Novu Health Engagement Blog

2 key insights: how rewards and engagement programs influence HEDIS quality measures and CAHPS ratings

Jordan Mauer

With the recent (and ongoing) shift toward a value-based care model, quality scores like HEDIS and CAHPS are more important than ever. Through such quality scores, Medicaid health plans must prove that members get the best care—resulting in the best outcomes—at the lowest costs. This, in turn, allows plans to gain and retain sway in the marketplace, as well-informed members and purchasers turn to quality rankings, such as the recently released 2016-2017 NCQA report (partially based on HEDIS and CAHPS scores), to determine value and cost-effectiveness of various plans as they shop for insurance.


Driving high-value behaviors amongst hard to reach populations: At Novu, our programs have driven a 70% increase in gap closure, 7% increase in activation among hard-to-move populations, and an impressive 83% participation rate.


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So how do we impact these quality scores, mobilizing health plan performance while driving outcomes and lowering costs? That’s exactly where a Medicaid rewards and engagement program comes in, and the way it works is twofold: 

  • Closing gaps in care
    HEDIS quality measures, developed by NCQA and used by more than 90% of U.S. health plans, hinge largely on preventive care. Plans earn a higher ranking based on the percentage of eligible members who complete health care activities like breast cancer and colon cancer screenings and diabetes care. A Medicaid rewards and engagement program incents members to complete these high-value behaviors, targeting exactly those members who will have the biggest impact on quality scores.

    Not only will this improve member health, but as a bonus for Medicaid health plans, getting members in to see a primary care doctor for preventive care may cut back on emergency care usage, saving costs.
  • Member satisfaction
    CAHPS ratings are all about making your members happy. With a rewards and engagement program, your members get a tangible reward—like a gift card—when they complete a high-value health behavior. That reward serves not only as motivation but also creates a positive experience for your member. This type of interaction can directly benefit your plan when it comes to CAHPS ratings, a member survey which assesses member satisfaction. Happier members = higher ratings.

Want to go deeper on implementing Medicaid rewards and engagement programs to improve quality scores like HEDIS and CAHPS? Download our white paper today.

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