The RISE of Population Health

By Anne Davis
Mar. 28, 2019

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Earlier this month, HMS joined over 1,200 participants at the 13th Annual RISE Conference in Nashville to discuss Supporting Risk Adjustment through a Coordinated Member Engagement Strategy. The conference focus of “Risk Adjustment” often centers around provider strategy, coding opportunities, and payment arrangements. Understanding and addressing the risks of your membership, however, fall squarely in the camp of Population Health. If you want to improve the triple aim, you must motivate individuals to take charge of their health and wellbeing.

How can we inspire people to make positive changes? It’s all about relationships.

At HMS, we support our clients’ relationship strategy, no matter where they are in their engagement journey.  Need support with identification of the right members? We’ve got you covered. HMS Elli, our risk analytics solution can lead or supplement existing processes in order to target the right members early in the year. Support in engaging members at scale? Yes, HMS Eliza, our member engagement solution will help relieve your resources to work on the most vulnerable.

Ideally, building relationships with your members begins with a welcome to the plan. This early welcome promotes brand loyalty and benefit awareness as well as giving you early indicators of pre-planned surgeries and prescription medications. Information gleaned from this preliminary outreach provides much more than “nice-to-have” data; the targeted messaging in HMS’ Welcome and Onboarding program ensures prompt PCP appointment scheduling and initial capture of chronic conditions, which will align your risk adjustment with the health of your population.

Many clients choose to enlist the support of HMS’ Health Risk Assessment (HRA); both the HRA and Welcome programs funnel members into year-round chronic condition management efforts. These targeted programs can have an incredible impact on clients’ Risk Adjustment strategy. In 2017, one HMS client saw an ROI of 27:1 through an HMS Diabetes gap closure program.

In Q4 2017, a national health plan with a large Dual SNP population targeted 3750 D-SNP members with a diagnosis of Diabetes and open gaps in care. HMS was engaged with a goal of scheduling provider appointments, closing gaps in care, and ensuring RAF scores appropriately reflected the disease burden of the population.

HMS’s proprietary propensity modeling, segmented messaging, and member outreach strategies combined for an impressive result. After five months of claims run out, this plan saw $2,175,000 in additional revenue improvement. 956 members who completed an appointment had a Risk Adjustment Factor (RAF) score increase from 1.382 in 2017 to 1.595 in 2018.

In addition to seeing improved and accurate payment, the plan had an incredible grasp of the needs of the D-SNP population, incorporating this information into member engagement strategies moving forward. Understanding the full picture of your plan’s membership early allows for the provision of micro-targeted messaging and met needs. Let HMS help you build and sustain strong relationships with your members and experience significant results.


To learn more about the measurable results your health plan can expect when working with HMS, schedule a conversation with one of our health engagement management experts.

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