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. 

This 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.


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. Upon success, Icario was fully integrated into all outreach efforts starting the following year. 

The strategy involved the client and Icario sharing resource planning and outreach work equally. Icario implemented an omnichannel approach that spanned interactive voice, 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 are 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, it became possible to make daily segmentation adjustments as members became due and even establish new anchor dates for capturing a second HRA for non-compliant members.

Targeted, Personalized Outreach to Overcome Cultural and Language Barriers

When a particular D-SNP appeared to be lacking in terms of 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 important communications and improve trust.


Increasing HRA Completions to Achieve 4 and 5 Star Performance

The results are in, and the health plan can easily access data that is fully compliant and CMS audit-ready. 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.


of plans are at 4 or 5 Stars


plans have earned 5 Stars


of members completed HRAs

The client has also made significant inroads engaging with historically non-responsive, non-compliant members. In fact, 51% completed an HRA, and 27% have completed two HRAs in just one year. 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. Of the 1.4 million members who received outreach, there were fewer than five complaints, 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 their members. As member trust in their plans continues to grow, so does the opportunity for increased engagement and health action as well as improved outcomes over time.