Challenge

Maintaining the All-Important 4-Star Rating

AvMed is one of Florida’s oldest and largest not-for-profit health plans, serving approximately 230,000 members across the state. Since 2014, AvMed Medicare has received a 4-Star (or higher) overall quality rating, demonstrating their ongoing commitment to quality and member satisfaction. 

Like many successful Medicare plans, AvMed knew that maintaining their 4-Star Rating would be crucial but increasingly difficult, so they partnered with us to help ensure they stayed at or above the 4-Star threshold without falling back.

Solution

A Targeted, Personalized Approach Tailored to Each Member

AvMed’s previous gaps in care program mailed letters to non-compliant members explaining their open care gaps and offering a small incentive for completion. While this program delivered a small lift in gap closures, it was heavy on content and light on strategy and personalization, and didn’t necessarily focus on the measures or members that could directly impact quality. 

AvMed partnered with Icario to develop a more strategic approach with measurable ROI. The result was a member engagement program called Healthyperks™ which was designed to drive gap closure on key measures that would maintain (and improve) the plan’s Star Rating while also building a stronger relationship between member and plan. 

With these objectives in mind, we designed an engagement strategy that was available to all yet focused on historically non-compliant members with open care gaps in key priority measures such as flu shot, breast and colon cancer screenings, and diabetes A1C blood test. 

“Before Icario, we were treating all members the same and having limited success. Now, we can tailor the experience across multiple channels, and it’s made a huge difference in our results.” — Cynthia Weiss, RN, MSM, Director of Quality, Accreditation

Results

Year-Over-Year Improvement in Quality and Satisfaction

The program launched in mid-2016 and has been delivering positive ROI year-over-year ever since, demonstrating the value of investing in a multi-year engagement strategy. 

Improved Participation
From 2016 to 2018, the number of eligible members participating in the Healthyperks™ program more than doubled. Plus, once members joined the program, they were extremely likely to stay. A full 97% of program participants in 2017 chose to participate again in 2018—a testament to the “stickiness” and affinity a strategic engagement program can drive. 

More Closed Care Gaps
From 2016 to 2018, Healthyperks™ program participants completed 34% more high-value healthcare activities (HCAs)—those that directly impact and/or influence quality ratings. In total, program participants closed more than 18,500 care gaps in 2018. 

Better Digital Engagement 

The Icario program also revealed new insights for AvMed. For example, members who engage digitally close 2x as many care gaps as members who engage through traditional channels like print and call center—which is why Healthyperks™ encouraged online participation. More than 25% of program participants engaged online in 2018, thanks to a concerted effort by our call center to collect member email addresses and remind members of the benefits of engaging online.

97%

of program participants chose to participate again the following year

34%

increase in health action completions by participants from 2016 to 2018

2x

as many gaps closed by using digital engagement channels

Key Takeaways

The Value of a Strategic, Measurable Approach

As CMS cutpoints shift and competition between plans becomes more fierce, it can be difficult to maintain your Star Rating, let alone increase it. AvMed saw the value in a partner like Icario who could help them stay ahead of the curve instead of falling behind. 

AvMed is so pleased with the year-over-year impact on quality and member satisfaction that they’ve signed on for a multi-year partnership, saying they look forward to the program’s continued success.