The start of the year presents health plans with a valuable opportunity to use preventive care to accelerate plan performance, financial expectations, quality and risk scores. An early focus on preventive care visits enables plans to continuously improve health outcomes throughout the year.
To take advantage of this opportunity, health plans need to design targeted outreach campaigns that support stronger patient-provider relationships and early detection for chronic conditions. Explore how to build creative strategies to improve preventive care compliance at the start of the year and set the stage for powerful improvements in plan performance.
Where to Focus Resources
At the start of the year, helping members build meaningful relationships with primary care providers (PCP) should be a top priority for a plan in any market. Members who have positive patient-provider relationships are more likely to also report better health outcomes and member experiences. Helping members find a PCP and schedule preventive care visits is a major step in guiding members on their health journeys.
These initial preventive care visits will vary in name and definition depending on plan type and region, but the main activities plans should focus on are:
- Annual Wellness Visits (AWV): Medicare Advantage and Dual Special Needs Plans (D-SNP) are required to cover yearly wellness visits with doctors and facilitate the completion of health risk assessments. These visits do not include a full physical exam but can lead to additional exams and screenings to address member-specific care gaps.
- Adult Preventive Visits: Medicaid, Affordable Care Act and Commercial plans use several different clinical codes to address preventive care visits for adults who are not covered by Medicare. In general, an Adult Preventive Visit or Annual Physical will facilitate the important preventive care activities members need and are more comprehensive than AWVs. These visits will also fulfill the Adults’ Access to Preventive/Ambulatory Health Services quality measure for the Healthcare Effectiveness Data and Information Set (HEDIS).
Both types of preventive visits allow members the chance to review clinical, social and behavioral needs, complete screenings for chronic diseases, update immunizations, complete health risk assessments, develop a personalized care plan and receive advice regarding physical and mental health conditions.
Benefits of Preventive Care Visits
Designed to lay the foundation for future healthy activities, preventive visits give members the support and guidance they need from a PCP to proactively maintain or improve their health. When conducted under a value-based care model, providers can deliver an integrated and streamlined member experience that significantly improves health outcomes. Research conducted by Humana demonstrated that value-based care reduced emergency room visits by 30%, improved compliance across multiple preventive care activities and a 0.5 increase in CAHPS scores.
For health plans, preventive visits are a cost-effective method of fulfilling multiple healthy activities, HEDIS measures, risk adjustment regulations and quality requirements in one appointment. The earlier in the year these visits are completed, the faster plans can collect valuable information about members, including updated health statuses, high-priority care gaps, prescriptions and social risk factors. By using these visits to capture the latest HEDIS data, plans can refine care gap initiatives to maximize quality scores.
Improving complex quality areas such as chronic disease management and behavioral health requires a strong focus on preventive care. Not only do these visits encourage early detection of chronic illnesses and mental health conditions, but they also allow PCPs the chance to connect at-risk members with specialists to address unmet basic needs.
For example, heart disease requires the coordination of good nutrition, consistent exercise, a reduction in stress, and tobacco and alcohol cessation, if applicable. Depending on the type of support members need, different specialists will need to be consulted at different points in a member’s health journey to address their condition. Through preventive care visits, providers can begin establishing a member’s healthcare team.
Medication adherence rates also benefit from coordinated strategies earlier in the year. These quality measures are time-sensitive and rely on continuous interventions to avoid significant drop-offs in the fourth quarter. By reviewing member medications and assisting them in accessing 90-day supplies in the first quarter, plans set themselves up for strong scores later in the year.
From a financial and regulatory perspective, diagnoses reported during these visits have a significant impact on Medicare Advantage risk adjustment strategies. Risk factor scores are reset every year, and plans need to collect updated hierarchical condition category (HCC) codes to receive appropriate risk adjustment funding. As regulators implement harsher risk adjustment audits than previous years, routinely assessing members for chronic conditions is vital for maintaining compliance and avoiding penalties due to HCC coding errors.
How to Use January to Improve Preventive Care Visits
January marks the start of enrollment for many members. Members are primed to use their benefits and take advantage of their coverage during onboarding. Plans should take this opportunity to emphasize the importance of preventive care.
Here's how to use onboarding to improve preventive care rates:
Start With Data
Data collected during enrollment, or prior with legacy members, can provide the basis for a comprehensive onboarding experience. Without a clear understanding of where members are in their health journeys, plans will not be able to guide them to the next step.
Start by reviewing and organizing member contact information, preferred channels, known care gaps, zip codes, provider information and risk factors. This data should be used to determine which communication channels plans leverage and how to craft the right messaging to motivate members to complete preventive care visits.
For new members, look at the data from your interoperability strategies to ensure you’re building the complete member profile with past medical and pharmacy data. If a member does not have a PCP listed, a must is to contact the member to establish their preferred PCP or assign them to a high-quality PCP. Welcome calls or welcome back calls and pulse surveys are valuable tools for confirming this information.
Deliver a Seamless Experience
Whether a member is new to a plan or been loyal for years, plans should deliver a unified onboarding experience to keep them feeling positive about their decision and engaged with their health.
The level of personalization and type of language used may vary based on where members are in their journeys, but members should step away from the material feeling like they know what they need to do next. Preventive care outreach should be conducted alongside personalized welcome and welcome back calls, pulse surveys and health risk assessments to minimize abrasion and maximize data collection.
Generally, encouraging members to complete annual preventive visits will remain a top priority, but plans will always want to factor in how specific outreach will impact overall member experiences. Remember, Medicare Advantage members still have the opportunity to change plans during the first quarter, so it is vital to make a strong first impression. This should also be prioritized for Medicaid members who can change plans at any time.
Keep Messaging Simple
It is tempting to pack as much information into a welcome package or emails as possible to get the most out of a single outreach campaign, but this can be overwhelming for members. Instead, plans should keep all messaging direct and focus on one main action. Straightforward and member-centric calls to action like “Review your welcome package,” “Find a primary care provider” or “Schedule a telehealth visit.” In this case, calls to action should guide members in completing a preventive care visit.
Continuously Track, Reassess and Engage
The first wave of outreach may not yield immediate results, but it does not mean it is a failure. Members may require multiple nudges across various channels to complete preventive care visits and build trust with a plan. Closely monitoring performance on each campaign allows plans to make appropriate adjustments and guide future outreach. This may include conducting A/B testing, surveys and follow-up campaigns to bolster response rates.
With ongoing campaigns, it is important keep the focus on as few demands as possible at the start of the year. Engaging members with too many activities at once is overwhelming and can make a member feel disconnected from their plan. Instead, keep the message clear, personalized and direct.
Craft a Preventive Care Strategy with Healthmine
Increasing preventive care rates early in the year can impact financial performance and quality and risk scores, but it requires a significant amount of time and attention to support ongoing campaigns.
Through Healthmine’s member engagement solution, health plans in all markets can initiate cost-effective omnichannel outreach to support preventive care gap closure. Our technology suite enables health plans to engage members through preferred channels and languages at scale to improve preventive care compliance, risk factor identification, HEDIS performance and financial performance. With the support of pulse surveys, plans can rapidly capture feedback after visits and identify access issues to guide ongoing improvements.
Download a strategic guide for designing effective Medicare Advantage and Medicaid preventive care outreach strategies and explore how to improve gap closure with Healthmine’s support. Contact us for a demo.