Challenge
Engaging Historically Non-Responsive, Non-Compliant Members
Dual Eligible Special Needs Plan (D-SNP) populations are considered the hardest to reach with critical health information. As a result, the plans that serve them often struggle to move the needle on Health Risk Assessment completion and, ultimately, quality scores.
In 2018, a nationwide D-SNP was in trouble from both a member engagement and a quality ratings standpoint. In fact, 73% of its contracts were rated 3 Stars or lower on C-08, with 15 contracts falling to 1 and 2 Star performance.
The plan had worked with multiple vendors on outreach initiatives for its 1.4 million members, but disparate efforts meant it had minimal line of sight into HRA completions during the year. This lack of visibility made it difficult to find meaningful ways to intervene before quality ratings were set. It also made the process of preparing for CMS audits cumbersome and time-consuming.
Solution
Implementing a Coordinated Partnership Model to Drive HRA Completions
For this client, coordination in the form of involving a delegated entity was key. The health plan connected with Icario to launch an outreach pilot program in 2019. Upon success, Icario was fully integrated into all outreach efforts starting in 2020.
The strategy involved the client and Icario sharing resource planning and outreach work equally. Icario implemented a multi-channel approach that spanned IVR, text messages, email, live agent outreach, and direct mail to drive engagement based on an evolving understanding of member communication preferences.
Using this coordinated delegated entity model, all member outreach programs were rigorously tracked to develop lock-step orchestration of when and how to engage members—as well as the associated cost. In addition, the new approach established real-time visibility of progress toward the plan’s HRA completion goals so both parties could monitor progress and proactively allocate resources to specific contracts in need.
Icario and the client established monthly review meetings to evaluate the latest HRA metrics and identify specific ways to personalize member engagement in ways that wouldn’t lead to abrasion. With the heightened data visibility, making daily segmentation adjustments as members became due and establishing new anchor dates for capturing a second HRA for non-compliant members became possible.
Targeted, Personalized Outreach to Overcome Cultural and Language Barriers
When a particular D-SNP appeared to lack engagement or HRA completions, Icario and the client worked together to zoom in quickly on determining the cause and initiating personalized outreach strategies.
This has been highly effective during the pandemic as some agents have had extra bandwidth for outreach due to lower call volumes. The client was able to redeploy these resources to complete targeted outreach activities for plans showing increased levels of member non-compliance.
For example, in one New York City ZIP code, the client’s data indicated 98% of members spoke English. However, language-specific targeting revealed this wasn’t the case, and materials were developed in Spanish and other relevant languages to reach members with essential communications and improve trust.
Results
Increasing HRA Completions to Achieve 4 and 5 Star Performance
The results are in, and the health plan can easily access fully compliant and CMS audit-ready data. Icario generates half of the HRA completions and the client generates the other half in a well-balanced partnership.
Strong, year-over-year improvement in both HRA completions and Star Ratings happened swiftly, underscoring the power of an integrated approach and visibility to actionable data.
97%
of plans are at 4 or 5 Stars
8
plans have earned 5 Stars
82%
of members completed HRAs in 2021
The client has also made significant inroads engaging with historically non-responsive, non-compliant members. As a result, 51% completed an HRA in 2020, and 27% have completed two HRAs in 2020. This is significant as 50% of this population had gone at least two years, and in some cases more than 10 years, without taking any action. In addition, there were fewer than five complaints of the 1.4 million members who received outreach, translating to a member abrasion rate of just .0003%.
The client is pleased with how quickly its D-SNP contracts are rising in quality and developing stronger relationships with its members. As members’ trust in their plans continues to grow, so does the opportunity for increased engagement and health action as well as improved outcomes over time.
