Businesses are now focusing on prioritizing employee health and wellness, which reflects in organizational productivity and workplace wellness.

Offering employee benefits and perks has been a corporate tradition for many companies, and employers have gone out of their way to support and safeguard their employee’s interests and needs. However, employee expectations for workplace benefits and services have changed over time.

Of all the different employee benefits and perks, one of the most vital and preferred employee benefits is the – Healthcare and Medical Insurance Plans.

Providing health insurance to the employees is a way of showing that you care for their health and wellness. Many small companies are putting efforts to support some kind of health insurance for their employees, despite not being able to afford it, or not needed to provide coverage under the Affordable Care Act.

However, a recent J.D.Power study revealed that there is lack of communication by the health plans to convey all the needed information to the customers, especially during the COVID-19 pandemic. A 2020 survey analysis studied the member and customer attitude towards their health plans, and they found that –

• Almost 60% of the health plan members were not contacted by their health plan provider with information about COVID-19.
• 48% felt their health plan did not show any concern to their wellbeing during the pandemic.

This research study emphasizes the fact that members expect more information and communication from their health plans. On the other hand, member engagement is the key aspect of the plans.

CMS Guidance To Boost Member Engagement

Since member engagement is elusive for plans, the Centers for Medicare & Medicaid Services (CMS) has issued a new guidance tool for the health plans to engage the Medicare Advantage (MA) members, and provide them the healthcare and related services that they need.

According to the new guidance, CMS allows the health plans to include rewards and incentive (R&I) programs to counter COVID-19. Plans can either include these R&I programs in the bids that have been submitted in the previous year, or can expand their existing program in response to COVID-19. This exemplifies the flexibility and readiness of CMS to provide the plans with tools to effectively engage members and also to encourage them to pursue the health and wellness care that they need require.

Accumulating Delayed Care Increases Member and Health Plans Risks

Studies show that a huge number of Americans are delaying their healthcare plans due to the pandemic, resulting in the alarming growth of the accumulated deferred care. An NPR study revealed that almost half of the Americans who are 70 years of age or older have stalled their medical treatments, including vaccinations, health and cancer screenings, and also emergency care, after the pandemic started. These delayed healthcare services imply that the members are not receiving the needed care, and also build medical loss ratio (MLR) issues for the plans.

Medicare Advantage and Medicaid MCO plans are supposed to be spending almost 85% of their revenue on medical expenses. However, with deferred services, a couple of plans have reported surprisingly high profits. On the other hand, many other plans have waived off their co-pays and are also paying the premium deductions. Nevertheless, these waivers are all dependent on the members getting the care they are looking for.

Strategic and Proactive Member Engagement

The key focus of plans is to engage members and balance the MLR. Offering rewards and incentives have been proven to proactively engage members and also set the MLR. The R&I programs for Medicare Advantage members are included under their clinical spend, and so, the investments on these programs contribute to the MLR.

Furthermore, with the new CMS and NCQA regulations to make telehealth and digital health solutions a more viable option for almost 80 healthcare services, the health plans do not have to worry about the lockdown regulations, and can encourage the members to get the needed care right away, without delays. However, based on the J.D. Power study, health plans have to focus more on the telehealth options, as only 75% of the members are aware of the telehealth preferences, and 54% do not know the benefits covered by their plans.

Wellness360 works with health plans offering dedicated member engagement programs that also promote telehealth services to manage annual wellness visits, health screenings, monitoring many chronic health disorders, and more. Our associated health plans are thoughtful about engaging members, and also ensure that they receive the best quality care they need.