Hudson Health Plan, a nonprofit Medicaid plan owned by MVP Health Care, is taking steps to ensure its members get important preventive health screenings like mammograms.
Since 2012, the Hudson Valley-based insurer's customer service representatives have been calling members to encourage them to get their mammograms. And to incentivize their members, Hudson Health gives them a $25 gift card when they undergo a mammogram.
To learn more about Hudson Health's outreach program, FierceHealthPayer spoke with Margaret (Peggy) Leonard, senior vice president of clinical services.
FierceHealthPayer: How did you come up with the idea to have Hudson Health's customer service reps reach out to your members?
Peggy Leonard: We tried a number of things over the years to encourage our members to get mammography screenings, including offering a manicure/pedicure incentive, and we struggled with getting people aware of how important this screening is. We also sent out letters and used clinical staff to make follow-up calls, but they didn't have enough time in their days. We tried having our nurses call members, and we realized we weren't able to reach that many people.
As we started to find out why people aren't going, we realized that they have to understand what it is they need to do, and then they need to be motivated to do it. And sometimes people just aren't ready to do what's best for them for a number of reasons.
So we spoke internally about how we could reach more people while being mindful of resources. We realized that our customer care folks, if they were trained by some of our clinical folks about the different aspects of the healthcare screening that was needed, could reach a heck of a lot more people.
So we worked with our customer care folks who are used to giving quality service. We have been number one in customer satisfaction for 11 years in our area (according to the local department of health).
FHP: Can you quantify how well this program has been working?
Leonard: We've seen an increase in the number of women who have actually gone to get mammograms. Our numbers have improved and we think that about 10 percent of the last 2,000 women that we called actually had the mammography. So they didn't just make the appointment, but they actually had a claim in the system that said they had the service.
A lot of people still say they're going to go and we try to help them actually make appointments while they're on the call. That works because they have the best of intentions when they talk with their doctor and then they leave the office and life kicks in and they don't call and make that appointment.
FHP: What is the incentive for members to actually go and get the mammogram?
Leonard: One is that we hope they're having a meaningful conversation where we re-educate them and it's purposeful. And then there's a $25 gift card incentive. We think we've hit the right number--it sounds significant enough that you can do something with that amount of money. Everyone who has received an outreach call and actually went and got the mammogram receives the gift card.
FHP: What kind of training do the customer service reps receive before they make the outreach calls?
Leonard: We have a call center that is second to none. They are excellent and they have different training they have to go through in order to be a customer care person. They receive a lot of training on the customer care side. For this project, I believe 4 people were selected from customer care to make the calls. Our senior director of case management and one of our nurses trained and offered classes for these reps. They are trained in motivational interviewing so they can tell whether the patients are ready to listen. You can't expect someone to be worried about getting a screening if other things are on their mind.
FHP: How have your members been responding to the outreach calls?
Leonard: We haven't done a formal survey, but we check in with the reps all the time. Their first response is usually "I can't believe my insurance company is calling me to ask these things." They're opening up and not annoyed and not hanging up on the reps. We haven't had any kind of real negative response to this, which is encouraging. And the care folks really feel like they're making a difference, so they love that feeling.
FHP: What lessons have you learned from implementing this outreach program?
Leonard: The days of having full-blown research studies about what actually works and doesn't work are a luxury we can't afford in the new Affordable Care Act world. We try something, see if it works, and if it does, we put more resources into it. And I think that's the biggest lesson learned. We're not relying just on data or we will never make changes because we can't wait for a two- or three-year formal study to tell us what could work. And this process allows us a shorter check in.
You can't change the world, but we're doing everything we can to change as many lives in a positive direction as possible.
Editor's note: This interview has been edited for clarity.