Maintaining a Medicare Four-Star Rating at Healthfirst

Decision Point Healthcare Solutions recently spoke with Joyce Chan, AVP, Clinical Performance Management, at Healthfirst, a not-for-profit health plan serving more than one million members in downstate New York. Healthfirst has been a Decision Point customer since 2013, and in October, the Healthfirst Medicare Advantage Plan was awarded a Four-Star Quality Rating from The Centers for Medicare & Medicaid Services (CMS).

We spoke to Joyce Chan about improving the plan’s Star Management rating, how Healthfirst is working to prevent member abrasion and dissatisfaction in a socio-economically diverse urban population and the role of data and technology in these efforts. Here’s what she had to say.

Q. The Healthfirst Medicare Advantage Plan was recently awarded four-star quality rating from the Centers for Medicare & Medicaid Services (CMS). How does this award impact (or reflect) your overall business strategy?

Healthfirst is thrilled to earn four stars from CMS. It reflects our focus on quality as well as our goal to become the preeminent plan in our market. It also speaks to the Healthfirst mission and vision to transform the healthcare system and treat members with the same care and attention we would want for our families.

Our performance has only increased our commitment to ensure we maintain this level of quality. The current four-star rating reflects work that was performed largely in 2013, which is when we started working with Decision Point. Decision Point is a big part of our commitment to maintaining and improving upon our Star rating.

Q. Does Healthfirst have multiple member outreach efforts initiated by different parts of the organization?

Yes, we do. While we definitely don’t think it’s ideal, it is a fact of life. At Healthfirst we have a handful of departments driving member outreach. For example, we push out communications for:

  • Regulatory compliance, such as new member materials or current member explanation of benefits after each PCP visit;
  • Wellness messages, such as reminders for upcoming services or connecting with their PCP;
  • Marketing activities, such as member satisfaction surveys to take the pulse of what they are thinking and feeling; and,
  • Care Management, such as a nurse case manager calling members who have had a hospital admission or are at risk for one.

To ensure that the tone and style are consistent, all outreaches must go through our communications department for approval. Also, we’re very focused on understanding member behavior and determining what members need the most so that we’re more streamlined in our member communications. We are always trying to improve upon this process.

Q. Are you worried about excessive/redundant outreach to members?

Yes, it’s an ongoing concern. We are constantly seeking a true understanding of our membership and outreach as a whole, and strive to provide our members with relevant, meaningful communications. We want members to get the right care and services, and we must balance our outreach with doing what we can to not frustrate them by over-communicating. It’s different with each member: some indicate that we are contacting them too much, while others enjoy and look forward to the interactions.

Q. How do you coordinate member outreach efforts across your organization? How have you optimized member outreach efforts across multiple business and clinical domains?

At Healthfirst, we are continually trying to improve member outreach. While campaign-driven outreach is generated in a handful of departments, we create one yearly calendar that includes all of the organization’s big campaigns, and then we slot in ad hoc campaigns as we go. It’s both simple and helpful.

For example, at the end of 2014 we targeted both renewal messages as well as quality of care outreach encouraging members to get services before the year ends. With Decision Point we can identify the members who are at greatest risk for certain outcomes, decide which channel is most appropriate, and message them based on their barriers to engagement.


Q. Does your organization track the number of member outreaches, methods of outreach and outcomes of each outreach?

We create control groups on a campaign level, and at the end of the year, we look at the efficacy of those in the control group versus those who received outreach. Once we’ve crunched the numbers, we can determine if a campaign was more effective at getting members to act. This helps determine what we need to do in the future. We’ve found that results can vary by type of message, so we test the message too.

Because we refresh the data on a regular basis, we have the most updated information on member behavior. This, in turn, lets us refine how we outreach that member in the future. Our goal is continuous improvement, which ultimately is more cost effective too.

Though there aren’t any specific, hard-and-fast outreach metrics that we’d like to achieve, we’re always striving to get better. For instance, if telephone campaigns are unable to reach 30% of members, we can work to minimize that with more accurate data.

Q. What types of outreach channels have you considered? Do you believe that that’s changing with younger Medicare members?

Outreach preferences among our members are definitely changing. Historically, three to four years ago, we did traditional phone, letter, and in-person outreach. Now we are taking advantage of more modern channels as well — email, text, and social – but still on a small scale. We’re finding that even Medicare members are tech savvy.

Q. Does your organization use emerging methods of outreach, such as smartphones, remote sensing devices, apps, texting etc.? Please discuss your experience with them.

This is an interesting area. Many of our members use smart phones as their primary way of accessing the Internet. So we have mobile-enabled our web site and developed an app. We piloted a text campaign in 2013 and had good luck with it, so did more in 2014. We expect to continue to increase our use of new outreach methods, such as text-based campaigns, in the year to come.

Q. What are the challenges in using technology in a culturally and ethnically diverse population?

The biggest challenge in contacting the very diverse Healthfirst membership is making sure we have translated content. The primary languages we use are English, then Spanish, Chinese dialects, and Russian. It’s very important that we outreach to our members in their primary languages so that we can better engage them with their health.

Q. Do you believe that health plans today collect enough data on members to make as accurate and effective assessment of their needs as possible? What do you think is missing and why?

While health plans collect lots of data, it’s not always the right type of data, accurate or consistently available. For instance, while we do collect language data, we don’t always collect email addresses for members. Also, we don’t always look at data in the right way to understand members and their needs. I’d like to see us:

  • Collect socio-demographic data – i.e., education level, which would help us understand the right level at which to communicate with members. Instead, we keep our messages as simple as we can.
  • Better integrate data with providers – while we may have timely, accurate data, if it’s not integrated with provider data, we cannot give members the optimal care they need. The PCP has a view of a member in the office, but no information about when that member goes to a different provider outside of their organization. We have a view on member activity throughout the health care system, but often do not have the detailed information (e.g., lab values, assessment data) that is captured in the provider office. As these disparate sets of data are integrated it becomes more powerful and can really improve member care and outcomes.

Stay up to date

Keep in touch.  Give us your name and email and we’ll keep you in the loop.