Published on October 2, 2020
The rapid rise of consumerism in the healthcare industry has caused a steep escalation in member expectations. At the same time, recent changes in Star Ratings emphasize the importance of these expectations by giving extra weight to scores in member engagement and satisfaction. Star Rating performance impacts a health plan’s bottom-line profitability and shapes consumer perceptions, which, in turn, further amplify bottom-line impacts.
Health plans now find themselves in the uncomfortable position of being held to high standards for quality improvement in seemingly ambiguous categories with no clear feedback loop to measure the ROI of their efforts.
Member outreach programs have traditionally informed quality improvement plans. Observing open gaps in care and open hierarchical condition category (HCC) recapture data from clinical sources can improve quality metrics and outcomes. But these traditional efforts fall short of capturing unique consumer behaviors, interests, aptitudes, and preferences.
Without addressing granular consumer behaviors, outreach efforts are at risk for sending the wrong message through the wrong modality at the wrong time — this could result in member abrasion, wasted resources, and missed opportunities to improve member engagement and quality of care.
Ideally, plans want to improve performance while reducing outreach costs and member abrasion. This will serve to improve the bottom line while boosting satisfaction among members and providers.
Leveraging Advanced Data & Analytics
A more sophisticated approach to outreach leverages data to target members in narrow segments for specific initiatives and goals, allowing plans to optimize resources and results.
Carrot Marketview pulls data from claims, chart reviews, health information exchanges, providers, member surveys, and consumer databases. We then optimize that data by combining it with analytics to produce models that accurately predict outcomes. Such models can help plans to form a more robust understanding of member behavior.
A Targeted Approach to Outreach
For example, a plan can identify which consumers and providers are most likely to help close gaps in care. It can also determine their preferred communication channel.
Knowing who to target, how to influence their behavior, and which mode of communication they’re most likely to respond to allows plans to target outreach efforts where they have the most likelihood of moving the needle on Star Rating performance.
Comparing predictions to actual results will determine the impact and ROI of outreach and engagement in improving overall health and reducing total cost of care.
Results: Estimated initiative impact is 165 newly compliant members by the end of the year, just across the threshold required to drive the Star Rating for that measure from 3 to 4.
Highly targeted and effective member outreach is a critical component of achieving optimal Star Ratings and enjoying the positive bottom-line impact of improved quality performance. Accessing, understanding, and leveraging consumer data in near-real-time can help plans build outreach strategies that become an engine of organizational learning and growth from year to year.
For more about how to build and operate an exceptional quality improvement program, download our white paper, “How to Leverage Data to Boost Star Rating Performance,” or listen to the replay of our webinar, “Bringing Consumerism to Quality Improvement Campaigns for a Better Member Experience.”