Health risk assessments (HRA) provide the foundation for improvements in risk adjustment, care gap closure and regulatory compliance, but only when properly integrated into the member journey. By prioritizing HRAs in member lives, health plans can efficiently create whole-person views to guide year-round engagement initiatives.
Explore the key components of a successful health risk assessment campaign and how to accelerate plan performance by optimizing member engagement strategies.
The Role of HRAs in Member Journeys
Alongside annual preventive visits, health risk assessments are one of the most important activities a member can complete. These questionnaires provide comprehensive views of members that help plans to rapidly create new member records or update legacy profiles.
Through a single questionnaire, plans can:
- Update risk factors
- Track care gaps
- Identify health disparities
- Fill gaps in member records
- Evaluate member behaviors and goals
Based on this information, plans can develop year-round member engagement strategies to guide members through their unique health journeys. From short-term goals like completing preventive screenings to the long-term challenges of managing chronic conditions, health risk assessments help members and health plans determine which healthy activities should be prioritized.
When Should Health Assessments be Conducted?
Health plans can conduct health assessments outreach at any time, but some markets have specific timelines:
- Medicare Advantage: The Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage plans to perform health risk assessments as part of Annual Wellness Visits within 12 months of enrollment and every year afterwards.
- Special Needs Plans (SNP): SNP members must complete health risk assessments at least 90 days after enrollment to fulfill CMS requirements. Some states like California also require assessments within 45 days of enrollment for high-risk members.
- State-based plans: State health agencies have various guidelines for conducting health risk assessments among Medicaid and Affordable Care Act plans based on different quality goals. These requirements often align with CMS’ Medicare-Medicaid Plan reporting requirements.
- Commercial health plans: Commercial plans may conduct health assessments on a voluntary basis.
As a best practice, health risk assessments should be conducted as early in member enrollment as possible to ensure plans have appropriate data to guide care gap initiatives, risk adjustment updates, quality strategies and member experience improvements.
If plans have just started outreach for annual preventive visits or welcome packages, then assessments should follow shortly after to maintain ongoing engagement and fill gaps in member records. Unlike activities that require provider involvement, health assessments can be conducted digitally or physically at any point in a member’s journey. The versatile and cost-effective nature of digital assessments also allows plans to resurface them multiple times a year to continuously update member records and keep members engaged in their care.
How to Improve Campaign Performance
The more data health plans collect through health assessments, the more effectively they can provide ongoing and impactful engagement throughout a member’s journey. To streamline HRA administration, health plans should focus on four key areas.
Most members will view an HRA as just another questionnaire unless plans take the time to educate them about the benefits of completing the assessment. HRAs should include clear explanations about how they help plans guide members to the right activities and services. By providing members with relevant information, plans can increase engagement not only with the questionnaire but also any follow-up care. To achieve this, plans will need to nudge members multiple times with different channels, use member-centric language and reiterate these values in different ways to meet members’ unique needs.
Incorporating the right questions into survey designs facilitates the creation of whole-person views of members. This information is easily paired with biometric screening data from preventive visits to enable plans to conduct personalized and impactful engagement. Plans should start by designing HRAs based on CMS and National Committee for Quality Assurance (NCQA) requirements to identify:
- Health status
- Risk factors
- Social needs
- Sexual orientation
- Gender identity
- Preferred languages
- Contact information
The versatile nature of health assessments allows members to complete them at their own pace without reliance on providers, but plans will need to provide the right nudges to keep members aware and engaged. Accounting for member preferred formats, channels and languages enables plans to conduct targeted outreach. Outreach can be further refined by using an engagement calendar to guide messaging and manage budgets.
Personalized Care Plans
Capturing comprehensive data is just the first step in a longer member engagement strategy. Based on this data, plans should design member-specific care plans that speak to their health needs and goals. While this is a requirement for SNP, all health plans can benefit from mapping out how to best use survey responses to guide care gap initiatives and deliver follow-up care. Accounting for social needs, risk factors, care gaps and member behaviors allows plans to guide members to the next best healthy activity.
Implement a Comprehensive HRA Campaign
Moving from designing questionnaires to conducting assessments to improving health outcomes requires a great deal of interoperability. Health plans need a strong technical foundation in member engagement to support survey administration and an efficient process for categorizing and actioning responses.
Healthmine suite of digital tools streamline the health risk assessment administration experience for health plans in all markets. Designed to maximize data collection, our NCQA-certified and market-specific health risk assessments work in conjunction with our member engagement solution to provide the right encouragement to help members complete HRAs.
Post-assessment, all responses are stored in longitudinal member records that enable plans to evaluate data and stratify smart lists based on similar elements. Based on the results, plans can continuously engage members with their care and achieve organizational goals through follow-up outreach, personalized care plans, educational materials and rewards programs.
Explore a detailed guide for building impactful health risk assessment campaigns and discover how to improve your administration processes with Healthmine’s technology solutions. Contact us for a demo.