5 Tips for engaging and motivating the Mom & Baby Medicaid population

5 Tips for engaging and motivating the Mom & Baby Medicaid population

Research shows that early and regular prenatal care leads to improved birth outcomes, but for Medicaid members, social determinants of health (SDoH) can create barriers between pregnant women and the care they need.

Early (and frequent) engagement can make all the difference for moms-to-be and their babies, as well as health plan performance and cost management—especially given the timeliness requirements around the prenatal, postpartum and well-child HEDIS measures.

Download our engagement guide to get 5 tips for successfully engaging and motivating the Mom & Baby population.

DOWNLOAD THE GUIDE  <https://www.novu.com/corporate/resources/5-tips-for-engaging-and-motivating-the-mom-baby-medicaid-population data-recalc-dims="/>

At NovuHealth, we’ve worked with several plans across multiple states, engaging moms-to-be with timely, actionable communications and motivating them with meaningful rewards. Check out our Mom & Baby Engagement Solution to learn how we’ve helped deliver results.

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. Combining its sophisticated engagement engine with proven loyalty and data science strategies, plus deep industry and regulatory expertise, NovuHealth motivates consumers to complete high-value healthcare activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 10 million consumers across all 50 states. Learn more at novuhealth.com.

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Introducing NovuHealth’s Medicaid Member Engagement Solution

Introducing NovuHealth’s Medicaid Member Engagement Solution

Reaching Medicaid members and motivating them to participate in their own care can be a challenge—especially when you have limited or outdated contact information and your members have complex care needs, fluctuating eligibility, and are impacted by social determinants of health (SDoH). But that doesn’t mean it’s impossible.

Most plans use a one-size-fits-all engagement approach, but members—especially in a Medicaid population—aren’t one size. With Medicaid membership growing, costs rising, and budgets and resources getting tighter, you can’t afford to treat everyone the same way.

A personalized approach to engaging hard-to-reach populations

NovuHealth’s Medicaid Member Engagement Solution delivers personalized content and incentives that motivate members to complete the healthcare activities that can improve plan performance and member health and satisfaction.

Unlike one-size-fits-all member engagement, NovuHealth’s solution creates a highly personalized experience by tailoring content, channels and incentives to each member’s needs and applies proven loyalty and data science strategies to optimize segmentation, engagement and results.

We help health plans engage and motivate the most complex and challenging Medicaid populations, including:

  • Mom & Baby
  • Dual SNPs
  • Members with diabetes
  • Members with chronic conditions
  • Children & adolescents
  • …and more

To learn more about NovuHealth’s Medicaid Member Engagement Solution, check out the solution webpage or read the press release.

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 25 million consumers across all 50 states. Learn more at novuhealth.com.

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Calculate how much risk adjustment revenue you could be missing

Calculate how much risk adjustment revenue you could be missing

Based on our calculations, approximately 20 percent of members in a given population aren’t accurately risk adjusted. Which is surprising given the investment health plans have made in solutions like chart-chasing, in-home visits and data mining.

Here’s the thing: those efforts are only as productive as the members who go to the doctor, and the quality of those visits once they do. When you consider the value of each hierarchical condition category (HCC), and the average number of HCCs per member, the members who aren’t getting accurately coded could be costing you. Use the calculator below to find out approximately how much revenue you might be missing.

Annual Wellness Visits (AWVs) are a key opportunity to identify HCCs, which help determine risk adjustment payments from CMS. If your members aren’t going to their providers, your current approaches won’t help.

At NovuHealth, we take a member-centric approach to risk adjustment by motivating the members who need to be coded and empowering them to have a more productive AWV with their physician. It’s a fundamental shift in how plans capture risk adjustment revenue, but it can also make your existing efforts more accurate and productive.

To learn more about how member engagement can help optimize your current risk adjustment approach, and to get 5 effective strategies for reducing unknown risk, download our presentation from RISE Nashville.

GET THE SLIDES  <https://www.novu.com/corporate/resources/why-risk-adjustment-is-an-engagement-problem-not-a-data-problem data-recalc-dims="/>

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, offering rewards and incentive programs that improve consumer health and plan performance. NovuHealth applies proven loyalty and data science strategies and leverages its deep industry and regulatory expertise to motivate high-value consumer activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 15 million consumers across all 50 states. Learn more at novuhealth.com.

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CMS finalizes non-medical MA benefits, increases use of encounter data

CMS finalizes non-medical MA benefits, increases use of encounter data

With the April 1 release of the 2020 final call letter, CMS has finalized updates for Medicare Advantage plans to expand supplemental benefits, revise certain Star measures, and increase the use of encounter data in calculating risk. Does your plan have a strategy in place to adapt to and take advantage of these changes?

Here’s what you need to know about these key new updates, and how to address them as you prepare your 2020 MA bid:

Supplemental benefits expansion

Although supplemental non-medical benefits were included in last year’s call letter, their late addition meant that many plans didn’t have time to include them in their 2019 bids. Now, in 2020, this guidance has been expanded, giving MA plans the opportunity to cover nontraditional benefits that address social determinants of health, such as healthy food programs to ease food insecurity or transportation initiatives to make it easier for members to get to the doctor.

In addition, CMS gave plans greater flexibility to offer certain benefits only for groups with specific conditions—for example, covering the cost of monitors for members with diabetes, or fresh produce for those with heart disease.

With these new MA benefits, plans can focus more on proactive, preventive care to keep members healthier, reduce hospital admissions and readmissions, and prevent higher care costs down the line.

And the good news is, as health benefits evolve, so can the rewards and incentives that promote them. In fact, a rewards and engagement program can be a great way to educate your members about any new supplemental benefits available to them—and motivate them to take advantage of those services. The key lies in knowing how to effectively engage your members—and connect the right members to the right benefits.

So, as your plan dips its toe into the water with supplemental benefits, make sure you’ve got a solid engagement strategy in place.

One final note: With this new guidance from CMS, we expect non-medical benefits to become increasingly key for MA plans that wish to stay competitive and maintain a sterling reputation going forward. However, if you’re a pioneer in offering supplemental benefits, adverse selection risk can certainly be a concern—so an effective risk adjustment strategy is essential. (More on that later.)

Star measure changes

In addition to the expansion of supplemental benefits, CMS also made changes to a handful of Star measures, including:

  • Measure C16: Controlling High Blood Pressure
    This measure will be temporarily moved to a display measure. In the meantime, CMS expects plans to continue to focus on improvements in this area for the health and wellbeing of their members, so keep paying attention to this measure—and don’t remove it from your rewards program; it will be back in 2022.

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  • Measure C07: Adult BMI Assessment
    This measure will be permanently removed beginning in 2020. Electronic health records have enabled nearly all plans to make great strides in performance in this measure, so its reliability has declined and CMS no longer believes it’s useful to track.

  •  

  • Permanent exclusion of I-SNP members from the denominator of HOS measures
    CMS will be excluding beneficiaries enrolled in Institutional Special Needs Plans (I-SNPs) from the Health Outcomes Survey (HOS) baseline beginning in 2020. For plans, this will have a small effect on the amount of outreach required for HOS.

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  • New display measure: Transitions of Care
    After patients are sent home from the hospital, plans are expected to provide documentation of “patient engagement” (office visits, in-home visits, telehealth, etc.) provided by the primary care practitioner within 30 days after discharge. Though this measure won’t affect your Star ratings this year, it’s likely to become a Star measure in 2021 or beyond. So keep an eye on it, and consider: How can you better collaborate with providers to engage members? How can data be better shared and leveraged to engage members?

  •  

  • New display measure: Follow-up After Emergency Department Visit for Patients with Multiple Chronic Conditions (Part C)
    Similar to the previous display measure, this is another one that has a strong chance of becoming a 2021 Star measure. Intended to assess follow-up care provided after Emergency Department visits for those with multiple high-risk chronic conditions, this measure asks plans to document follow-up care provided within 7 days of the ED visit.

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  • Proposed new C Measures related to Pain Management
    In an effort to address the opioid crisis, CMS is supporting non-opioid pain management therapies that may lead to new Part C Star measures. If approved these new measures would likely be introduced in 2021. So again, for now, keep an eye on this one—and consider how to engage your members to improve chronic pain management.

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  • Proposed new C Measures related to Patient Reported Outcome Measures
    Like existing measures C04 and C05—improving or maintaining physical and mental health—CMS is considering adding more patient-reported outcomes in future years. Topics under discussion include assessments of change in mobility, depression and change in depression, patient activation or engagement in the treatment process, physical activity, health-related quality of life, goal achievement, cognitive function, pain, social support, and more. For plans, this means there’s even more reason to continue investing in member engagement and satisfaction—powerful tools for improving outcomes and impacting members’ attitudes about their own health.

  •  

Encounter data in risk adjustment

Another significant change in the 2020 call letter is CMS’ updates to the risk adjustment model, including an increased use of encounter data.

While encounter data—information about members’ medical conditions documented by providers and hospitals—has contributed to risk score calculations since 2016, CMS now wants to increase the amount of encounter data used from 25% to 50%.

The other half of the risk score calculation will come from claims data, submitted to CMS via the risk-adjustment processing system, or RAPS.

Many MA plans have fought this change, arguing that encounter data is often inaccurate, inappropriately lowering risk scores and leading to lower MA payments.

However, given this change, it’s more vital than ever that your plan has an effective and accurate risk adjustment strategy in place.

Beyond chart chasing, in-home visits and data-mining, you need to motivate your members to get to the doctor and complete their Annual Wellness Visits (AWVs).

Why AWVs specifically? These visits represent a key opportunity to identify hierarchical condition categories (HCCs), which help determine risk payments from CMS. If your members aren’t going to their providers, traditional data-centric approaches simply can’t capture HCCs accurately. We recommend taking a member-centric approach, incentivizing members to complete their AWV and empowering them to have a productive visit.

Looking for more insights on what these changes mean for your MA plan in 2020—and beyond? Contact us here with any questions.

 

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, offering rewards and incentive programs that improve consumer health and plan performance. NovuHealth applies proven loyalty and data science strategies and leverages its deep industry and regulatory expertise to motivate high-value consumer activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 15 million consumers across all 50 states. Learn more at novuhealth.com.

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UnitedHealthcare CEO Steve Nelson talks to NovuHealth about the bold moves needed to transform healthcare

UnitedHealthcare CEO Steve Nelson talks to NovuHealth about the bold moves needed to transform healthcare

NovuHealth recently welcomed UnitedHealthcare CEO Steve Nelson to speak at an all-employee quarterly meeting. Nelson shared his perspective on the future of healthcare and how leading healthcare companies can address an increasingly complex set of consumer and market challenges.

“We have a problem in healthcare,” Nelson stated matter-of-factly as he kicked off his presentation. He shared that our nation’s healthcare expenditures are 18% of our gross domestic product (GDP), roughly double the spend of our peer countries.

Given that 90% of those expenditures are on chronic conditions, and that the percentage of people with multiple chronic conditions is only expected to increase in the coming years, it’s not hard to agree with Nelson’s assertion.

So, how do we fix the problem? According to Nelson, it won’t be simple, and it’s not necessarily even about finding a solution. Like other industry experts, Nelson describes healthcare as a “wicked” problem. Wickedness doesn’t represent difficulty—rather it describes a complex societal challenge that traditional processes can’t resolve. There isn’t a right or wrong answer to a wicked problem, or even an answer at all. Often, it’s about developing an intervention rather than a solution.

Tackling a wicked problem, Nelson said, requires bold moves. Using rock climbing as an example, he talked about the importance of being willing to pursue bigger, higher summits. “In climbing,” Nelson described, “you’re constantly looking for the next foothold. You’re always on the move—always taking calculated risks.”

Making bold moves, however, requires strong leadership. Here are the 5 qualities Nelson says every leader and every leading company must have if they hope to have a meaningful impact on the future of healthcare.

1. A sense of purpose

Nelson says it’s critical to “have something to get out of bed for.” For him, it’s improving the lives of the 50 million people who carry UnitedHealthcare insurance. While he ultimately answers to a board of directors, Nelson also knows he’s accountable to the several million members who count on UHC for care, and that gives him purpose.

2. Diverse thinking

“Have a team that thinks differently than you,” Nelson said in talking about the importance of diverse perspectives. The Harvard Business Review agrees, noting that teams with greater cognitive diversity perform better on strategic execution exercises.

3. A big audacious goal

Remember the bold moves mentioned earlier? Nelson regularly challenges himself and his teams to set goals that make them stretch. The key, he says, is having a plan that connects each team’s work to the big audacious goal, so people understand the impact of their efforts and see a path to achievement.

4. Flawless execution

Having a plan for achieving big audacious goals is the first step in executing flawlessly. The second is managing to that plan and holding each team to a high standard of performance.

5. Good communication

Finally, Nelson said that in order to succeed at the highest levels of leadership, it’s critical to foster clear and thoughtful communication at every level of the organization.

At the end of his presentation, Nelson talked about the importance of remaining committed to making bold moves, especially when trying to address a wicked problem like healthcare. He also said companies like UnitedHealthcare and NovuHealth, with their focus on continuous improvement and innovation, are well-positioned to drive change—and by working together, transformation.

To stay up-to-date on Steve Nelson’s perspectives on healthcare, follow him on LinkedIn.

About NovuHealth
NovuHealth is the leading healthcare consumer engagement company, offering rewards and incentive programs that improve consumer health and plan performance. NovuHealth applies proven loyalty and data science strategies and leverages its deep industry and regulatory expertise to motivate high-value consumer activities. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served more than 15 million consumers across all 50 states. Learn more at novuhealth.com.

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