Challenge
Improving Year-Over-Year Performance in a Pandemic Year
With the challenges and barriers to healthcare created by the COVID-19 pandemic, many plans have seen a dip in utilization in 2020. Members have been reluctant to attend healthcare appointments during this time—deferring care out of uncertainty and concerns for safety. This trend not only puts member health at risk—it impacts plan performance as gaps in care go unclosed, HCC data doesn’t get captured, MLRs slide, and the possibility of member churn increases.
However, a Pennsylvania-based health plan set a goal to not only maintain, but improve year-over-year performance in 2020. Building on the success of their 2019 rewards and engagement program, this plan once again counted on their collaborative partnership with Icario to drive quality improvement, impact HOS measures, and keep their members healthy during a challenging time.
Solution
Designing an Engagement Solution to Overcome COVID Challenges, Drive Gap Closure, and Impact HOS
By developing a strategic and proactive partnership with this innovative health plan, Icario designed a program to support members in getting care during the pandemic. Offering members telehealth options, education and resources to navigate COVID-19, as well as information on the safety guidelines that hospitals and clinics have put in place to keep members safe, the program successfully encouraged members to get the care they need to stay healthy.
What’s more, the program deployed highly personalized, targeted communications to high-risk and non-compliant members, effectively motivating those members to complete vital visits and close HEDIS gaps. By engaging and rewarding members to close essential care needs, the program was able to focus on the highest-value measures for plan performance and member health.
And, to impact HOS scores, Icario’s program offered members 8 weeks of uplifting, relatable content on physical and mental wellness. This content was designed to engage members and help them feel better about themselves and their health during these isolating times. In addition, the program created regular touchpoints with members, helping them feel cared for and strengthening their affinity for the health plan.
Results
Increased Utilization and Healthier Members
Although a year-over-year performance decline may have been expected due to COVID-19, Icario worked with this health plan to adjust the program accordingly and exceed performance objectives.
As a testament to the “stickiness” of the program, 95% of program participants from 2019 chose to participate again in 2020. And in an improvement on prior year performance, 86.5% of targeted members who signed up for the program completed and redeemed at least one healthcare activity.
As a result, the program achieved a member utilization rate of nearly 10% above the client’s 2020 goal—a rate surpassing what was achieved in 2019. One of the keys to this increase in utilization was the decision to align program communications with the reopening of hospitals and clinics, resulting in a sharp upward trend Q3-Q4 of 2020.
The program also had a measurable impact on key priority HEDIS measures, driving previously non-compliant members to close 6,187 open care gaps. Annual Wellness Visits, in particular, were completed at a higher rate, which is an excellent indicator of the program’s success. Not only are these visits essential to member health and accurate HCC capture, they often lead members to complete more health actions in the future. In fact, members who completed an Annual Wellness Visit in the program were 8x more likely to close other healthcare gaps.
In regards to HOS, nearly 88% of members who participated in the program rated their physical and emotional health as improved in the final week of the program as compared to week one. And for those members who ranked their health as fair, poor, or unchanged, this plan was able to take that information and do additional outreach to support those members and help get them the care they need.
In the end, the program achieved an outstanding projected 172% ROI. Pleased with these strong year-over-year results, the plan chose to continue their partnership with Icario, leveraging a multi-year engagement strategy to stay ahead of the performance curve and continue improving member health.
