Three Innovative Ways to Close Gaps in Care, Break SDoH Barriers

Icario’s senior vice president of design & product marketing, Louise Briguglio, recently presented at the NCQA Health Innovation Summit on the importance of preventive care and Annual Wellness Visits (AWVs) with a member’s primary care provider. She shared Icario research (see chart below), which has found that members who get an AWV are 40% more likely to complete health actions than those who do not. These activities include diabetes blood tests, cancer screenings, eye tests, and more. 

*Based on Icario data analysis

While in-person provider visits are returning to comparable 2019 levels, all of the institutional and social barriers to care remain. In many cases, these social determinants of health (SDoH) have been exacerbated by the pandemic. This means millions of Medicare and Medicaid members struggle in a variety of ways to achieve everyday health and wellness due to barriers such as transportation, food insecurity, and much more. These challenges make AWVs even more important for member health as well as a plan’s risk assessment. 

In light of these complexities, how do we motivate members to engage in preventive care? 

The Value of Thinking Differently

As we approach this challenge, we have to get back to basics. It sounds obvious, but it’s important to start with the member in mind to develop programs and outreach from a highly personal perspective to find what motivates different individuals. Let’s look at 3 innovative ways to engage members and move them to take positive health action and close gaps in care.  

Three Ways To Close Gaps in Care and Break SDoH Barriers

#1 Know Your Role in the Member’s World

It’s critical to understand the unique relationship you, as a plan, have with your members and how this differs from the role a provider plays in the same person’s care.

Think of it like this: Perhaps you’ve enjoyed a hot towel wrap or scalp massage at a hair salon. These are designed to be relaxing and enhance the overall experience. But what if your auto mechanic offered the same service? It would be off-putting to say the least, right?

The point is service providers have particular roles and have to respect boundaries. Providers and plans need to engage members differently because people have and want different relationships with each of them. What they want to hear from you, their plan, is about all the resources and benefits they’re eligible for and ways to make it easier and more convenient to obtain them at the least cost.  

They look to their provider for a personal relationship and a discussion of their specific health concerns and goals, including highly personal and potentially embarrassing medical details. For example, when a member named Bernadette was asked whether she would share health information with her plan, she said, “No, I’d be worried they would change my coverage.”  

It’s important to respect these limits and craft member outreach in a way that aligns with these expectations. Take the examples below. A simple copy change can be the difference between gaining or losing your members’ participation. Which of these prompts convinced more members to complete a health risk assessment (HRA)? 

• Option A: We’re always working to serve you better. You can help us by completing a brief survey about your health care experience, so we can better meet your needs and improve your access to no-cost and low-cost services.
• Option B: As a valued member, please complete a brief survey about the quality of care you’ve received. We’ll use this information to evaluate your physicians and care staff, and work to provide you with the best care possible.

If you picked Option B, you’re right! Option B resulted in 11% more people completing their HRA than Option A. This is why Icario employs qualitative and quantitative research methods to ensure that we get our content right. 

#2 Develop Capabilities That Not Only Predict Needs But Also Discover and Respond to Them 

There are many barriers health plans must overcome with their members, including fear of the health care system overall, varying levels of understanding about the value of visits and screenings, and a plethora of SDoH challenges.  

For 2023, HEDIS has added 5 new measures, including one that addresses social needs screening and interventions (SNS-E). SNS-E encourages plans to focus on members’ food, housing, and transportation needs and follow up with a corresponding intervention within 1 month of identification.  

Given the critical nature of supporting social needs, it’s important to broaden your focus beyond screenings to consider the types of assistance and resources that will truly improve member quality of life. We can start by using the power of data and demographics to predict some of the barriers members may be experiencing.  

Artificial intelligence and machine learning can be useful for analyzing and interpreting member data to inform engagement opportunities and preferences for how and when messages are received.  

We can also listen to member concerns using HRAs, pre-CAHPS surveys, and other interactive vehicles. These forms of engagement are important for impacting member health, but in-person visits are key. 

#3 Know When to Use Incentives 

Everyone likes rewards and incentives. But what you, as a health care leader, are interested in is likely very different from what members facing SDoH would find valuable. Once again, we have to remember that our experience as plan administrators isn’t always useful when developing meaningful incentives that will move members to take health action.  

Think of it like this: During her talk about the success of the Diaper Connections Program, executive officer of population health for UnitedHealthcare Community Plan of Tennessee Lauren Barca shared a story about a female college student receiving Medicaid coverage. The student heard about the plan’s involvement in the Diaper Connections program through a local community center while pregnant and began receiving diapers for her twins every time she came in for weight checks. The mom continued with these routine care visits for both infants well past their first birthdays. With the help of the free diapers, she freed up other funds, graduated from college, and secured a job at Comcast.  

People will take action if the activation energy needed to complete the activity is greater than the barriers involved. Use data to understand the member experience and tailor rewards accordingly. Perhaps you’re targeting moms-to-be or a member improving their diet and exercise to get their diabetes or high blood pressure under control.  

Additionally, offering choices goes a long way toward making members feel valued and in charge of their decisions. The Icario Benefits Care Card highlights the importance of meeting Medicare Advantage members where they are through flexible funds that can be used for groceries, transportation, and more at the member’s discretion.  

It’s also important to right-size the dollar amount of any incentive by aligning it with what you’re asking the member to do. So, the reward for an AWV should be higher than the reward for a flu shot, for example, but less than the reward for a colorectal screening.  

Motivating Members and Closing Gaps in Care 

Breaking SDoH barriers requires innovative thinking. The 3 insights in this commentary—considering your role in your members’ health, predicting and responding to SDoH challenges, and using incentives—can help you improve the member experience and help people live longer, healthier lives.