Fresh Start: Getting a Jump on 2016 Outcomes in Q1

Andrew Whitman

Andrew Whitman

By Andrew S Whitman

Is it too early to start acting on some of your key performance indicators (such as HEDIS, Medication Adherence, Retention, Satisfaction, etc.) in the first quarter? I recently sat down with Saeed Aminzadeh, our CEO at Decision Point, to discuss what he’s observed as best practices for health plans.

When is the best time to start engaging members for important metrics like HEDIS and Medication Adherence? After all, a lot of the HEDIS 1-year measures and Medication Adherence metrics restart at the first of the year, leaving virtually all members with open gaps in care in Q1.

It’s critical to start right away and focus on members that need the most help. This way, you’ll have the full year to try to engage, educate and encourage these members to become more compliant and adherent. They key is to target the right members. It’s obviously not advisable to communicate with your entire membership this early in the year, but if you target members that are unlikely to get their tests/screenings or stay on top of their medications, you’re giving these members more time and more help to stay on top of their health. Even if you’re ultimately unable to get them to the 80% medication adherence threshold for example, or in for a colorectal screening, at least you’re building a foundation that can carry over to future years.

What about other metrics like Retention and Satisfaction?

Retention and satisfaction are important metrics, but ultimately you’re trying to build loyalty and trust. Building loyalty and trust takes time, and, like anything else, it’s important to start early and target members that are at highest risk for disenrollment and dissatisfaction with the goal of trying to engage these members. It’s equally important to try to know why they’re high risk. Are they unhappy with their doctor? Are they simply not that engaged with their health? By targeting the right members, and identifying and addressing the reasons for their behavior, you’ll be able to work your way towards becoming a “trusted advisor” to your membership.

How do you get to know a person’s reasons for leaving the plan, or staying on top of their medications?

The short answer is that historical data can give you some clues, both in terms of who and what the challenges might be, which can then be substantiated by engaging with the member and addressing the issues directly. Since it’s not feasible to target your entire membership, one of the most critical steps in the process is targeting the right people. Who is at the highest risk to be non-compliant with evidence-based guidelines (like HEDIS)? Who is at the highest risk to be non-adherent with their medications? Or highest risk to leave the plan. Once you’ve zeroed in on the right people, then you can observe certain patterns in their behavior. Do they go to their doctor regularly? Have they switched doctors often? Have they responded to any health plan communications? These patterns provide you with clues as to what might be driving a member’s behavior, which can then be substantiated, addressed and acted on.

What about the rest of the year? If we focus on the “toughest” members in Q1, when do we communicate with members that just need a small push or a gentle reminder?

If we break this down to a math problem, a formula that we use all the time is: Yield per Contact (compared to Control). We’re trying to maximize behavioral change with each member communication, so to maximize effectiveness, we’re aspiring to the maximum yield per member contact. For HEDIS and Medication Adherence, in the beginning of the year, my maximum yield per member contact (compared to an equivalent control group) would be through targeting the highest risk (or “toughest”) members. By mid-year, my maximum yield per contact would be through targeting the moderate and low risk members. In plain terms, this means that I target the toughest members that require the most help in the first half of the year, and then target members that are still non-compliant and need gentle reminders in the second half of the year.

Measures like Retention, Readmissions, ER visits, etc. are different: I’m only focused on the highest risk members throughout the year. There is no yield by targeting any lower risk members, except through mass communications like newsletter outreaches and general communications.

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