2015 Member Incentive. Program Evaluation. Our mission is to improve the health and quality of life of our members

Transcription

1 25 Member Incentive Program Evaluation Our mission is to improve the health and quality of life of our members

2 25 Member Incentive Program Evaluation Annual Participation Rate Program Title: Member Incentive Program Evaluation Period: January, 25 December 3, 25 Introduction: Passport Health Plan s (Passport) Member Incentive Program encourages members to make and keep their screening appointments with their clinicians. The rewards-eligible screenings for all Medicaid categories of aid in 25 include: Dental $2 Cervical Cancer $2 Breast Cancer $2 Adolescent Well-Child Exams $ Spirometry $2 Mommy Steps up to $ Diabetes up to $5 Blood Pressure $2 25 Program Goals: Increase percentage of members receiving screenings: o Dental o Cervical Cancer o Breast Cancer o Adolescent Well-Child Exams o Spirometry testing o Prenatal and postpartum visits o Diabetic recommending screenings o Blood pressure reading 25 Program Objectives: To increase member adherence with recommended preventive health screenings and immunizations in accordance with preventive health guidelines. To ensure completeness of all age appropriate screening and tests. The Member Incentive Program is available to all members who qualify for each incentive. Members may opt-out of the Program and elect not to receive services by notifying the Rapid Response Member Incentive Team or the Care Connector Program, either telephonically or in writing. //26 Page of 8

3 25 All Member Rewards Percentage by Incentive (Traditional and Expansion Membership) 25 All Member Rewards Cost by Incentive (Traditional and Expansion Membership) 3/9/26 Page 2 of 8

4 25 Male vs. Female 25 Total Incentives by Age Group 3/9/26 Page 3 of 8

5 25 All Member Rewards Percentage by Region (Traditional and Expansion Membership) Region 3 72% Region 4 6% Region 5 8% Region 2 3% Region 2% Region 8 4% Region 7 2% Region 6 3% 25 All Member Rewards Cost by Region (Traditional and Expansion Membership) Region 3 $336, Region 4 $25,945 Region 5 $38,8 Region 2 $3,65 Region $9,385 Region 8 $2,33 Region 7 $7,48 Region 6 $2,87 3/9/26 Page 4 of 8

6 ,657 2,742 7, All Member Rewards by Incentive (Traditional and Expansion Membership), 9,5 9, 8,5 8, 7,5 7, 6,5 6, 5,5 5, 4,5 4, 3,5 3, 2,5 2,,5, 5 2,995 2, ,55 3, ,568 2,28,768 4,248 2,86 3,28 2,3, Traditional Medicaid Expansion Medicaid 25 All Member Rewards by Incentive (Traditional and Expansion Membership) 7,8 7,5 7,2 6,9 6,6 6,3 6, 5,7 5,4 5, 4,8 4,5 4,2 3,9 3,6 3,3 3, 2,7 2,4 2,,8,5, Dual Eligible Foster Care Medicaid Expansion Adult SSI - Adult SSI - Child TANF - Adult TANF - Child Access to Care Blood Pressure Community Engagement Dental Diabetes HRA Completion Mammogram (Breast Cancer) Mommy Steps (Pregnancy) Pap Smear (Cervical Cancer) Spirometry Teen (Adolescent Well Care/Immunizations) 3/9/26 Page 5 of 8

7 Member Complaints: During 25, there were no complaints received regarding the Member Incentive Program. Turnaround Time: Turnaround time is based on influx of rewards forms received and inventory of cards. Limited storage space and limited monthly budget allowance available for purchasing gift cards creates a backlog. Previous years incentive requests are accepted through the end of first quarter. In addition to the space and budget barrier, demand was more than what could be supplied causing a significant delay in processing the rewards forms. Average st Quarter 25 2 nd Quarter 25 3 rd Quarter 25 4 th Quarter 25 Turnaround 5 days 42 days days 7 days 68 days Returned Mail: During 25, a total of 26,85 gift cards were rewarded to members. Of the 26,85 cards distributed, 388 (5%) were returned due to insufficient/incorrect demographic information. Program Materials Member Incentive Letter Mammogram Rewards Form Dental Rewards Form Pap Test Rewards Form Diabetes Care Rewards Form Prenatal Visit Rewards Form EPSDT Teen Well-Child Rewards Form C-Section Incision Check Spirometry Tests Rewards Form Postpartum Visits Rewards Form Blood Pressure Rewards Form Barriers and Opportunities Barrier: Incorrect or insufficient member demographic information for timely distribution of gift cards. Opportunity: Communicate to member the importance of timely notification of demographic changes to the Department of Community Based Services (DCBS) office to decrease the return mail/reprocessing of gift cards. Barrier: Limited information provided to the member regarding incentive criteria. Opportunity: Create and include a detailed insert in the member newsletter and Passport s website with specific information on eligibility for each incentive. Barrier: Manual review of claims data. 3/9/26 Page 6 of 8

8 Opportunity: Add claims data to the Member Incentive application, based on acceptable procedure/diagnosis codes specific to each incentive, for ease in identifying members eligibility for the reward. Interventions completed in 25: Developed: o Member incentive forms for members to take to their clinician offices for completion and submission to Passport. Maintained additional outreach via the Member Newsletter, including articles on the different member incentives available. Verified claims data on members who had a form submitted for a gift card to be sent out. Collaborated with: o Provider Relations to educate clinicians regarding incentives available for members. o Embedded Case Managers, in the high volume clinician offices, to engage members in face-to-face education regarding incentives that may be available to them. Implemented outbound automated call technology reminders. Paid incentives as follows: Incentive Type # of Eligible Members # of Utilizing Members Success Rate Incentive Payments Dental exam 57,2,598 2% $23,96 Cervical cancer 4,273 5,58 3% $3,6 screening Breast cancer,57 4,48 38% $8,96 screening Well child visit 5,93 9,7* 38% $5,98 Spirometry test % $3,54 Prenatal visit 9,83 7,9 73% $7,9 Postpartum visit 9,83 7,9 73% $7,9 Diabetic,747,395 8% $69,75 screening/test HRA completion 64,52 9, 4% $9, PCP exam 39, % $4,235 Total 227,852 46,29 38% $,5,625 *,598 teen members included in the number of utilizing members 3/9/26 Page 7 of 8

9 Planned Interventions for 26: Develop member incentive forms for members to take to their clinician offices for completion and submission to Passport for 26. Maintain additional outreach via the Member Newsletter, including articles on the different member incentives. Verify claims data on members who had a screening/test completed in 26 for a gift card to be sent out. Collaborate with: o Provider Relations to educate clinicians regarding new incentives available for members. o Embedded Case Managers, in the high volume clinician offices, to engage members in face-to-face education regarding the new member incentives available to them. Educate members regarding the importance of screenings/tests through: o Face-to-face outreach o Telephonic outreach o Member newsletters o Passport s website o Member educational materials Evaluate the Member Incentive Program to establish which rewards are the most productive and re-organize resources, as needed. Develop article on all member incentives available to members for st Edition Member Newsletter. Overall the Member Incentive Program saw improvements by noting an increase in the number of members that received a screening/test. Passport coverage statewide showed that the expansion members who have not had insurance prior, utilized their benefits and took advantage of these special rewards available to them. 3/9/26 Page 8 of 8