Key Takeaways

The Importance of Accurate Data

The conversation highlighted the struggle plans are facing in obtaining accurate data. CMS regulations demand data accuracy, which poses compliance risks for plans. However, it goes beyond regulations; member trust also hinges on accurate and consistent data. Building a solid foundation of trust through reliable information is essential in the digital age.

Creating a Frictionless Experience

The key to success is a technical ecosystem that enables individuals to access the right care seamlessly and helps with informed decision-making, including the ability to schedule appointments. Consistency in information across different access points is vital to prevent degradation of member trust. Plans need to provide channel consistency, addressing the challenge of accuracy between the variety of provider data access-points.

Collaborative Problem-Solving

The panelists shared how they collaborated to enhance provider data, working across the provider and payer systems to surface the highest quality data. Knowing their providers best, the plan provided guardrails, specifying attributes for improvement that resource constraints prevented them from facilitating. Through their partnership, HealthSparq was then able to leverage their data integration expertise to enhance provider records, bridging the gap between health plan and health system. The collaboration was essential as discrepancies impacted member satisfaction scores, such as NPS and star ratings.

The results? While it was recognized that these changes don’t “happen overnight”, there was a call out that the HealthSparq solution was “so easy…it was a no-brainer” and impact and engagement statistics showed remarkable success. By addressing the importance of accurate data, ensuring consistency across access points, and empowering members to act, collaboration across payers and providers can create a significant impact.

When it comes to healthcare, individuals often find themselves navigating a complex web of options and information. HealthSparq has a passionate commitment to fostering close partnerships with plans to help connect members to the right care – reach out to see how we can help you in your journey.

The post A Study in Success: How collaboration leads to significant impact for one plan partner appeared first on Kyruus Health.

In today’s healthcare landscape, patients not only want more accurate data about their healthcare providers, but more personalized information so they can select the right one for their needs. With so many choices, patient experience must be a crucial focus for healthcare organizations.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) annual survey measures member perceptions of their health plan by asking patients to rate their experiences with healthcare providers. Starting out with inaccurate provider data can have a significant impact on CAHPS scores.

But it’s not just CAHPS scores that matter, they are an important performance measure of the Medicare Advantage Star program. And with the recent quadrupled-weighting – CAHPS scores currently account for 32% of the overall Star Rating for 2023. These recent changes put an ever-greater burden on health plans to get their provider directories right. 

And the problem isn’t small – CMS found that 52% of Medicare Advantage online directories included at least one inaccuracy. This can lead to incomplete survey responses or inaccurate scoring, potentially harming a healthcare organization’s reputation. In addition, if a directory has inaccurate location, specialty or contact information, patients may not find or reach that provider, which can end up in missed appointments or difficulty accessing care – not to mention a negative experience and member dissatisfaction.

The impact can also result in penalties that impact your organization’s bottom line. CMS is paying closer attention to health plans that don’t place enough importance on accurate data – imposing up to a $25,000 fine per beneficiary for inaccuracies in Medicare Advantage directories. Insurance agencies are also getting in on the act, only last year the Georgia Insurance Commissioner levied a $5 million fine for violation of state regulations, which included persistent “inaccurate provider directories”.  

To combat the impact of inaccurate provider data on CAHPS scores and your Medicare Advantage Star rating scores, healthcare organizations should prioritize data accuracy and invest in technology solutions that streamline data management processes. This includes regularly updating provider information and leveraging processes to verify provider data and flag any inaccuracies.

See how HealthSparq’s Validated Provider Profiles solution can help you implement a compliant provider directory that tracks every provider engagement while giving providers a fast and easy way to verify their data and members a trusted and accurate representation of available care. 

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With over 85 million individuals enrolled in Medicaid, finding the right provider shouldn’t be a barrier to accessing care. Yet, inaccurate provider directories present roadblocks to some of the nation’s most vulnerable populations – pushing them towards uncertain long-term outcomes.

Despite recent federal and state mandates aimed at improving the quality of provider directories, with ~24% of provider demographics and 20%-30% of physician affiliations changing every year – it’s not easy to keep provider data up to date. In fact, recent research found 4 in 10 consumers have found inaccurate doctor information on their health plan website. 

But you can guide members in choosing the most appropriate care, while also meeting your own compliance and business goals. Plans can save on administrative costs around managing data, deliver consistent provider data across touch points, and foster a relationship of trust with the people who count on their plan to help them get care. With 84% of Medicaid beneficiaries saying online provider search tools help them make more informed decisions about healthcare, let’s not create more work for those who need help the most. 

And guidance doesn’t simply end with online search. HealthSparq solutions support accurate and rich provider data across online, print and API’s, meeting Medicaid and Medicare requirements for data accuracy. Couple that with our ability to provide access to patient reviews, non-English languages, telehealth and scheduling availability – well that 85-million-person challenge just became a whole lot easier! 

Learn more about how to streamline provider data to support Medicaid members in our latest eBook. 

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Why Should We Care?

Cost is the most common reason people avoid or delay care. As mentioned in the mandate, “shifts in plan design and enrollment are correlated with consumers bearing a greater share of their overall health care costs.” However, the problem plans face is bigger than a cost estimation tool alone can fix. Why? Because many plans already offer cost estimation, yet the utilization by members isn’t high. One cited study “noted that only 12 percent of participants, beneficiaries, or enrollees currently use the tools available to them.”

How do we increase utilization? The final rule points out that those with health insurance “often lack incentives to seek care from lower-cost providers” and shared savings programs can increase engagement with price transparency tools – encouraging employers to “adopt incentives for consumers to choose more cost-effective care.”  HealthSparq’s own consumer research shows that 91% of folks are interested in incentive programs and 64% believe incentive programs are more valuable than other benefits offered.

It’s Time to be Innovative

COVID-19 has created a tectonic shift in the way health care is managed and delivered, accelerating people’s reliance on their health plans’ digital solutions at a pace we couldn’t have imagined at the beginning of 2020. The federal government acknowledges that “unique plan designs would motivate consumers to make more informed choices by providing consumers with tangible incentives to shop for care at the best price.” They go on to comment that “innovative benefit designs” can “increase consumer engagement in health care purchasing decisions.” What’s in it for plans? Simply put, savings. Recent examples of average savings earned via HealthSparq Rewards include $5,280 for ACL repair, $808 for colonoscopies and $461 for CT scans.

Here’s what’s clear: Plans and employers need ways to educate and engage members in the cost conversation. Sharing part of the savings for going to cost-effective providers is a creative way to increase the value of money spent on health care without shifting more of the cost burden on members.

Bonus Medical Loss Ratio Benefit

There’s another significant benefit of offering a shared savings program.  The Department of Health and Human Services (HHS) allows plans that institute these types of programs to take credit for such shared savings payments in the numerator of their Medical Loss Ratio (MLR) calculations starting with the 2020 reporting year. This means that plans will not be required to pay MLR rebates based on “shared savings” payments for members choosing to obtain care from a lower-cost provider.

However, at the end of the day, this mandate is not about managing bottom-line business decisions. It’s about increasing consumer engagement in health care decisions to address rising health care costs and providing meaningful ways for people to improve their own health outcomes.

To learn more about how shared savings benefits your members and groups, and your bottom line, reach out for a demo of our HealthSparq Rewards program.

The post Read Between the Price Transparency Lines: The Importance of “Shared Savings” appeared first on Kyruus Health.

• 72% of respondents are willing to switch imaging providers for a $25 reward
• 57% of respondents say they would ask for another referral from their PCP if the original was not an incentivized care option

Even better, members say they want these types of programs, highlighted by the below findings:

• 91% are interested in healthcare incentive programs
• 76% want employers to give them tools to save money on healthcare

Now that the data has presented a great case for why health plans should offer this type of resource to members, we’re happy to share a few best practices to help you launch a successful rewards program and engage with your members.

Build an Omnichannel Approach: While tech teams are implementing, marketing teams should be building a multichannel plan to reach members with the new offering. Why? Because each of your members is unique and will engage differently. In fact, those who have access to a rewards program report initially hearing about the availability of the program through many different channels:

• 39% first heard about their health plan’s rewards program through their employer
• 16% first heard about the program through their health plan website
• 13% first heard about the program through a mailing from their health plan
• 9% first heard about the program through their health plan’s call center
• 9% first heard about the program through an email from their health plan

Leverage Partnerships: As stated above, 39% of respondents in our recent survey first heard about their health plan’s rewards program through their employer. That’s a huge impact. Partnering with your employer groups to market your rewards program will not only ensure more people are aware of the program’s availability, but that more people are using it—saving your employer groups, your members, and you, money. Partnering with your employer groups to promote awareness and usage of the rewards program is a very important step in achieving utilization.

Focus your Messaging: Some of the messages we’ve found most successful for marketing rewards programs include those that focus on the reward itself and on shared savings. Below are some messages we recommend trying out in emails, member portal CTAs, search results CTAs, and regular mail to promote the availability of your program:

• Choose a cost-effective provider and share in the savings
• We offer hundreds of rewardable services from quality providers that save you money
• Get rewarded for seeing quality, cost-effective providers
• We give you the power to save money on care and get rewarded, too
• Earn up to $100 when you choose a cost-effective provider
• Save money and earn money
• Save money on your service AND get rewarded for it

Simplify Access: Members shouldn’t have to jump through hoops to find your program – keep it simple. Update website content and CTAs to reflect the new rewards offering prominently. Create an easy-to-remember URL to promote the program on a publicly accessible landing page and a clear path to sign up. Campaigns should be targeted and bring members to their specific savings opportunities through direct links.

Promote, Promote, Promote: Ensure you include dedicated outreach announcing the program and how it works and be sure to include email in your tactics. We’ve found dedicated emails promoting rewards programs to be particularly effective (resulting in as high as a 2,000% increase in signups for one client). Continue to promote the offering as part of regular member communications, including newsletters, EOBs, in-app messages, mailings, new insurance card letters, hold messaging and SMS.

Implementing these best practices will put your program on a path to success. Learn more about how HealthSparq can help your members be more engaged and earn rewards for going to cost-effective providers while you and your employer groups save money – it’s a win-win!

This post adds on the to the tips we created a few years ago in the blog “Five Steps to a Successful Incentives and Rewards Launch” and goes further into what marketing and member facing teams can do to help ensure reward program engagement and success.

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The push to remedy healthcare’s market failure

As we speak, CMS is pushing new mandates that will change the face of how healthcare operates. These new cost transparency mandates are a new force in an industry-wide push for creative “shopping” solutions that will help lower consumers’ healthcare costs. The hypothesis is that when consumers actively shop and exercise choice regarding their healthcare from a position of knowledge, “market pressures encourage providers to produce a more affordable, higher quality product or risk losing out to their competitors.”

But one of the major sticking points is this: How can a consumer act in their own best interest when they don’t know the cost of the service? And therein lies the failure – that the healthcare pricing model is flawed (and not “fair”) when it excludes the consideration of cost. It relies on our belief in the old adage—you get what you pay for. The belief that something more expensive is of higher quality—just because it’s more expensive!

Addressing healthcare’s market failure with shoppable services

For the most part, healthcare providers today aren’t beholden to offer competitive pricing because they aren’t subject to typical market forces. Their prices are completely obscured from their buyers. The goal with current mandate proposals and healthcare transparency trends is to remedy this by showing people what the costs of certain procedures deemed “shoppable” are.

But, what does that mean? Simply put, a shoppable service is one that people are able to plan for in advance, compare providers/facilities/locations, and make an informed choice. Oftentimes, these shoppable services can have wide price variations and can generally be viewed more as commodity products, rather than unique services. These shoppable scenarios certainly don’t comprise the majority of healthcare services, but they make up enough to make a big difference in driving down healthcare costs. Did you know that the price of the same MRI of the Head or Neck can vary from $212 to $3,619 in Seattle alone? Or that a regular preventive colonoscopy can range from $969 to $4192 in Philadelphia?

Making prices visible is just the first step

In the midst of this push for shoppable services and healthcare cost transparency (which are great things!), there remains a question in the backs of many people’s minds: Does choosing a lower-cost provider mean you’ll receive lower-quality care? Do the wide price variations I’ve highlighted above actually relate to anything regarding how great the MRI or colonoscopy was? The answer is no.

Education and awareness are critical to any transparency effort’s success so that people understand price variation. It will take a lot of adjustment for individuals to understand what several studies (including from HCCI and in the Annals of Internal Medicine) already show, that healthcare quality is largely unrelated to healthcare price. It’s a whole new world that today’s digital technologies will help with, but creating healthcare consumers doesn’t happen overnight – it will take a concerted effort.

Healthcare will always be personal

While price transparency will do great things for healthcare, we have to remember that all our efforts to promote shopping will fall on individuals with their own circumstances and preferences. Healthcare is very personal. We can’t know what factors play into the final value assessment for every individual. HealthSparq’s cost transparency and guidance solution helps members find pricing for quality in-network providers based on their unique preferences. Members can assess cost with other aspects that factor into their own value judgement—quality scores and recognitions, reviews, affiliations, training, languages, locations and gender, all provided within the HealthSparq One application.

HealthSparq’s mission is to help people make smarter healthcare choices. Helping a member go to a low-cost provider without sacrificing quality means everybody wins.

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