An end-to-end health risk assessment solution to drive superior member experience and Star Ratings

Health Risk Assessment (HRA) is mandated by the Centers for Medicare and Medicaid Services (CMS) for Medicare-Medicaid plans and specific Special Needs Plans (SNP). In addition, Annual Wellness Visits are required by regulation to provide members with personalized preventive plans, taking into consideration HRA surveys.

A large proportion of Star Ratings on Medicare Advantage Plans are based on member experience. HRA surveys are the bridge between member experience and health plan performance. Improving survey completion rates is the foundation for improving member experience and Star Ratings.

However, completing HRA surveys is challenging and time-consuming. Wipro understands these challenges and has solution levers in place to address them:

• Analytics on previous HRA responses to gain member insights and improve member behavior
• Verification with USPS API and other websites to identify and correct wrong addresses, then use social determinants of members to their full potential
• Auto-route HRA surveys to channels aligned with member preferences and AI-based HRA forms for optimal outcomes
• Optical Character Recognition (ORC) for HRA paper forms, eliminating data entry errors and loss of productivity
• Auto email reminders/alerts and BOT dialers to save agent time
• Pre-defined algorithms to categorize members that might have changes in their risk levels analyzing previous claims, Rx data, clinical notes, care plan instructions, etc.

Wipro also has HRA360, an end-to-end Member HRA, and Member Engagement system. Integrated with the existing Member 360 and Encounter Data Processing System (EDPS), HRA360 helps identify potentially high-risk populations that need immediate attention.  HRA360 is built on a tracking process designed to successfully complete pre-enrollment and post-enrollment HRA assessments.

Wipro has extensive experience handling HRA activities. Clients using our solutions have experienced the following:

• 40% increase in HRA completion rate
• 20% reduction in operational inefficiencies
• Ability to leverage flexible solutions with configurable questions as per the health plan’s need
• Integration with existing pre-enrollment, broker, or membership management systems
• Compliance with CMS regulations through audit trail and CMS reports
• Integration with Member360 to pre-populate key information, enabling members to fill the forms easily
• Capability to prioritize outreach based on member risk score and days left to complete HRA
• Ability to identify partially filled forms and capture member engagement follow-ups through calling support