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Engage members,
inspire change, repeat.

Engage members,
inspire change, repeat.

Progressing health plans in a changing industry

 
 

Health care plans in the government space have unique challenges and opportunities. A deep expertise in compliance and regulatory guidelines is part of what we offer—but we combine it with consumer loyalty best practices, data science and behavioral analytics. For progressive commercial plans, these strategies are equally impactful for member engagement.

Over the past 10 years, the Centers for Medicare & Medicaid Services (CMS) has introduced increasingly challenging and detailed quality standards. NovuHealth specializes in optimizing your plan’s performance to both federal and state quality standards.

 

Medicare

The last few decades have been heavily influenced by two landmark events: the introduction of the Medicare Star ratings and the Affordable Care Act. NovuHealth has led the charge in providing solutions that optimize quality measures within compliance regulations while incorporating consumer engagement best practices. For Medicare plans, we help:
  • Close high-value gaps in care
  • Improve quality scores:
    • HEDIS measures
    • Medicare Star ratings
    • HOS (Health Outcomes Survey)
    • CAHPS (Consumer Assessment of Healthcare Providers and Systems)
  • Build trusted relationships with members
  • Encourage efficient use of health care dollars
  • Optimize the Medical Loss Ratio to drive plan performance.
 

 
 

Medicaid

The Medicaid quality core set and CHIPRA quality program are positioned to mirror the HEDIS-driven Star rating system of Medicare. As CMS works closely with individual states to implement these new quality standards, plans will require better member engagement programs that target communications and exceed customer expectations. For Medicaid plans, we help:
  • Close high-value gaps in care
  • Improve HEDIS measures and contract plan performance
  • Optimize risk adjustment
  • Align and partner with providers

 
 

Qualified Health Plans

Many states have their own rating systems, but CMS has a nationwide standard in the works for the near future. We specialize in focusing your engagement strategy and rewards program on driving the right behaviors with the right members for both systems. For QHPs, we help:
  • Close high-value gaps in care
  • Engage hard-to-reach members
  • Optimize risk adjustment
  • Improve quality and experience

 

Commercial

While we’re not a wellness program, we do deliver high-value behaviors from your hardest-to-reach members. This optimizes plan performance by managing risk and improving quality metrics. For commercial health insurance plans, we help:
  • Close high-value gaps in care
  • Increase member engagement and satisfaction
  • Manage outliers and highly chronic individuals
  • Develop and define incentive programs to target business drivers

 

Research & Strategies: Check out our white papers, case studies and industry insights.

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