We analyzed the top member engagement mistakes we see health plans making and provided proven strategies for designing and executing a more effective, cost-efficient program. We’ll cover everything from improved outcomes to member segmentation—and some different ways you can strategically align engagement program communications to diverse member populations to achieve specific business goals.

Part 1: Measure Prioritization

While most health plans today are doing a lot to engage members, we often see engagement programs that focus on too many or too few measures.

You may think, why not reward members for as many measures as possible? Or, if one is underperforming, why not focus exclusively on that?

The truth is, neither of these approaches proves very effective. And neither will use your program dollars very effectively.

So what are plans getting wrong? And, more importantly, what should they be doing differently? Here’s a closer look at the top three mistakes plans make when prioritizing measures—plus tips for how to fix them.

Mistake #1: Rewarding Members for Completing Every Open Care Gap

Including too many measures in your program can mean wasting money on low-priority actions rather than zeroing in on the efforts that matter most and focusing your investment there.

With any engagement program, it’s vital to align program activities with the plan and program objectives—identifying and focusing on the measures and activities that can directly improve quality, enhance satisfaction, and more.

So when it comes to choosing the proper measures to include in your program, prioritize those that will serve your goals.

Don’t forget to consider what’s most important for your members. Which measures are a top priority for a particular member to complete? For example, you may have a historically compliant member closing care gaps such as their Annual Wellness Visit and flu shot but doesn’t always complete necessary diabetic measures, like their A1C test. These diabetic measures should be prioritized, while the actions members usually complete may not need to be included or can be had at a lower priority.

Not only does this lead to a better member experience, but it helps engage the member to close the care gaps that matter most to their health—and to plan performance—first.

Mistake #2: Including Activities That Won’t Impact Your Star Rating

Every plan wants to improve or maintain its Star Rating, but all too often, plans include measures in their engagement program that won’t move the needle.

To get the most value out of your program, prioritize underperforming measures. Once you’ve identified which actions deserve your focus, you can then set a strategy in place to improve or progress each step to the next cutpoint—or maintain its current cutpoint position.

Because the truth is, not all measures are created equal. A measure’s value is determined by multiple factors, including not only its cut point position but how many members are eligible for that measure. The fewer the members, the more value in getting each gap closed. And for Star Ratings and CAHPS, specific criteria are weighted more heavily by CMS. Considering these factors can help you narrow your focus and ensure you’re getting the most bang for your buck.

Mistake #3: Focusing on One Measure to the Detriment of Others

Some plans are hyper-focused on just one measure, but being too narrowly focused isn’t a good thing, either. Including too few measures—especially just one measure—can motivate members to engage. There’s simply not enough incentive for the members to participate.

We’ve found that offering an aggregate reward value of $100 or more per year is one of the keys to motivating members to engage.

So include at least a few activities for each member. You’ll have a much better shot at impacting your highest priority measures—and engage members to close other critical care gaps as well.

In the end, it all comes back to prioritizing the proper measures—focusing on those that will have the most significant impact on quality and member satisfaction, and guiding the member to complete essential care gaps first. With this prioritized approach, your program can deliver better results more cost-effectively.

Part 2: Strategically Segmenting Your Member Population

It’s no secret that one of the biggest challenges facing plans is the tremendous backlog of deferred care. Not only are members not getting the care they need, but plans are also way behind on their quality measures, hierarchical condition category (HCC) capture, and even their medical loss ratio (MLR).

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 critical than ever. With the current competition for appointments, prioritize your outreach and communications to 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? 

Mistake #4: Sending the Same Communications to Every Member

We often see plans engaging with every member using the same communications, channels, and cadence.

At Icario, we use proprietary predictive analytics to identify at-risk populations, such as 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 as a virtual option for members during the pandemic.

We can even identify a member’s preferred communication channel (email, phone, text message, 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 #5: Passively Rewarding Members for Taking Action

Plans that passively reward members for completing all activities—even ones they didn’t know they were eligible for—effectively use an “opt-out” strategy that fails to deliver results cost-effectively. It’s inefficient, doesn’t allow you to focus on the at-risk members you most need to engage and doesn’t build valuable member affinity for your health plan.

A more effective approach is to use an “opt-in” strategy that allows all members to participate but communicates more robustly and frequently to the 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 #6: 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, it’s hard to account for all variables that may influence a member’s propensity to act with such limited data.

With Icario’s approach to propensity modeling, we consider member behavior data and 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.

Part 3: Optimizing Your Program to Improve Outcomes and ROI

This year, optimizing your engagement programming is more urgent than ever. With the trough of deferred care caused by COVID-19, members are behind on getting care, and plans are behind on their MLR. Plans should be adapting to the unexpected events of this year and adjust their communication efforts to get back on track in 2020 and beyond.

While many plans have engagement programs to boost performance, they may not evaluate and optimize their programs for the best results. Here are four common mistakes to avoid and what you should do instead to maximize your program successfully.

Mistake #7: Taking a “set it and forget it” approach.

Once an engagement program has launched, some plans simply let it run, reviewing metrics only quarterly or year-end. When you “set it and forget it,” however, you miss out on the opportunity to build a measurable, targeted program that allows you to evaluate performance and adjust course as your business and membership base changes.

Plus, in this current climate with COVID-19, a “set it and forget it” approach can come across as tone-deaf to your members. If members don’t hear from you during this time—whether you’re sharing information and resources about staying healthy or otherwise providing support—they may think your plan doesn’t care about them or is more interested in making a profit than member care.

Instead, we recommend plans frequently take the pulse of their programs, adapting and fine-tuning as they go. At Icario, we actively monitor client programs weekly, dynamically adjusting various levers—including which measures and member segments to prioritize, how many communications members receive (and in what channels), and what rewards to offer to meet the program and plan objectives.

In the end, this strategy ensures members get the correct information at the right time for the best, most cost-efficient results.

Mistake #8: Not leveraging behavioral science to optimize member engagement.

Plans frequently communicate with members, hoping to motivate them to complete needed healthcare activities—but they’re not always taking advantage of behavioral science strategies that drive action and optimize member engagement.

In addition, at Icario, we know how to motivate members to be more receptive to our messages—and more likely to engage. For instance, after sending information to a member about getting their annual flu shot, we can offer them a reward, making them far more likely to complete the activity.

One final behavioral science strategy plan to take advantage of is the “present bias.” As people, we tend to value what we have in the present more than delayed and distant. By offering members a tangible, immediate reward for completing a healthcare activity—the health benefits of which may be far into the future—plans can negate that present bias and motivate members to take action now.

Mistake #9: Building an inefficient program using various internal and external resources.

We often see plans cobbling together engagement programs from a combination of internal resources, such as marketing teams and call centers and multiple vendors. And while some plans manage this approach well, it can make it nearly impossible to measure ROI accurately and attribute a program’s success or need for improvement to a specific variable.

Plus, it leaves the door open to the possibility of crossed wires and duplicate efforts, not to mention the difficulty of understanding exactly what’s going on across your program.

That’s why Icario takes a streamlined approach. We handle all engagement efforts on one platform with one dedicated team, delivering a program with clear and measurable ROI. After all, we evaluate your program continually and provide detailed reporting on exactly what’s working and what’s not to make laser-focused adjustments in real-time. This brings us to our next mistake.

Mistake #10: Not implementing reporting to track KPIs and measure ROI.

Plans that don’t measure their programs’ success may actively throw money away. They can’t pinpoint what’s responsible for a positive (or negative) ROI and can’t make dynamic, informed decisions to optimize their programs.

At Icario, we design programs that are measurable, attributable, and truly move the needle on performance. That’s because data drives our efforts. We know precisely how effective your program is and optimize its effectiveness because we actively track key performance indicators. By continually evaluating your performance—and adapting to focus on the suitable measures, member segments, and communication channels—we can ensure your program meets objectives and delivers positive ROI.