Improving Performance Metrics During a Challenging Year

Motivating historically unengaged members to close gaps in care can be a challenge in the best of times—and especially during a pandemic. With the spread of COVID-19, healthcare utilization has trended down as more members delay health visits. For plans, this translates to struggling with gaps in HEDIS measures, less opportunity for accurate risk adjustment, low MLRs, and decreasing member satisfaction.

Still, in the face of these challenges, Blue Cross Blue Shield of Rhode Island’s Medicare Advantage plan chose to forge ahead and amplify their engagement efforts. Looking to improve HEDIS measures, capture more risk, and optimize their MLR, the plan partnered with Icario to offer their members a rewards and engagement program—something they had never done before.


Designing a Targeted Program to Boost Utilization and Drive Quality Improvement Activities

Icario designed a targeted, omnichannel program with the goal to engage the previously unengaged and boost utilization. By investing in quality improvement, risk identification, and member care, the program impacted program performance in a holistic way, closing gaps in care while creating a better member experience.

While the program was available to all members, Icario leveraged data and proprietary propensity models to focus on high-risk members and those with care gaps—assessing which members were most likely to churn, most likely to engage, and which channels they were likely to engage in. With this targeted, cost-effective approach, we were able to quickly impact the most valuable HEDIS measures—leveraging rewards to motivate members to complete the health actions with the biggest influence on quality and member health.


Exceptional Member Engagement and Critical Care Gaps Closed

Even though member communications were briefly paused at the outset of the program due to the arrival of COVID-19, the program still outperformed objectives—engaging more members and closing more gaps in care. Within just 7 months, an exceptional 33.9% of targeted members signed up for the program. And out of those members, 32.7% completed and redeemed at least one health action—over double the program’s initial goal of 16%.

The program also drove previously unengaged members to close 11,471 high-value care gaps—including Annual Wellness Visits, which are essential for member health and accurate risk adjustment. What’s more, we found that Annual Wellness Visits were a gateway to greater health engagement: Members who completed an Annual Wellness Visit during the program were 9x more likely to close other healthcare gaps, such as cancer screenings.

Lastly, due to the targeted nature of the program—reaching the right members at the right time with the right message—and by investing in the most valuable measures for quality ratings, the program achieved a stellar 271% estimated ROI.

With such strong program results, especially during a pandemic, the plan is looking forward to building on their success and helping more members get the care they need to stay healthy.