How Tufts Health Plan Encourages Members to Shop for Care

We recently had the privilege of presenting at the CONNECT19 conference with our client, Boston-based Tufts Health Plan. Jim Gallagher, VP of Marketing & Product Strategy for Tufts Health Plan, and Matt Parker, HealthSparq’s VP of Product, shared the stage to discuss how incentivizing members to shop around for care can drive savings and improve the member experience. Here is a quick recap of their discussion and a few valuable tips from Tufts Health Plan to help other health plans launch incentives programs to help members make smarter health care choices.

To help anchor the conversation, Parker highlighted why HealthSparq, a long-time provider of online provider directories and cost transparency solutions for health plans, launched its incentives program to nudge members shop for health care. The factors that drove the creation of HealthSparq Rewards, and that highlight the program’s value for Tufts Health Plan today include:

  • Price variation can be extreme. Prices for the same services of the same quality continue to vary by hundreds, even thousands of dollars.
  • Consumers want cost information but often aren’t seeking it. Research shows that consumers want to know their out-of-pocket costs before they see a provider, but there’s low utilization of cost estimation information via health plan portals.
  • Motivation to compare costs for care wanes after a deductible is met, or for covered preventative care. For members who’ve reached their deductible or have no OOP costs, there is little motivation to seek quality, cost-effective providers.
  • Incentives work in health care. Research found that people are willing to switch providers for an incentive as low as $25.

For Gallagher, the idea of helping Tufts Health Plan members save money while increasing engagement with their digital tools motivated the plan to launch MyRewards this last summer. “The average family in Massachusetts spends $8,100 a year out of their own pocket on health care,” said Gallagher. “And 48% of employees are part of a high deductible health plan. Consumers are faced with more choices and more skin in the game.”

In planning for the program, he explained that member experience was a critical component of the MyRewards program. He knew that delivering a solution that was fully integrated into their existing cost transparency solution, already provided by HealthSparq, would help accomplish that. Having an integrated solution allows members to learn about, compare and sign-up for rewards directly within their cost search experience. This integration not only delivers a seamless end-user experience, but also increases utilization through visibility and ease of use.

“If this is hard – if it’s another phone call consumers have to make – we know adoption is going to suffer,” explained Gallagher. “It has to be easy and our MyRewards consumer experience is just that.”

To close out the presentation, Gallagher shared a number of lessons learned while launching a rewards program that are valuable for any health plan consider:

  • Picking the right procedures: It was incredibly important to work closely with HealthSparq and Tufts Health Plans’ own clinical team to identify which procedures should be rewardable (shoppable and clinically appropriate). Tufts chose 72 rewardable services, including colonoscopy, MRI, CAT Scans and maternity services.
  • Build for today and tomorrow: This was a new concept for the operational teams, so it was important to think about potential future states and how to build the solution to accommodate those scenarios. This way you can bring value to the market quicker and more efficiently.
  • Boost your provider data: Implementing MyRewards became a forcing function to improve the accuracy of provider data. You are only as good as your data and a great biproduct of a new member benefit like this was improved data to best serve members.
  • Understand provider and partner implications: Tufts Health Plan is proud of the strong relationships they have with providers and it was important to consider the implications of a program that incentivizes members to lower cost providers that may steer potential revenue away from those providers. Some providers will qualify as rewardable and benefit, but others will not, and you need to be prepared to have those conversations.

HealthSparq is proud to partner with Tufts Health Plan and help give their members meaningful, educational and beneficial experiences that help them take more control of their health care spending. If you’re interested in learning more, get in touch!