Historically, Medicare Advantage (MA) plans have approached rewards and incentives (R&I) programs with a too-narrow view, choosing to spend incentive dollars only on eye exams or mammograms or colonoscopies. While those activities are still important—although becoming less of a priority due to HEDIS® screening measures counting for less of a plan’s Star Rating—the one health screening that must be prioritized is yearly wellness visits, whether an annual physical or annual wellness visit (AWV).
AWVs serve up a goldmine of clinical information about seniors. With so many regulatory signals directing plans towards “whole-person care,” getting seniors into the doctor for their yearly wellness visit must be a priority. And what better way to do that than motivate members with a tailored, compelling incentive?
Whether you offer R&I currently or plan to soon, if AWVs are not among your incentivized activities, you could be missing out on a lot of opportunity. Here’s why:
Emphasize Caring for the Whole Person
Beyond the health plan, Medicare beneficiaries benefit greatly from yearly wellness visits with their doctor. Where specialists can provide depth in a particular condition or clinical need, primary care providers (PCPs) can provide a wide range of services to address many needs, including referrals to specialists as well as prescriptions for medication and even non-drug therapies like education programs for specific diseases (e.g., diabetes).
This is especially important when you consider that 63% of Medicare Advantage beneficiaries have multiple chronic conditions. Annual wellness visits allow the PCP and the patient to discuss a multitude of resources and solutions to target multiple chronic disease areas.
AWVs are also an opportunity for seniors to develop or update a personalized care or prevention plan based on their current health and risk factors to help prevent disease and disability. Questions about medical and family history, cognitive impairment, and current medication lists help guide the development of this plan. After the visit, the patient leaves the physician’s office confidently with a plan for screenings, shots, preventative services, and personalized health advice—all of which is great for positive CAHPS responses, a critical component of Medicare Star Ratings calculation.
The takeaway? An investment in incentivizing AWVs is an investment in whole-person care.
AWVs as the Gateway to Better Health Engagement
The value of the yearly wellness visit extends beyond what happens in the actual appointment. People who complete an AWV are more likely to:
- Complete other preventive health screenings like mammograms, colon cancer screenings, etc.
- Take an active role in managing their health, such as taking medications as prescribed and participating in disease management activities
- Receive clinical care and referrals to drive positive responses on CAHPS and HOS surveys
- Experience reduced spend on hospital acute care and outpatient services
Healthmine’s experience has shown that members who complete an AWV close other gaps at a 31.5% higher rate. AWVs are the equivalent of getting your foot in the door of better health engagement. If you can get seniors to see their PCP, the likelihood that they’ll take action beyond the routine visit is much higher, which makes the R&I spend that much more worth it.
Enhance Risk Adjustment Through Better Coding & Documentation
The yearly wellness visit is the first step to getting members to the right doctors each year, which is critical to coding and documentation for risk adjustment programs. By adding an incentive to this activity, more members will see their PCP for a wellness exam… which leads to more conditions captured and coded… which leads to more accurate risk adjustment revenue capture. The annual wellness visit is what drives and preserves accurate and compliant coding, which makes up a significant percentage of your revenue stream in MA and all of revenue in ACA plans.
To take it a step further, with the right data and technology tools in place, you can compile risk adjustment gaps and Stars needs (including HEDIS, PDE, CAHPS, and HOS) into one resource for members to share with their doctors and for providers to reference during the visit. Consolidating gaps to address in a single intervention is more efficient and effective for both member and provider.
The Caveat: Don’t Guess. Run the Numbers.
For many health plans and their members, incentivizing the annual wellness visit makes sense. It delivers on your core mission as a health insurance company.
However, before doing or creating anything for your reward and incentives program, you have to run the numbers. That’s the only way to know if you should, for example, incentivize eye exams or flu shots or mammograms in addition to (or possibly, instead of) annual wellness visits or physicals.
If your provider network is already doing well on those activities, you don’t need to incentivize seniors to do them. And if you don’t have a large budget, the annual wellness visit can address many needs in one fell swoop. You have to trust that when a member goes in for an annual visit, they’re going to get their problems addressed by the doctor or nurse. That’s going to trigger referrals, which leads to increased performance on the quality metrics you care about.
One hard-won lesson from our experience: Design reward and incentive programs with a quality improvement lens, in addition to a sales and marketing lens. This allows you to tie the reward program very tightly into the clinical quality improvement mission, which helps you meet CMS’s intent.
Health plans need to do more to get members into the doctor’s office for these critical visits. To summarize our best practice tips and tricks:
- Look at your measure-by-measure performance to identify opportunities, such as measures where you’re nearing the cut point
- Offer incentives that allow members to receive either an AWV or an annual physical
- Allow members to receive their AWV or annual physical once per calendar year instead of once every 366 days
- Use bidirectional provider data to surface all risk adjustment and Stars (including HEDIS, PDE, CAHPS, and HOS) gaps for provider consideration during the visit
As you consider plans for 2022 and beyond, make R&I part of your member engagement strategy. Don’t be afraid to start small: You can start with just one behavior like a $25 reward for completing the AWV. Keep in mind that Medicare Advantage beneficiaries love rewards—and you want your plan to remain competitive.
Healthmine has a wealth of expertise to help create and launch impactful health rewards and incentives programs with demonstrable return on investment. Contact us for more information.
As Senior Director of Government Programs, James ensures that Healthmine’s solutions have a strong positive impact on performance by acting as a subject matter expert on government programs including Medicare Advantage, Medicaid, and ACA/Commercial. A forever-learner and thorough researcher, James is the go-to resource for what’s up and coming in the healthcare space. He is passionate about leveraging technology and advanced analytics to engage members in their health.
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