For the past two years, there has been a steep increase in ACA marketplace enrollments, hitting a record high of over 14 million at the start of 2022 and will reach even higher numbers for 2023. People across the country continue to feel the effects of the global health crisis through job insecurity, inflation, and global conflicts creating a greater need for government-sponsored health coverage. Health plans are having to accommodate a growing member base while trying to keep costs down, yet ensuring the best level of care is provided for their members.
Managing a growing and complex member base requires a personalized experience paired with motivation and engagement to yield positive long-term outcomes. Wellth partners with health plans and providers across the board to do just that – helping ACA, Medicaid, Medicare Advantage Plans, Special Needs Plans (SNP) and other lines of business to improve quality metrics, lower costs, and better member outcomes for their hardest-to-reach populations.
Every one of the over 14 million ACA enrollees is an individual. The member experience that works for a 45-year-old small business owner won’t work for a 60-year-old with a disability, or a single mother and her newborn baby. One of the key components of the Wellth program is creating a member-centric experience. From outreach to daily check-ins, member support, and rewards, Wellth uses a combination of behavioral science and live support to cater to the needs of each of our members.
Personalization has intrinsic benefits such as building trust and motivation, and encouraging daily engagement. Creating a personalized experience goes beyond making sure you have someone’s name right. It can be using their preferred pronouns, language options, inclusive messaging, gamification, and behavior-based journey mapping.
By partnering with Wellth, health plans can better address their members’ individual needs by acting as a daily touch point and keeping a pulse on their day-to-day health needs and habits. The Wellth program is able to:
Each of these daily touch points provides an opportunity to remind, educate, and nudge members into closing key care gaps and improving their quality of care. These capabilities directly uplift a health plan's Quality Rating System Measures.
About 90% of Wellth members check in every single day, providing data on how members are doing with their care plan and if there is additional support needed in close to real-time. These variety of touch points are beneficial for growing ACA plans to keep a pulse on how members are doing and when they may need to intervene.
For many members, actively engaging in healthy habits may require a little extra motivation. In behavioral economics terms, health plans can benefit by bridging the intent-to-behavior gap, so that members keep up with their care regimens. Wellth uses financial incentives to help members overcome this intent-to-behavior gap and stay on track by forming sustainable, long-term healthy habits. These incentives are ultimately member investments.
Both federal and state-based marketplaces allow the use of incentives under certain guidelines. However, state-based exchanges allow greater flexibility in plan management and create the opportunity for utilizing new ideas in health innovation, including the use of incentives. This past year, Covered California, California’s health insurance marketplace, released a statement applauding the use of incentives geared toward closing care gaps and promoting health equity. Wellth’s model is effective in forming long-lasting healthy habits, while actively solving for social determinants of health by incentivizing the desired healthy behavior.
The first role the incentive plays is to kick-start a behavior. Wellth will reward members for checking in with their medication, glucometer reading or other care plan task. This helps eliminate present bias or the idea that we are more likely to do what feels good to us right now rather than what is best in the long run. By reframing the decision, and incentivizing the desired behavior, the Wellth program makes the right choice, the easy choice.
The secondary role comes in when it's time to spend the reward. Each Wellth program has consistently shown that members are spending their incentives in ways that actively benefit social needs. Many members spend their rewards on groceries, gas, extra care needs, household necessities, and personal care. Healthy foods can cost nearly twice as much per serving compared to unhealthy foods, so that extra financial boost helps close equity gaps driven by financial inequality.
A result of members spending their rewards for their everyday needs is that the extra money introduced will help boost their local economies. Studies show that over 90% of everyday purchases are made within 20 minutes from home, directly benefiting local communities.
By incorporating incentives, Wellth members not only become engaged and stay engaged, they feel supported by their health plan. Over time, prolonged engagement creates improved health outcomes, therefore creating an internal motivation to continue their habits beyond the incentives.
As ACA marketplace populations grow, it is critical to stay on top of quality measures and outcomes, ultimately keeping care costs low. Wellth has been able to reduce per member per month (PMPM) costs for partners by improving outcomes in PDC and closing care gaps.
For example, Wellth partnered with a large government-sponsored plan in Arizona to support their members with a range of chronic conditions such as diabetes, heart failure, COPD/ asthma, severe mental illness (SMI), HIV, and opioid use disorder. Results showed:
Through supporting member engagement and ultimately lowering utilization, Wellth helped this health plan save $125 per member per month in utilization costs.
Daily engagement decreases the likelihood of costly treatment in the future and improves the day-to-day lives of members. When they feel like their health plan is genuinely invested in their health and wellbeing, they are more likely to engage in member experience and SDOH surveys as well as care gap closures. Another Wellth partner achieved an 86% response rate with in-app surveys, providing valuable insights into what their members need most and how they are doing in relation to their QRS measures.
With the growing ACA marketplace population, member-centered programs that provide personalized and effective outreach, engagement, and care will be beneficial in improving the health of members while meeting the goals of health plans. Wellth is proven to help our partners support the hardest-to-reach members with their medication adherence, closing care gaps, and giving them the tools to invest in themselves and their health. As a result, health plans improve quality measures, reduce unnecessary costs and increase member satisfaction.
Wellth is expanding and helping ACA health plans meet their quality and care goals. How can we help you meet your 2023 goals?
