The pressure is on for health plans to finish 2023 strong and get a head start on their Medicare Advantage Star Ratings strategy in 2024. The Center for Medicaid and Medicare Services (CMS) has implemented big changes that are putting pressure on health plans to get a game plan together now in order to adequately move the needle on health outcomes while tackling social determinants of health (SDOH). Wellth recently connected with Tamara Migut, Director of Quality for Health Alliance Medical Plans, during an exclusive webinar. Below we're highlighting those key discussion points around how we're partnering to address these pressing changes.
Health Alliance (HA) serves members throughout Illinois, Iowa, Indiana, Ohio, and Washington with a keen focus on ensuring members are receiving the right care, at the right time, for the right cost. But they were facing a challenge. The insurance provider had a growing Medicare Advantage population dealing with multiple chronic conditions, and they faced challenges effectively engaging with these members, resulting in high-cost utilization and care gaps. They needed a solution that could help improve health outcomes and quality metrics, and also assist in achieving health equity requirements to hit Star Ratings goals for 2023 and beyond.
So they turned to Wellth, a behavior science-backed platform empowering members to prioritize their health and build long-term healthy habits. Wellth uses principles of behavioral economics with machine learning AI to create an optimized and personalized member experience to help members follow through with their care plans. Through meaningful daily interactions, Wellth motivates members to take healthy actions customized to their care plan and lifestyle, while rewarding them for taking steps toward their wellbeing.
Health Alliance and Wellth set out three main goals for the partnership:
Together, HA and Wellth established a program for their highest-risk and hardest-to-reach members with chronic physical and behavioral health conditions to improve health outcomes and increase overall member engagement. Members check in with daily health tasks and can earn rewards for demonstrating consistent care plan adherence via the Wellth app. Daily activities included taking photos of their glucose readings, blood pressure readings, or healthy meals, along with non-incentivized tasks like medication check-ins.
“The implementation process with Wellth was seamless,” Migut said. “They were highly communicative through each touch point of the process and what was required.”
The Wellth program is designed to require very minimal lift on a health plan’s part with outreach, enrollment, and support being provided from Wellth’s live member support team. Our customer success team ensured that HAMP was well informed throughout the process to create an easy and hassle free implementation. After only the first four months of the program launching, Wellth’s member enrollment team had already enrolled over half of the target number of activated members.
Demonstrating such high engagement right off the bat led to an expanded program with Wellth, bringing value-added services such as deploying mock-CAHPS through the app in order to collect higher-quality feedback from members. Additionally, members could add demographics information and answer questions related to the social risk factors they may be facing to satisfy CMS’ Health Equity requirements as well as additional health nudges and encouraging stories from other members.
“As soon as communications about the Wellth program had gone out to our members, people were wanting to get signed up, and these are the members we had previously had trouble connecting with,” Migut said.
94% of Health Alliance members check in with the Wellth app every single day.
While the program just kicked off at the beginning of this year, astonishing increases to member engagement have already been demonstrated. This level of engagement is consistent across ALL task types, including non-incentivized medication check-ins, resulting in positive health outcomes. For example, one of the HA contracts that had dropped in their star ratings the previous year, has seen a vast improvement in medication adherence for triple-weighted drug classes through the Wellth program.
As a result of consistent engagement, members begin to build a familiarity and trust with the program and with their health plan. Health Alliance also saw an increase in participation with additional nudges for care gap closures, information verification, and even mock-CAHPS questions because of the seamless integration with the Wellth app that they already use every day. Another component to building this trust is providing rewards that members can use to help address their personal areas of need.
When members have flexibility in their rewards, it gives them the autonomy to choose the best way to utilize them. For HA members, 63% of their rewards are spent on food and groceries alone. Studies have also shown that approximately 90% of purchases are made within 20 miles from home, therefore when members spend their rewards within their neighborhoods it is putting additional dollars into the community at large.
“I have really enjoyed the Wellth program. It has helped me stay focused on making sure I take my medicine on time, do my blood pressure, and check my glucose. Not only that, it has also helped put food on our table. And I just want to say thank you so much for this and for helping those that can't afford to raise money any other way.” - Becky, HAMP member
As we have turned the corner on 2023, the pressure is on to deliver on quality, outcomes, and member experience improvements. The specificity of insights the Wellth program is able to provide their partners like Health Alliance Medical Plans, allows them visibility into the exact care gaps members are facing and opportunities for improvement.
For example, by incorporating mock-CAHPS into the program, HA will have more actionable insights at their disposal to drive member experience improvements ahead of 2024 CAHPS fielding.
The biggest change in upcoming Star Ratings is the Health Equity Index (HEI) replacing the Reward Factor. It will be imperative to begin collecting demographics data that will be affecting the HEI and most importantly implementing a plan to address those social risk factors head on.
Across the board, it will be most important to utilize programs that understand how all of these elements are connected. Creating long-term and steady engagement with your hardest-to-reach members will bring improvements in health outcomes, drive down high-cost utilization, bolster health equity, and ultimately create personal and positive experience for your members.
Through Wellth and Health Alliance’s partnership, we are able to connect with the highest-risk members and improve their overall health and member experience while paving the way for HA to hit their Star Ratings goals for this year and years after. How can we help your health plan achieve your 2023 goals and beyond?