CenseoHealth & GHG Poll on Prospective Evaluations

Question: What percentage of your membership are you targeting for prospective evaluations?

Answers:                                                                                                   Prof. McCallum Report Card:
9% of webinar attendees said 80 – 100% of members                       A+
7% of webinar attendees said 65 – 79% of members                         A-
21% of webinar attendees said 50 – 64% of members                       B+
19% of webinar attendees said 35 – 49% of members                       B
44% of webinar attendees said less than 35% of members             More Attention Needed

It looks like the marketplace is evolving and those who are evaluating 80-100% are the pack leaders.

They get an A+ because these health plans & medical groups should have:
• Great member information for medical management and physician as they design treatment plans
• High member satisfaction
• High member retention
• Accurate & timely premium impacts to account for medical expense and aid in bid development
• If they are using a comprehensive evaluation instrument, they should be impacting HEDIS & STARS

The next group to focus on is the 44% who are looking at less than 35%. We have a few questions:
• Are you competitive in your marketplace with benefits?
• What’s your MLR?
• How is your member retention & satisfaction?
• How is your physician satisfaction?
• How are you doing on HEDIS & STARS?
For this group, our suggestion is to double your targeted population so you can continue to excel. Make sure you have good member stratification so you are targeting the most appropriate and impactful members.

For those in the middle — continue to increase the number of evaluations, refine your tool, stay competitive and compliant, and make certain you integrate the data into other areas of your health plan or medical group.

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