Implementing a strategic member wellness program is one of the most effective ways to keep members engaged which in turn, leads to better outcomes, a reduction in claims, optimal member satisfaction and higher retention.
In fact, according to a study by Humana, members with preventable conditions like high blood pressure and diabetes who were engaged in HumanaVitality, a wellness and rewards program, had 60 percent lower claims costs than members with these conditions who were unengaged with the program.
With some planning and foresight, there are simple ways to ensure that your member wellness program effectively engages your members and lowers claims. Here are 4.
1.Encourage A1C testing with a multi-channel, multi-touch approach
Data from prescription fulfillments, outcomes from doctors’ visits and hospital claims as well as health risk assessments that have been completed can help you to know if your members have been diagnosed with diabetes, are pre-diabetic or are at risk.
If you devise a multi-channel, multi-touch approach, you can leverage the data to further identify those members who might be at risk and who would also benefit from an ongoing A1C data collection program.
Instead of simply sending healthy recipes that lower blood sugar as part of a quarterly mailing for example, use other channels such as text and video in addition to phone and email to engage members and you’ll experience a more successful engagement.
2. Reward members for good behavior
Consistently keeping members engaged in their care with rewards is one of the most effective ways to lower claims and cut costs. According to a report by UnitedHealthcare, when engagement strategies and incentives were used, they improved outcomes and saved $107 million in the first 36 months.
When members follow through on their annual wellness visits, mammograms, prostate screenings, and flu shots, for example, it reduces the risk for hospital admissions and claims that drive up costs. A rewards program not only keeps members engaged but it allows you to report back on HEDIS scores and STAR ratings.
Rewards programs vary depending on your state’s regulations but it might include things like a gift card to a major retailer or a coupon for a vitamin store.
A sophisticated campaign management partner can help use the data you garner to create and send personalized mailings, manage fulfillment and creative and communicate results back to you.
3. Be proactive and have a plan for hospital admissions
If your members don’t fill their prescriptions or follow through on their prescribed care plans, they could end up being readmitted to the hospital.
When members are released from the hospital, it’s important to be proactive and have a plan in place that includes specific triggers that eventually lead to the desired outcome.
Call, email or text members with reminders to fulfill their prescriptions or make their follow-up appointments with their doctors. Reach out to solicit feedback and see if they have questions about the medication they were prescribed or if they need help setting up their appointments.
4.Ask for feedback
Most health plans view their call centers as a cost and scrutinize handle times to manage the price. Yet those plans that allow for more time capitalize on an important opportunity to engage their members and capture HEDIS and STAR data.
When members call in with questions about their benefits, claims or bills, the call can be used as a care consultation of sorts. If your agents have access to other systems, they can encourage those members who have missed their annual wellness visits to do so, or follow up on past inquiries about new ID cards, for example.
This preventative, proactive approach also becomes a forum to gather additional HEDIS data or STAR ratings criteria while also lowering costs.
Although your cost-per-call might be higher, you’ll save in the long run because you won’t have to send three additional direct mail pieces, for example.
Tim Collopy, VP Business Development