Archive for the ‘Incentives’ Category

Infographic: The Skinny on Workplace Wellness

October 29th, 2013 by Jackie Lyons

By rewarding lifestyle behavior change over program participation, using texting and social networking to promote programs and putting more weight on patient satisfaction as a program success metric, employers are creating a health-oriented work environment.

About 51 percent of U.S. employers offer wellness programs, with larger companies more likely to have more complex programs, according to a new infographic from the RAND Corporation. This infographic also outlines the services included in the wellness programs, disease management services, the incentives that fuel the programs and the types of screenings that take place.

The Skinny on Wellness in the Workplace

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You may also be interested in this related resource: 2012 Healthcare Benchmarks: Health & Wellness Incentives.

Infographic: Dietary Supplements Provide Health Benefits, Lower Healthcare Costs

October 9th, 2013 by Jackie Lyons

Use of specific dietary supplements in targeted populations not only provides health benefits, but also offers significant healthcare cost savings, according to a new economic report from the CRN Foundation.

If targeted populations take supplements at preventative intake levels for coronary heart disease, the savings would be in the range of $2.8 to $26.5 billion dollars, according to a new infographic from the CRN Foundation. This infographic also looks at other dietary supplement regimens in four conditions in targeted populations, along with risk reduction, avoided medical events and expenditures, and net savings.

Dietary Supplements for Smart Prevention

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You may also be interested in this related resource: Health Risk Stratification: Targeted Tools and Methodologies to Prevent Illness and Improve Health.

HINfographic: Secrets from a Medicare Advantage ‘Star Czar’

October 2nd, 2013 by Jackie Lyons

Kaiser Permanente is known as a ‘star czar’ in Medicare Advantage (MA) circles. Ninety percent of Americans in a five-star health plan belong to a Kaiser Permanente plan, according to a new infographic from the Healthcare Intelligence Network.

This infographic goes behind the CMS Star Quality Rating System for MA plans and shares key population health management strategies behind Kaiser Permanente’s high-tech, high touch five-star success.

Secrets from a Medicare Advantage 'Star Czar'

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Information presented in this infographic was excerpted from: Formula for CMS Five-Star Quality Population Health Management. If you would like to learn more about star quality improvement strategies, this resource includes even more information, including an in-depth case study in Kaiser Permanente’s total panel ownership approach, advice from L.E.K. Consulting on stratifying and prioritizing strategies to improve quality ratings, tactics to engage providers and members in improvement efforts, and insight into CMS’s future direction for this quality improvement effort.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Pioneer ACO to Specialists: If the Care Coordination Role Fits, Wear It

September 24th, 2013 by Patricia Donovan

Monarch HealthCare took top honors in quality performance in year one of the CMS Pioneer ACO program.


As far as Medicare beneficiaries are concerned, it’s time for healthcare to acknowledge specialists as principal caregivers of the chronically ill, advises Monarch HealthCare, a top-performing CMS Pioneer ACO.

Monarch came to this realization in year one of participation in CMS’s Pioneer ACO program, when it discovered that 70 to 80 percent of office visits by its 14,000 accountable care organization (ACO) patients were to specialists.

“We have to start treating [specialists] like a primary care provider (PCP), especially for those patients that are chronically ill, where it is actually appropriate that a cardiologist is the primary care giver for a patient with CHF and coronary artery disease (CAD),” said Colin LeClair, Monarch HealthCare’s executive director of ACO.

Engaging and incentivizing specialists in its ACO are two key facets of Monarch’s year three performance strategy, noted LeClair during a recent webinar on Medicare Pioneer ACO Year One: Lessons from a Top-Performer. Going forward, Monarch plans to tap patient data from specialist encounters to enhance its care management and quality improvement efforts.

Despite its regret at not engaging specialists earlier, Monarch’s Pioneer ACO has plenty to be pleased about at the outset of year two, in which the number of ACO-attributed patients has swelled to 22,000 patients.

In terms of quality performance, Monarch, the largest IPA in Orange County, Calif., was year one’s top scorer in several patient-centered metrics in the Pioneer ACO program, and the second highest performer in the area of medical cost reduction — a result largely driven by reductions in hospital and skilled nursing facility (SNF) utilization and unit costs, noted LeClair.

Monarch is one of 32 originally selected CMS Pioneer ACOs. Today, 23 remain in the program.

During the 45-minute program, LeClair outlined Monarch’s six-step ACO implementation strategy, a patient-centered approach built around risk stratification, ACO team-building, and care management. Trial and error during the first year yielded some interesting findings, such as the optimal time to engage a patient, he said.

Among the four success drivers LeClair shared was a coterie of Web-based population health management tools Monarch developed for its ACO team, he said, that are supported with Web and face-to-face training.

One such tool is the annual senior health risk assessment (ASHA) reviewed by the patient and doctor during the Medicare Annual Wellness Visit. The free annual well visit provides an opportunity to identify key risk factors, perform screenings and reconcile medications.

Unfortunately, the new CMS benefit is largely unfamiliar to patients, LeClair added.

Another year one lesson learned was the value of the office staff in ACO rollout. As Monarch tweaks its ACO architecture, it is considering incentivizing the office staff as well. “Too often, incentives are focused on the physicians, and the office staff actually drives most of the work to support the ACO population,” said LeClair.

In closing, LeClair said Monarch remains committed to the ACO model, and as it looks ahead to year three, it hopes to identify mini-networks of physicians, explore episodic or bundled payments, and partner with hospitals, SNFs and ancillary vendors to reduce avoidable utilization.

Click here to listen to an interview with Colin LeClair.

HINfographic: Medicare Pioneer ACO Year One, Lessons from a Top Performer

September 5th, 2013 by Jackie Lyons

Pioneer ACOs have earned over $76 million in bonus payments by providing coordinated, quality care, according to the Centers for Medicare and Medicaid Services (CMS).

The keys to success in year one of the Medicare Pioneer ACO for Monarch HealthCare, as shown in this HINfographic, were engaging vulnerable patients in the ACO and developing a strategy to align non-contracted physicians. Monarch HealthCare was the third most successful pioneer ACO in terms of cost savings and the second most successful in beating the trend.

This HINfographic also identifies the greatest ACO implementation challenges, metrics to evaluate the ACO, members of the care team, time needed to implement an ACO, and much more.


Medicare Pioneer ACO

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Information presented in this infographic was excerpted from: 2012 Healthcare Benchmarks: Accountable Care Organizations. If you would like to learn more about the first year of a , this resource documents the numerous ways in which accountable care is transforming healthcare delivery, population health management, reimbursement for care and, most importantly to this year’s survey respondents, the patient experience.

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9 Questions to Evaluate Your Culture of Health

May 9th, 2013 by Jessica Fornarotto

Webinar Replay: Health and Wellness Incentives: Positioning for Outcome-Based Rewards

“There’s reasonable research that shows that culture and a strong communications strategy are more powerful than an incentive in creating change. And when the three of them come together, it’s extremely powerful,” explains John Riedel, president of Riedel & Associates Consultants, Inc.

Prior to his presentation during HIN’s webinar, Health and Wellness Incentives: Positioning for Outcome-Based Rewards, Riedel mapped out nine questions organizations should ask themselves when driving toward a culture of health:

  • What’s the organizational support for employees?
  • Does the organizational support manifest a commitment to health?
  • Do you have a mix of programs and resources that serve all employees?
  • Do you have health policies in place in the company so that there’s a tangible communication around the importance of health?
  • Is senior management committed to workforce health?
  • Does the company provide ways of encouraging healthy behaviors, and not just by providing incentives but also in ways that changes can be made that will help you?
  • Does the company care about the well-being of their employees and does that come across?
  • Are you providing your employees different types of incentives? Encourage them to participate in events.
  • Are wellness goals aligned with the business strategy?

If you can answer yes to those questions, then you may not have a big issue with employees and ‘big brother’ syndrome. But no one size fits all.

Success is based on addressing challenges unique to your particular organization. And the beauty of it from my perspective, and I come from a systems thinking perspective, if you can come at these culture issues to a variety of different touch points in the organization, there are many ways you can start in.

One of the first things you want to do is make sure you’re establishing the wellness norms that work and make sure that you eliminate those that don’t. There are many companies who suggest, or indicate, that they are wellness-oriented. But often, there are understated policies that suggest, does my company care about my health? For instance, frontline supervisors who are still being evaluated on getting products out the door may be least interested in allowing their employees to take time off during the day for wellness activities. You have to get the message out to the whole organization.

Risk Assessment, Case Management Help to Improve Dual Eligibles’ Health

April 30th, 2013 by Jessica Fornarotto

“When you look at some of the characteristics of the dual eligibles, in the under 65 population, 66 percent have only a chronic condition and have no functional impairments. But as you move up to the older ages, there’s fewer frailty and a bit more of the chronic conditions,” according to Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. SCAN has a strategic approach to serving the dual eligible market, and Dr. Schwab recently discussed how they get this population to complete health assessments as well as the role of case managers in deciding who needs nursing home services. He also discusses how case managers work with the most extreme health condition cases.

Question: SCAN-risk stratifies individuals to determine those at highest risk, using HRAs, claims data and other assessment tools. How does SCAN encourage or incent completion of HRAs and other assessments in what can sometimes be a transient or hard-to-reach population?

Response: Getting completion of the HRA instrument is a challenge in any population, but more so in a very diverse population like the dually eligible. We initially mail our HRA to all new members. Then we follow up with reminder postcards. If we still don’t receive a response, we have a shortened risk assessment form that we ask them to complete through telephonic interactive voice response (IVR). Even with that, we still probably have a 30 percent failure rate to get the HRA done in a timely fashion.

We try to supplement that with information from our physicians. On the first visit to the physician, we can gather information and ultimately supplement it with our claims data on both the medical side and importantly the pharmacy side. We get a lot of valuable information, which makes up for people who don’t complete the HRA.

There are two groups that usually don’t complete it. The first is the group in long term institutions, like nursing homes. There’s a low response rate there. We also have a lower response rate in populations with mild dementia who are living on their own. But we also have a fairly low response rate from very healthy individuals. It’s important to recognize in the dual population that there are a group of duals that are relatively healthy. The only reason they’re a dual is because of financial conditions qualifying them for that. They could be out and about and just not concerned about completing the HRA.

We do not currently provide incentives for the general population to complete the HRA. We have tried some minor incentives with subsets of the population; for example, years ago with our diabetic population we offered a small gift of a foot care program if they completed a mini risk assessment. But in general, we haven’t found it effective.

Question: What percentage of your dual eligibles require disability support and what particular challenges would a case manager working with this subset of beneficiaries encounter?

Response: For our over 65 dual population, about 40 percent are what we classify as nursing facility level of care, or individuals who live in the community but have deficiencies in usually three or more activities of daily living (ADLs). They are frequently getting services for some of those deficiencies and are at high risk of ending up in a nursing home for long-term care, unless interventions are placed.

Of that 40 percent, probably about half are getting some sort of home-based services that are non-Medicare covered; things like personal care, homemaking, bathing assistance, and transportation assistance. For our case managers to make these assessments, do the in-home visits, and develop a care plan, we focus on hiring social workers, geriatric social workers and geriatric nurse practitioners. We spend a lot of time training them, both in how to identify the needs in the home, and how to identify the needs when talking with the caregiver, who is frequently an important part of this conversation.

We also offer on the job training for working with the rest of the team when they present these cases at our team meetings and the interdisciplinary care team meetings.

Question: How can care managers work with the most extreme cases that have multiple physical health and behavioral health, chronic and acute conditions?

Response: Those are the tough ones to work with. The first step is to find the right care manager for that individual. For example, if the primary issue is behavioral health, choose a care manager that excels in behavioral healthcare. That care manager then works with others to resolve the other issues. These people will require more time. You may also need to engage the help of the personal care workers or those in the home, so that they become both the physician and the care manager’s eyes and ears there. Teach them ways to pick up very subtle changes or differences in that person so that you can quickly provide new interventions if the person starts to show signs of deterioration. It’s a classic example of ‘one size doesn’t fit all;’ if your model says we will contact an individual monthly, some may need weekly and some may need daily contact. You may need to figure out ways to get that contact in an easy, efficient way for that individual.

Advice from 5-Star Medicare Advantage Plans: Engage Low-Performing Providers, Members

April 25th, 2013 by Patricia Donovan

Webinar Replay: Best Practice Approach to Improve CMS Star Quality Ratings

Medicare Advantage health plans in search of higher Star Quality Ratings should follow the lead of five-star MA plans, suggests Joe Johnson, vice president of L.E.K. Consulting.

Five-star best practices for improving all-important clinical performance markers include mailings and telephonic outreach to low-performing member cohorts, notes Johnson, as well as shared savings, profit-sharing goals and even provider report cards. The latter is likely to spur low-performing providers into aligning with health plan quality improvement efforts, which can help to raise ratings.

Provider engagement is critical, since the majority of the Star Quality Ratings’ 37 measures, which span five domains, is influenced by the work done by providers, such as in closing gaps in care and managing chronic conditions, and are weighted most heavily by CMS. For example, the monitoring of care transitions to prevent readmissions is one area where five-star plans shine, he says.

During a recent webinar on A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, Johnson suggested MA plans map out an enterprise-wide Star Quality Ratings strategy to target improvement opportunities and identify the most addressable gaps in the organization — giving priority to those that will give the plan the most ‘bang’ for its buck.

Reimbursement for MA plans is tied in part to awarding of stars for patient care and satisfaction. Factoring in the bonus structure for high-performing plans, L.E.K Consulting estimates that moving from a three-star to four-star rating is roughly worth $50 PMPM — or $6 million in revenue per year for a 10,000-member plan.

Of the five domains in the Star Quality Ratings Program, management of chronic conditions is ripest for MA plan innovation and improvement, Johnson notes. Plans should identify the size and magnitude of conditions presenting in their member populations, and prioritize efforts based on potential for economic impact.

The designated “Star Czars” team (individuals spearheading the quality ratings improvement effort) should be cross-functional and analytical but also speak the requisite clinical language to inform and engage providers, advises Johnson.

Johnson also shared a half-dozen other strategies for Star Quality Ratings improvement from five-star plans, including benchmarking of local competitors, and examined some of the changes CMS is considering for 2014 and 2015 Star Quality Ratings.

Listen to an in-depth interview with Joe Johnson here.

Power of Extrinsic Incentives Sometimes Elusive

April 23rd, 2013 by Jessica Fornarotto

Webinar Replay: Health and Wellness Incentives: Positioning for Outcome-Based Rewards

“It’s important for companies to keep their options open when offering incentives, especially since the impact incentives can have on people could be a mystery,” explains John Riedel, president of Riedel & Associates Consultants, Inc. “Sometimes it’s the value of the incentive that can affect an individual’s engagement in a health and wellness program.”

HIN spoke with Riedel prior to his presentation during the webinar, Health and Wellness Incentives: Positioning for Outcome-Based Rewards. Riedel discussed how the rise in the cap on how much employees can receive in 2014 will impact program participation, how to address those older employees who could have difficulty with outcome-based incentives, and if companies should move toward programs with only outcomes-based rewards.

HIN: The cap on how much employees can either receive as a reward or be penalized is set at 20 percent of the total healthcare premium, or about $1,120 for the average employee. When this limit is raised to 30 percent in 2014, how might this affect participation and adherence, and on the structure of incentive plans overall?

(John Riedel): It’s 20 percent now, going to 30 percent. And for smoking cessation programs it’s going to be at 50 percent. An increase from 20 to 30 percent is not going to make a big difference. Employers are going to have more leverage with their total dollars that they can offer for either incentives or disincentives on the extrinsic side of incentives and disincentives. Certainly, innovative companies are going to find ways to use the additional dollars in creative and unique ways. On the whole, I don’t think it’s going to make a big difference with participation — getting people into programs and keeping them engaged. But I do think it’s important.

One of the issues that we have to contend with is incentives, and extrinsic incentives are important. Keep in mind though that we don’t know much about the same power that extrinsic incentives provide. We know that incentives can get people engaged in programming. They typically do well when you’re trying to get someone involved in a discrete program, like completing a health risk assessment (HRA). Though, we don’t know if incentives have a strong impact on people who are now engaging in healthy behaviors. It’s a complicated relationship and we have to be somewhat cautious in how we look at that.

Also, be careful when talking about outcome-based extrinsic incentives. There are going to be some employees who are typically older and maybe less educated. There could be employees who are higher risk who may have a harder time getting to those incentives, and perceive the incentives in an unfair way. We want to be careful that we don’t alienate people. The whole point is to motivate people.

The amount of the reward is not always a predictor of healthy change. Kevin G Volpp conducted some research on smoking and found that a $750 incentive doubled the number of people in the incentive group in terms of quitting smoking, and that’s a great outcome. But 36 percent relapsed over the longer term, which is significantly higher than usual relapse rates. That’s something we need to take into account. The interesting thing in that research is that they asked the people who actually quit smoking if they would have quit for less money. Eighty-seven percent of the quitters said they would have.

So yes, I think that raising the limit is helpful. The larger incentives you have, the more creative you can get. But at the same time, we don’t know enough about extrinsic incentives to know how that’s going to play out down the road.

HIN: Should companies be moving toward a program of only outcomes-based rewards?

My notion is that it should be built into an overall incentives offering. I know that there are companies who are moving toward outcomes-based rewards and that makes sense. But again, we still don’t know much about the impact of incentives, especially on the moderate to longer term behavior change component. It’s a complex issue and it’s important for companies to keep their options open.

With outcome-only rewards, you may have more of an issue regarding those people who have a harder time getting that outcome. You don’t want to create a non-compliance issue on the part of people who feel that they can’t get where they need to be. Find a way to make the incentive program fair to all. Be creative with using incentives for basic participation and for progressed-based incentives as well as outcomes-based. Create a package; each has advantages. We know that small rewards can be very powerful and have an impact on individuals. So it’s important to keep options open. A good approach when talking about outcome incentives, is to say, “If you do this,” and we lay out the criteria, “this is what you’re going to get in return,” and that makes sense. People want to know what it means for them and what they can do in order to get a certain incentive.

At the same time, in the field of behavioral economics, it’s very interesting. They suggest that sometimes, now that you’ve done this, here’s a reward for you, without letting people know in advance what you’re going to get. There’s a power in that approach as well. In other words, make sure that you provide rewards that employees understand. They know they’re going to get something, but at the same time, try some unique and creative approaches as well.

Progressed-based is important. We’re trying to change people’s behaviors. If we focus only on outcomes incentives, our concern is that when you provide extrinsic incentives — money — people often make a change, but they are often making it for the dollar and not for their health.

Make sure that you create an incentive program that includes simple items — gift cards and t-shirts work in some cases — to help people move along. And then offer outcomes-based incentives for people who are taking their health seriously. Make sure that everyone can get something and make it more challenging as you go down the road.

Infographic: Employers Commit to Wellness Despite Economic Hard Times

March 27th, 2013 by Patricia Donovan

87 percent of global employers believe it’s their role to manage worker health, according to the latest report from Buck Consultants. Employers cite their commitment to promoting health and wellness as a business strategy and show continued desire to expand health promotion initiatives.

The report, “Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies” found that employers, regardless of location, identified improving worker productivity and reducing presenteeism as one of their top wellness program objectives. As health promotion takes its place as a top consideration among drivers of profitability and performance, an increasing number of organizations recognize their role in managing employee health — 87 percent in 2012 vs. 75 percent in 2010.

Employers and wellness

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You may also be interested in this related resource: Health and Wellness Incentives: Positioning for Outcome-Based Rewards.