How do Rewards and Incentive Programs Impact Quality Ratings?
So how exactly does rewarding members for healthy behaviors move the needle on quality ratings? The answer is two-fold—meaning that your rewards and incentives program can have double the impact:
Closing gaps in care directly impacts HEDIS—and helps with HOS
HEDIS measures, developed by NCQA and utilized by more than 90% of plans nationwide, scores health care organizations on a range of health issues so that plans can be compared “apples to apples.”
Preventive care looms large in HEDIS measures with plans earning their ranking based on the percentage of eligible members who complete health care activities like breast cancer screenings, colorectal cancer screenings, and diabetes care. Here’s the kicker—beginning in 2016, CMS began using clustering methodology to determine Star ratings for its measures: essentially, grading plan results on a curve rather than against predetermined thresholds. For plans across the marketplace, this has added pressure to perform.
Incentivizing members for completing high-value health activities not only increases rates of completion, but by targeting the hardest-to-reach members with dynamic reward values, plans can reach specific quality measures and goals without breaking the budget.
Using the same rewards and incentives programs, plans can also encourage and support the small daily steps that result in improved member health, like exercise and healthy eating habits. Although the outcomes themselves can’t be rewarded, participation in wellness programs can be. These incentives, in turn, can impact the HOS measure, a survey used to assess member health outcomes over a 2-year period.
From member action to member satisfaction
When members take steps to care for their health by completing preventive care steps, your rewards and incentives program rewards them with a gift card, for example, of the member’s choosing. Not only have you encouraged the member to take actions impacting HEDIS, but their actions have resulted in customer satisfaction once the member receives their reward.
Unlike HEDIS measures, CAHPS measures use member surveys to ascertain a member’s satisfaction with their health plan. So by delivering additional positive encounters with the plan through R/I programs, plans improve their chances of achieving higher CAHPS scores.
Medicare Star Ratings and Medicaid Pay-for-Performance then utilize these scores (along with others) in their own algorithms to assign overall, consumer-facing plan ratings. The results of which impact everything from optimizing revenue opportunities to member retention and acquisition.