As states and managed care organizations (MCOs) contend with the end of Medicaid's continuous enrollment period, now is a critical time for health plans to ensure they are optimizing their Medicaid and Medicare health risk assessment (HRA) processes. To provide beneficiaries with cost-effective, quality care, health plans should routinely refine their efforts to comply with the requirements of the Centers for Medicare and Medicaid Services (CMS) to maintain member information that's accurate, up-to-date, and complete.
Low completion rates, engagement strategies that lack personalization, relevance, and choice, as well as outdated outreach tactics are all factors that can drive substandard HRA data. By following best practices and deploying innovative approaches to collecting information, organizations can achieve robust response metrics to effectively evaluate members' health risks. Carenet has a deep understanding of CMS regulations and extensive experience reaching out to and connecting with the vulnerable Medicaid and Medicare populations.
When engaging with individuals about completing their assessment, it's important to identify which form of communication they prefer such as phone calls, emails, or texts. By giving members communication options to choose from, health plans can foster patient engagement, increase response rates, and obtain more-complete patient information. To maximize the effectiveness of HRA campaigns, organizations should also test and analyze their outreach communications strategy to determine what works well and what does not, and then implement changes to improve outcomes.
Other proactive steps include addressing opportunities for health and wellness intervention during (not after) the HRA process, addressing foreign language needs, follow-up strategies for non-participants, and having resources in place to integrate collected data into member profiles as quickly as possible. These are just some of the steps that are critical to achieving the best HRA process possible – for organizations that want to assess how their program measures up, check out Carenet's online HRA evaluation tool.
Innovative and Customized Plans Achieve Exceptional Results
For example, a not-for-profit health plan that was using conventional direct mail to conduct Medicaid HRA surveys partnered with Carenet to remedy its exceedingly low response rates. As many of its members did not reside at the address on record, the plan was unable to evaluate the health risk of a high percentage of its members and identify those with complex and costly healthcare needs, which compromised its clinical and financial outcomes.
Operating within a tight deadline, Carenet designed a customized plan to overcome the organization's Medicaid population obstacles that included insecure housing, invalid contact information, language barriers, and low health literacy. The plan addressed the need to conduct consistent HRA survey collection and follow-up communication that was personalized and focused on each individual's needs and unique circumstances. Every step of the program was designed to meet agency compliance and achieve the goal of increasing completion rates, improving the plan's risk stratification, and identifying gaps in care.
The strategy, which exceeded its reach rate goal, achieved a 67% HRA completion rate within the 60-day deadline. When the process was complete, many members also expressed gratitude for the compassion they were shown through the personal interactions they had with the agents who served them.
In a similar partnership with another not-for-profit health plan, Carenet devised a customized outreach strategy to boost HRA completion rates for the plan's dual-eligible members, a particularly difficult population to engage. CMS selected the health plan to deploy a dual-eligible demonstration project and the plan tapped Carenet to leverage its expertise to test a more effective outreach model. In addition to increasing HRA completion rates, CMS wanted the plan to elevate care quality and reduce costs among its high-, medium- and low-risk members, and identify as quickly as possible those members requiring case management interventions.
For the project, CMS required that the outreach be conducted by registered nurses and not non-clinical personnel. Carenet deployed a team chosen from its in-house workforce of nurses who are experts at engaging and educating members in order to guide the beneficiaries through the HRA process, respond to clinical questions, and initiate case management when needed. Carenet's solution also included integration with the health plan's customer relationship management (CRM) system and scripting tool.
The customized plan achieved a 56% HRA completion rate and the member data that was captured met the goals of the CMS demonstration project – the enrollment of high-risk members into case management programs, and the implementation of personalized care plans.
As health plans work in the weeks and months ahead to obtain and document updated member information during the Medicaid redetermination process, Carenet is available to provide innovative, leading-edge solutions with proven results.
Learn more about how Carenet Health can support your organization through the Medicaid redetermination process and beyond and contact us today.