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How to Fix Gaps in Care Leaks & Maximize High-Value Actions

Many plans saw a dip in Star ratings since last year. As you try to close gaps and increase patient experience in the months ahead, zooming in on getting patients engaged is more important than ever.    

But that’s easier said than done. The pandemic has created a “deferred care crisis,” with one-third of Americans saying they delayed or skipped care. This hastens health problems and negatively affects quality metrics, putting Star ratings and your business at risk.  

So, plans must be proactive about encouraging member actions that lead to better outcomes. To boost member experience, now weighing heavily in Star ratings, plans must get back to basics—starting with their data. Doing so will create personalized and inclusive experiences across all populations to support all members.    

Does your data guide your priorities? Because without the right kind, you can’t…   

Align team priorities to make the right strategic decisions   

If your data doesn’t give you a total picture of a member, it will be harder to know how to prioritize outreach for your teams looking to close gaps in care. Without an accurate idea of your audiences, you risk having teams working at cross purposes or in silos.   

Using claims and clinical data alone doesn’t give you enough information to make strategic decisions about what members to reach and how. The portion of health status data derived from a clinical setting doesn’t reflect everything that influences a person’s health–especially since lifestyle and environment have an enormous impact. Analyzing consumer data (including SDOH factors) and claims and clinical data can pinpoint members with current or future gaps and predict who is most likely to respond to your outreach and act. Otherwise, it will be difficult to personalize the kinds of outreach you need, and teams risk working towards goals that don’t align.  

Know who you’re reaching to avoid overspending  

To maximize your marketing budget, you want to be mindful of what outreach techniques you’re using. If you don’t know what methods work best to reach members and encourage them to act on their health, you risk making uninformed plans. Using the “spray and pray” marketing method to get members is unreliable and a waste of resources. Suppose half of your audience is responsive to text, and you send a mailing to all your members. In that case, you are unnecessarily overspending and likely underperforming.   

Getting access to more intelligent data gives you smarter teams & outreach  

Use predictive analytics to drive member action & loyalty  

Your marketing, quality, and product teams need access to predictive and behavioral analytics to prioritize and maximize their time. The more attributes we gather and analyze from a person, the smarter we can be about anticipating and meeting their needs.   

Technology that harnesses a variety of data can increase adherence, giving your members more accessibility and closing more gaps in care. Targeting the right people in the right way at the right time means you can focus your marketing spending. And if your outreach is more customized, you’ll get happier and more loyal members, a now critical part of increasing your Star ratings.    

Members want and need an approach as unique as they are  

Plans need to meet member expectations to drive desired health outcomes, going beyond a one-size-fits-all approach. Smart plans embrace the fact that no two member journeys are alike. Instead of offering all members the same resources through untargeted communication, they create more personalized, inclusive experiences through tailored outreach. This puts relevant resources into members’ hands at the right time.  

The pandemic has made it clear that individuals want and need different types of outreach and levels of support to have fair opportunities to live long, healthy lives. Plans can no longer ignore the impact social determinants of health have on a person’s health status. One-quarter (25%) of all members say digital ways to access care are now more important. However, the percentage was higher among members who live in the South, are dual-eligible members, are Hispanic, and are employed full-time.  

Make it rewarding  

Sometimes offering information and an invitation isn’t enough to motivate people to act. Twenty-four percent said they aren’t motivated to make lifestyle changes or try something new. Think about it, you’d be more motivated to go to a specific gas station if you knew you could earn rewards that would help with your bill later, right? When it comes to encouraging behavior change, members agree incentives work. In fact, 43% said they’d engage in healthier behaviors if they were financially rewarded.  

Giving a smart incentive matching the time and effort needed to complete a desired action – like offering a $5-25 reward for getting an annual flu shot – can tip the scales and get members to close all care gaps. However, staying on top of CMS policy changes can be challenging, primarily when incentivizing Medicare members across all parts. Partner with someone who will ensure your design and implement CMS-compliant incentive programs.     

Plans don’t have to try to close gaps in care alone  

Partnering with Virgin Pulse can supercharge your data and marketing. VP Activate is driven by the industry’s most powerful activation engine, which includes lifestyle and social determinants of health data from 275 million people.   

Your members will feel like your health plan is customized to them. We treat each member like a VIP with a personalized member engagement platform that drives year-round satisfaction and 5-star ratings. Learn more about what we can do for you. 

Additional Resources:

Member Experience Toolkit

eBook: 5 Things Your Members Haven’t Told You

2023 Member Marketing and Communications Calendar for Health Plans