The HEI checklist: Closing care gaps in D-SNP and vulnerable member populations
The future of your Star Ratings hangs in the balance of engaging your D-SNP members and other vulnerable populations.
March 27, 2024

While the Health Equity Index (HEI) won't launch until Stars 2027, the data used to calculate it will be collected starting this year. Effectively engaging with Dual-eligible Special Needs Plan (D-SNP) members will make or break your HEI performance.

The HEI is shining a spotlight on the health plan's ability to enroll, support, and uplift vulnerable and hard-to-reach members, and your D-SNP members are a key demographic to understand in order to succeed in this year's Star Ratings and beyond. 

There are five actions health plans can take to meet members where they are now– as well as in the future as individual needs or Star Rating measures change– because it is human-centered and comes from a place of understanding the behaviors contributing to disengagement. 

Make it Simple

There are a plethora of barriers members face when they think about healthcare. Especially members who face social determinants of health on a daily basis and may be dealing with chronic conditions. Step one, make the big picture small. 

Traditional outreach methods don’t work for most members but there are particular complexities when it comes to D-SNP populations. Contact information may not be up to date due to address and phone changes. Members may have different physical needs: difficulty hearing, different level of cognition, or other factors that contribute to not answering the phone.

Why are they not engaging in the first place? And how can you overcome that? Ask members how they like to be communicated with - and then communicate with them in that way. Make communication with the health plan easy and build a relationship before thinking about behavior change.

If complete care plan engagement and adherence is the destination, once a relationship is in place, starting with a smaller task, like checking your blood sugar once a day, is a manageable first step in building a sustainable habit of "engagement." 

Make it rewarding

The truth is that most healthy behaviors are not instantly rewarding. As humans, we face present bias, the behavioral science term that explains why we don't do what we know we "should" do. It's as simple as deciding between grabbing a donut for breakfast or preparing a well-balanced breakfast. The donut will taste better and satisfy my hunger right now, and I can eat it while I'm on my way to work, so the donut will usually win. 

Habits are best formed by a cue-routine-reward cycle. We receive the cue, take the action, and receive a reward for it. Let's use the simple task from the previous section, checking blood sugar levels. 

Cue: You are reminded that it is time to check your blood sugar.

Routine: You use your glucometer to take your blood sugar.

Rewards are twofold. 

We respond best to a combination of intrinsic and extrinsic rewards. Intrinsic rewards are encouraging words from a loved one, the feeling of accomplishment when you extend your streak or the satisfaction of seeing improvement. Extrinsic rewards are things like financial incentives and gift cards. For a reward to be effective, it must be:

  • Immediate,
  • Tangible,
  • Relevant

This criterion is why financial rewards tend to be the most effective when trying to kick-start a new habit. Wellth uses financial rewards as "endowments"—providing a sum up front—and if members miss their check-ins (like submitting their glucose reading), they lose money from that endowment. This method uses loss aversion-- we feel the effects of a loss much greater than we do gaining something new. 

Financial rewards also grant members in vulnerable populations an opportunity to offset some of their social determinants of health. A flexible financial reward allows the member to use it on what they need. 

"I happen to be in the food stamp program, and I can't buy anything I can't eat. So this extra money from the Wellth program helps out. I can buy toilet paper, laundry detergent, Kleenex, and stuff like that."—Kenneth, Wellth Member.

Make it Personal

Traditional healthcare outreach has operated on a "one-size-fits-most" model, but connecting with the populations for which it hasn't worked requires a more personalized approach. The demographics of D-SNP and other vulnerable member populations include a wide variety of health conditions, identities, abilities, and life experiences, and they deserve outreach that can meet them where they are. 

The starting point for personalizing the member experience includes more actionable tasks such as:

  • Make sure you are using a member's preferred name and pronouns
  • Offering a variety of languages in your outreach materials
  • Catering to a more flexible schedule (outside of working hours, for instance)
  • Providing flexibility in reward offerings

Technology and AI allows us to approach the member journey with even greater personalization. Behavior learning science and technology can help health plans cater to an individualized member experience and better anticipate member needs—including timely care gap nudges, prescription updates and reminders, and relevant health care information. Through a personalized member journey, members receive the right nudge at the right time, with a greater chance of completion. 

While the introduction of the above technology has expanded the capabilities of personalized outreach, there’s no replacement for  empathetic human support. Wellth’s member support team provides personal outreach to members who have missed check-ins to offer personalized assistance to whatever barriers may have arisen and help members get back on track. 

Make it Familiar

If the only times your friend reached out to you were to ask for money or give you bad news, you wouldn't be so keen to answer that friend's calls anymore. That can be the same association members have with their health plans. By introducing a consistent and positive form of communication, health plans have a better opportunity to build trust and bridge those communication gaps. 

Introducing a daily positive feedback loop is a significant first step in engaging with your members. They feel supported and have a positive association, so when it is time to pass along important health plan information, schedule appointments, or participate in member surveys, they are familiar with the outreach and more likely to follow through with the requested actions. 

For members, taking daily actions with their health has paved the way for them to become familiar with their health care. They can observe their numbers going up or down, assess their condition, and advocate for themselves and their health care. When supporting a population previously disenfranchised by healthcare professionals, building that trust and empowering the members to understand their health can go a long way in repairing the divide between marginalized communities and their health plans.  

Make it Scalable

Once a habit or behavior is created, building upon it is much easier when you can "piggyback" on the existing habit. For example, if I have made a habit of checking in with my glucometer every morning, I can now add taking my medication to that routine or having a healthy breakfast. 

Gradually introducing new habits that coincide with existing habits leads to greater habit "stickiness" and can help members connect the dots of their care plan. For example, "When I check my blood sugar levels every day, I can see the way my medications and meals affect my blood sugar. Now, I am more aware of taking my medications and more mindful of what I eat."

With the help of the aforementioned behavior learning principles and technology, health plans can also anticipate the optimal time to introduce a new habit or deliver the nudge, meeting the member where they are at rather than assuming their needs.

To learn more about the effect of Dual-Eligible Special Needs Plan members on future Star Ratings, check out this virtual session,  How your D-SNP members will impact your Future Star Ratings and What You Can Do About It

For more information on our dedicated Star Ratings  product, Wellth Northstar™, you can read more here