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By Matt Loper, CEO, Wellth
The more engaged individuals are in their own health, the more likely they are to adhere to their care plans and avoid hospitalizations. They’re also more likely to rate their health plan favorably — which is a huge determinant of CMS Star ratings and bonus payments.
However, turning the least-adherent, least-engaged consumers into super-engaged health plan members is increasingly difficult — and the stakes couldn’t be higher. Earlier this year, NCQA outlined several changes to the Healthcare Effectiveness Data and Information Set (HEDIS) that will impact payers in 2022, including the phasing in of five HEDIS measures focused on adherence to care protocols.
Driving engagement, therefore, will require a deeper level of empathy, thoughtfulness and follow-up. The good news is that it’s doable.
Understanding Your Patients
Who are the least-adherent patients and why aren’t they more engaged? And what is the secret formula to changing their behavior and motivation to improve their health?
These are the questions health leaders are asking, given the strong link between adherence, costs and outcomes. For example: According to a June 2021 report focused on the national impact of CMS’ Quality Measures, an estimated $27 billion to $46.6 billion in healthcare costs were avoided for Medicare beneficiaries between 2013 and 2018 because of improvements in patient adherence to medications for diabetes, cholesterol and hypertension.
However, emerging research suggests that adherence is also correlated with other factors that are often out of an individual’s control, such as the presence of one or more social determinants of health [SDOH]. A recent study shows that patients with lower incomes and poor adherence to antihypertensive medications suffered from increased mortality and cardiovascular disease risks. A separate report noted that poverty restricts the resources used to avoid risks and adopt healthy behaviors.
Looking deeper, it’s clear that members who are at higher risk for nonadherence are also the individuals who aren’t getting what they need — incentives, tools and resources that speak to their struggles in a way that isn’t condescending or lacking in empathy. In some of the most tone-deaf scenarios, health plans offer rewards like free T-shirts to entice individuals to lose weight or reach some other health goal. This is akin to a physician handing a patient who smokes a pamphlet about the dangers of tobacco use: It doesn’t acknowledge the unique set of circumstances that prevent someone from achieving their goals
There are two problems with this kind of short-sighted approach. First, these incentives don’t address real-life struggles, and second, they typically aren’t paired with a program that regularly encourages and engages individuals, celebrating small victories (following a care plan for one day), as well as larger ones (like abstaining from drugs or alcohol for 30 days).
Without incentives or resources that resonate with the desired cohort, the motivation to improve adherence to care plans is unlikely to change.
Making an Impact
Training individuals to adopt healthy habits can reduce hospitalizations and other claims by an average of 40%. Here are three things to consider when designing interventions that target patients’ real-life needs and ultimately improve adherence.
1. Positive drivers. Before participating in any incentive program, smoking-cessation plan or health challenge, members need to know what’s in it for them. To develop the right programs to improve medication adherence, health plans should understand individual motivation and ask themselves: Why would the least adherent patients change now? What kind of reward would motivate them?
Digital apps and health incentives platforms can help payers harness the power of behavioral economics to incentivize medication adherence with rewards tailored to end users’ real-life needs — such as groceries or gas.
2. Equitable care. Access to care is a key determinant of outcomes, and many of the least-adherent patients don’t see their primary-care physician as often as they should.
With no one holding them accountable, members lose motivation to engage in ongoing positive behaviors. Utilizing meaningful member incentives to encourage patients to engage in actions such as checking their blood pressure and weight on a regular basis can strengthen both these daily behaviors, as well as episodic behaviors like physician visits. Also, leveraging telehealth can equalize care for all individuals, and offer another way for members to connect with their healthcare providers through video or messaging applications.
3. Timing. Successful incentive programs tap into members’ real-time goals, for example, a desire to start a new exercise routine to speed up weight loss. And for many patients, timing is everything.
In the wake of an acute event such as a heart attack or emergency room visit, members are more receptive to help and to changing their choices and behaviors. For example, patients who were enrolled in a care plan adherence program following a 30-day readmission showed a decrease in further readmissions from 19% to 8%—or a 57% drop. Why? These acute events can drive individuals to invest in their ongoing care, considering more health coaching, goals and tools (e.g., mental health consultation, plus working with a dietician and a support group to change diet or adapt to a less-stressful lifestyle).
Transforming the least-adherent individuals into super-engaged healthcare superstars won’t happen overnight. But by working toward leveraging the right solutions at the right time, payers have a fighting chance of improving the long-term health of their members and ensuring that everyone they work with is happier and more satisfied with their care.
Matt Loper, CEO and Co-Founder of Wellth, has worked in the healthcare industry for over 12 years, previously working as an analyst and investor before co-founding Wellth in 2014. He is inspired by the chance to create scalable positive behavior change in patients with chronic conditions and grateful to work with some of the best healthcare providers and insurers in the industry. Matt holds a BS in Biological Engineering from MIT.