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Is Your Health Plan on Track to Meet Year-End Goals?


Three Customer-Centric Steps to Help You Meet Your Goals—From Member Satisfaction to HEDIS Measures

As you roll into the second half of the year, it can be important to conduct a business review to see where you stand with your year-end objectives, from HEDIS® and other quality measures to member satisfaction metrics.

Assessing your health plan performance now will give you time to implement any necessary adjustments that can significantly improve your chance of achieving your annual goals.

To help facilitate your success, here are three key areas to focus on this quarter.

1. Close Outstanding Gaps in Care to Improve HEDIS Measures, Outcomes and More

Now is the time to follow up with members who haven’t completed their annual physical exam or HEDIS preventive care measures, like colonoscopies and mammograms.

“Waiting until the end of the year to address outstanding care gaps will put both your population’s health and your plan performance at risk,” says Carenet Chief Client Officer Vikie Spulak. “Scheduling an in-person doctor’s appointment at any time during the year can take weeks, even months. Booking an appointment at year-end can be even more challenging, if not impossible.”

Year-end appointments are often in high demand as plans make last-minute attempts to close gaps in care and meet their annual HEDIS goals by getting their members into providers for exams and health screenings.

Provider offices are also inundated with people who have money remaining in their flexible spending accounts rushing to spend it before they lose it, and with those who have met their insurance deductibles scrambling to take advantage of cost-savings before the calendar flips.

The fourth quarter is also the busiest time of the year for many people, both professionally and personally, thus making it even more difficult to schedule medical appointments.

Limited provider availability and appointment scheduling challenges can contribute to member frustration, higher nonadherence rates, and services performed outside of the recommended timeframe and plan network.

“While a year-round approach is the best strategy for achieving a high gap-closure rate, there is still time to contact members, coordinate appointments, and follow up to ensure follow-through,” says Spulak. “But plans need to act now, otherwise they could jeopardize their member satisfaction, clinical outcomes, and bottom-line results.”

2. Conduct Satisfaction Surveys to Fuel Your Consumer-Centric Efforts

Do you know how your members feel about your plan? If not, the third quarter is an ideal time to conduct member satisfaction surveys.

“A personalized check-in with members enables Carenet and the plan to identify and remedy issues before they escalate,” says Spulak. “In addition, customer dissatisfaction can be addressed before members are surveyed by third-party agencies at the top of the year.”

Survey calls can also be used to remind members of their plan benefits and services. And they provide an opportunity to express appreciation and build loyalty just before open enrollment season begins in October. Ensuring member satisfaction is a critical retention strategy considering that satisfied members are five times more likely than unhappy ones to renew their plan.

“When members feel heard and appreciated, and know their experience truly matters, they’re much more likely to engage with their plan and much less likely to go shopping elsewhere,” says Spulak.

3. Plan Your Welcome Call to Establish Contact, Conduct Health Risk Assessments, and Introduce Telehealth and Other Services

A successful year starts the year before. One of your annual goals should include outlining your outreach strategy for the next year, starting with the January welcome call for both new and returning members.

Connecting with members following enrollment via a welcome call is essential for making a good first impression, establishing a solid foundation and building rapport.

The welcome call also provides a valuable platform for educating on benefits and preventive care measures, communicating services and resources, assigning a primary care provider, and collecting vital information. A health risk assessment can also be conducted at this time.

“A timely, well-crafted welcome call helps get members onboard and engaged from the beginning making it easier to achieve desired actions and outcomes down the road,” says Spulak. “It’s an invaluable opportunity to thank members for choosing your plan and to reassure them that they made the right decision.”

How Can We Help You Finish Strong?

As you take action toward improving your plan performance and reaching your 2018 goals, our specialists can provide additional insights and recommendations. Contact us to connect today.

Plus, to learn how Carenet implemented its high-touch HEDIS outreach mid-year to help a plan close 8,200 gaps in care, click here.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).