experience as a plan administrator isn’t always useful when developing meaningful incentives that will move members to take health action.
Think of it like this: During our webinar about the success of the Diaper Connections Program, UnitedHealthcare Community Plan of Tennessee shared a story about a female college student receiving Medicaid coverage. The student heard about the plan’s involvement in the Diaper Connections program through a local community center while pregnant and began receiving diapers for her twins every time she came in for weight checks. The mom continued with these routine care visits for both infants well past their first birthdays. With the help of the free diapers, she freed up other funds, graduated from college, and secured a job at Comcast.
People will take action if the activation energy needed to complete the activity exceeds the barriers involved. Use data to understand the member experience and tailor rewards accordingly. Perhaps you’re targeting potential parents holistically through diabetes management tools which range from monitoring blood pressure just as much as nutritional support.
Additionally, offering choices goes a long way toward making members feel valued and in charge of their decisions. The Icario Benefits Care Card highlights the importance of meeting members where they are through flexible funds that can be used for groceries, transportation, and more at the member’s discretion.
It’s also important to right-size the dollar amount of any incentive by aligning it with what you’re asking the member to do. So, the reward for an AWV should be higher than the reward for a flu shot, for example, but less than the reward for a colorectal screening.
Motivating Members and Closing Gaps in Care
Breaking SDoH barriers requires innovative thinking. The three insights in this blog—considering your role in your members’ health, predicting and responding to SDoH challenges, and using incentives—can help you improve the member experience and help people live longer, healthier lives.
