Five Questions to Ask When Evaluating Member Incentives for Your Plan

By HMS
Oct. 4, 2019

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In recent years, consumer-directed healthcare has gained significant traction in the United States. One way that health plans have embraced this trend is by offering incentives to members for healthy behaviors, such as preventive health screenings, medication adherence, chronic disease management and more.

Perhaps your organization wants to implement a new incentive program, or perhaps you want to replace your existing program with something more effective. Regardless of your situation, you should consider the following five factors when evaluating member incentive solutions:

  1. Is the incentive solution integrated into a comprehensive member engagement program? Offering members a gift card in exchange for changing their behaviors is a good first step. However, this alone may not be enough to overcome barriers to action. When the Center for Health Care Strategies surveyed Medicaid beneficiaries, it found that critical perceived barriers to action included issues such as specialist availability, transportation, and anxiety. Incentives tend to work best when they are one strategy in a broader engagement solution. For instance, a health plan may offer members with diabetes a financial incentive for completing important screening tests, as well as assistance from case managers who can help them find doctors and even public transportation resources. This type of integrated strategy is easiest to execute and most effective when the incentive solution is one part of a member engagement platform.
  2. Does the incentive solution have low barriers for participation? As noted above, any barrier—real or perceived—can prevent members from scheduling important health appointments. Many incentive solutions force members to jump through various hoops to get their rewards. First, members must navigate the “doctor silo,” which means finding a physician, scheduling an appointment and then remembering to go to the office on the right day and time. Second, they must deal with the “paperwork silo,” filling out forms for each visit. Finally, members have to go to the “incentive portal silo,” where they log in, attest for each visit and enter the relevant information. When faced with so many steps, many people feel that the cash reward or gift card is hardly worth the effort. The best incentive solutions lower the barriers to participation. Members should only have to commit to a behavior once and then the system should handle the rest—from analyzing claim information to confirm that action has been taken to automatically mailing the gift card to the member.
  3. Has the incentive solution been designed based on principles of behavioral economics? Incentives can take a variety of forms, such as reduced insurance premiums, cash rewards or gift cards. Behavioral economics research has found that people respond more favorably to gift cards or cash rewards. Members also tend to prefer incentive systems that deliver their reward soon after they have completed the desired action. Small, frequent rewards have also been found to motivate behavior more effectively than larger, annual rewards.
  4. Can the incentive solution predict which members are most likely to struggle with behavior change? When the Center for Health Care Strategies analyzed incentives for healthy behavior among Medicaid beneficiaries, it found that many individuals needed extra support to stick with long-term behavior changes. This is a common problem for members of all types of health plans. It’s human nature to resist change. “First-generation” incentive solutions have tackled this challenge by repeatedly offering incentives to all members. These incentives can definitely help move the needle in terms of closing care gaps. However, what if your incentive solution could go one step further and predict which members are most likely to struggle the most with behavior change and then create messaging specific to their health needs? This action could provide people with just the extra nudge they need to take care of their health. When evaluating incentive systems, look for solutions that can analyze member claims data and then identify those who may need additional encouragement.
  5. Is it easy to identify the return on incentive investment? Quantifying the impact of incentives on the cost of care is a top priority for health plans. As a result, it’s essential to find an incentive solution that offers robust reporting on investment levels, member redemption rates and spending across different member segments. This kind of data helps plans modify their incentive strategies over time to generate the highest possible return on incentive investment.

HMS’ Eliza Solution for Incentives leverages member engagement to incentivize healthy behaviors. It enables health plans to supercharge existing engagement programs with incentives and lower the barriers to well-being for members.


To learn more about Eliza for Member Incentives, read our solution overview. 

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