When members are engaged in proactive care, it can improve clinical outcomes and reduce costs. Still, despite health plans’ many efforts to modernize and improve the member experience, motivating members to be active participants in their healthcare remains a challenge.
Much of this challenge stems from a lack of clarity and transparency (what will something cost, which doctors or specialists are in the network, how to find and access care, etc.). Health plans have increased their focus on member activation, employing different strategies to empower and motivate members to make the most of their healthcare benefits. Incentive programs, or those that leverage behavioral economics to incentivize health and well-being among member populations, are gaining in popularity as an effective strategy to drive this change. Financial incentives specifically are increasingly seen as an important vehicle to bring about changes in behavior that lead to healthier lifestyles.
Why do incentives resonate with members?
Health plans can offer a rich benefit design with a low deductible, which attracts and retains members while providing them access to necessary services. But something additional is needed to promote or drive certain behaviors, like shopping for a care location that is high quality, but lower cost.
While some individuals are motivated to do things because of their goals and intentions (a certain action results in a certain feeling), others’ actions are driven by external rewards (performing an action to receive a prize).
Unlike traditional benefit strategies, incentive programs in healthcare leverage the principles of behavioral economics to encourage specific behaviors, and simultaneously push away from behaviors and actions that lead to negative consequences. Incentives like a gift card for attending an annual wellness visit or a prepaid card for receiving the flu shot can prompt a member to act, take charge of their care and lead to improved outcomes.
What makes a member activation program effective?
Several factors, like program design, incentive strategy, and personalization, can make or break a health plan’s member activation program. A few things are necessary to maximize member impact:
- Program Design. Health plans must be strategic about program design and identify detailed objectives and specific performance goals. Ensuring aspects of the programs like rewards appeal to members and align with overall health plan performance goals, whether that be wellness behaviors, containing rising costs of members with chronic conditions, or influencing HEDIS or Star Ratings, are important for success. With a specific performance goal, plans can more accurately target the right member population, like generally non-compliant members, for activation “nudges” and implement aspects such as incentive programs to help encourage action by the member. Plans can also ensure incentives are compliant, particularly for programs like Medicare Advantage.
- Incentive Strategy. There must be a meaningful incentive tied to the desired action. For example, cash incentives can drive more immediate action for larger, more invasive procedures, like a colonoscopy. It is important that health plans also consider how members want to receive their rewards. As we live in an increasingly digital world, physical gift cards as rewards might not cut it. Digital rewards, like virtual gift cards, are more flexible and enable health plans to better manage how members use their rewards, such as healthy foods at a grocery store.
- Personalization. Personalized – and targeted – communications are necessary for members to understand their specific goals and what needs to be done to achieve them. Health plans should consider how tailored messaging across several means of communication can boost participation in programs, especially among their target audience. Taking advantage of all channels (phone, email, text, etc.), and letting members choose how to interact based on their personal preferences, is key to building trust and encourages better engagement. It is equally important to leverage data to promote activities relevant to the member (i.e., recommending a colonoscopy based on age range and historical claims). Additionally, members should be able to monitor the status of their rewards or improved outcomes.
- Delivery and Support. The level of personalization is best provided through a consumer-friendly digital platform, specifically one that can facilitate interactions between members and plans at every major touchpoint of the healthcare journey. Members should be able to use technology—such as a mobile application—to engage in payer programs, understand their benefits, search for high-quality, low-cost care, and access support for a more holistic approach to care. Members should be able to access technology to engage in their program, but also have the option to interaction with a concierge team, for example, for a more personal touch.
The strategic use of incentives to bolster member activation is far from a mere trend—it is an evolved tactic that meets a critical need within the healthcare engagement landscape. By meticulously implementing and weaving such strategies into their business models, healthcare leaders can significantly enhance member interaction, care outcomes, and lower costs for everyone, ensuring a healthier future for all.
About Heather Cox
Heather Cox is an executive with more than 20 years of experience at the forefront of building and leading disruptive fintech, healthtech, data and digital businesses. She is the President of Insights & Empowerment, a division of Zelis that’s driving innovation and transparency for healthcare consumer solutions and shaping client and digital experiences.
