Planning for Q4 in a Year Like No Other

There’s no telling how the year 2020 will size up as a benchmark for future years of healthcare. Indeed, trying to use previous years as comparisons will be tricky enough given how incomparable this year has turned out to be (unless your EHRs from the 1918 flu epidemic happen to be handy). A few things you can count on, though:

• The volume of care gaps among your population has been growing significantly during the pandemic. 
• In the absence of most well visits, assessing the health risks of your population is now a critical component of your healthcare operations.
• A whole new chapter of patient experience with their providers has been written – including the emergence of telehealth.
• Your plan’s service to your employer clients will most certainly be under the magnifying glass as employers look to save costs and receive value for money in the current economic climate.

Care Gaps

In the midst of the current pandemic, about half of all patients have stated they will be avoiding regularly scheduled physician visits for the foreseeable future. Delaying care, unfortunately, will ensure that the number of open care gaps will only grow, thus negatively affecting the health of tens of millions.

Changing this trajectory has to be foremost on the minds of literally every healthcare organization. By reaching out to those patients who can benefit the most by closing gaps in their care, both health plans and providers can send targeted messages to reactivate care schedules and physician visits.

An engagement program remains the best way to close care gaps among your members. And four steps will get you there:

• Identify and target those members who are not meeting the standards for treatment of their chronic conditions or not receiving preventive screenings
• Focus on measures affecting a larger number of patients/members and high-volume provider groups
• A multi-modal outreach to activate and motivate members to make and keep appointments
• Closing the loop with scheduled and confirmed appointments

Health Risk Assessments

The term “health risk assessment” carries an awful lot more weight now than at any time in recent memory.

As the health risks of the population continue to climb during this age of COVID with missed doctor visits, delayed care, disrupted member routines, and absence of familiar resources, health plans must determine and identify the risk status among its population – particularly with newer members – and fast-track the appropriate healthcare management and wellness initiatives.

A Health Risk Assessment (HRA) survey program can 

• Gather key health information from new and current members
• Assess their health risk based on that information, identifying those with higher risk
• Inform the plan on where to best focus its resources and services to its members
• Help meet CMS and state-specific regulatory requirements
• Engage members to better understand their own health and future health risks
• Provide personalized feedback to members including tips and resources
• Help motivate members to act on their own to improve their health

CG CAHPS and Telehealth

Understanding member experience with their providers is important in every year. In 2020, it’s crucial. And there’s no stronger correlation to that member-provider relationship than the key CAHPS ratings questions from which additional insights can be derived as part of a CG CAHPS survey program.

CG CAHPS surveys can help assess members’ experience as a patient of their providers, with results that are directly related to these health plan CAHPS measures:

• Rating of Health Plan
• Rating of Health Care 
• Rating of Personal Doctor
• How Well Doctors Communicate

CG CAHPS insights can then help drive improvements for providers, sites of care, medical groups, and provider networks.

Adding custom questions to the standard CG CAHPS surveys can be used to gauge more specialized services, such as telehealth services that are in wider use than ever before. From the first quarter of 2020 to the second, the number of telehealth visits with providers tripled. One estimate has telehealth visits approaching 1 billion before the end of 2020. 

Though interest has slowed somewhat since Q2, telehealth is now a permanent fixture in 76% of hospitals, and in some form with 66% of all providers. Assessing patient/member experience with this system of care will now become a vital driver in your 2021 path of demonstrable improvement, which a customized CG CAHPS survey with telehealth insights will provide.

Performance Guarantee Surveys

Performance Guarantees (PGs) are a contractual agreement enacted between a health plan and its employer client companies that documents the clients’ employees’ satisfaction level with the plan. Some organizations prefer to call them “service level agreements.” Regardless of the name, a strong score can ensure full payment to the plan from the client. A lower score might incur a penalty to the plan. Either way, PG surveys provide a unique and accurate yardstick of the plan’s performance in the health of its clients’ many employees.

PG surveys can play a big part in a health plan’s (or PBM’s) revenue and client retention plan by:

• Driving your continuous improvement trajectory upward
• Satisfying PG contractual requirements
• Providing an overarching view of the member experience, identifying pain points and clearing a path to resolve them
• Retaining existing employer clients and increasing their loyalty to you
• Attracting new client companies
• Giving you some powerful information to use in upcoming sales, marketing, and promotional communications

Although 2020 will forever be the “year like no other,” preparing now in its final quarter will be a major influence on how your 2021 shapes up. 

Want to learn more about any of these Q4 initiatives? Watch and listen to our free webinar “Hindsight is 2020 – 4 Focus Items for Q4.” Click here to see it today.