Bid Prep: How Engagement Tools Are MLR-Eligible Expenses

Successfully preparing a 2026 Centers for Medicare & Medicaid Services (CMS) bid requires balancing financial sustainability with quality improvement (QI) initiatives. A key component of bid optimization involves integrating quality improvement strategies that enhance member engagement while meeting Medical Loss Ratio (MLR) requirements. Activities such as wellness assessments, chronic disease education, and lifestyle coaching not only improve health outcomes but also qualify as allowable quality expenditures under CMS guidelines. Additionally, tangible incentives—like gift cards for completing health risk assessments (HRAs) or engaging in wellness programs—are deductible expenses that also drive meaningful member engagement.

Healthmine solutions are eligible MLR expenditures within a plan’s CMS bid. Behavioral science-based member engagement strategies, personalized incentive programs and rewards, and near real-time analytics enable Healthmine to support plans in optimizing their engagement programs and increasing return on investment (ROI).

Here’s how CMS defines health promotion activities that are eligible to be included as MLR and how Healthmine’s solutions meet those requirements.

Health promotion activities

Health promotion activities improve health outcomes, enhance member engagement and align with MLR requirements, optimizing CMS bids. Here are some of the ways that Healthmine supports plans in boosting health outcomes:

1. Preventive health and wellness initiatives

• Wellness assessments and screenings: Identify at-risk members and close care gaps.
• Vaccination programs: Promote flu shots and immunizations to improve population health.

2. Member engagement and incentive programs

• Personalized rewards: Encourage risk assessments, wellness visits and medication adherence.
• Omnichannel outreach: Engage members via SMS, email, and calls.
• Digital health tools: Provide web and mobile platforms for health management.

3. Chronic disease management and education

• Lifestyle coaching: Support weight loss, smoking cessation, and fitness.
• Medication therapy management (MTM): Improve adherence and reduce complications.
• Digital and telephonic support: Offer 24/7 care tools for self-management.

4. Health IT and real-time analytics

• Personal Health Assistant (PHA): Guide members with tailored action plans.
• Digital surveys and analytics: Track engagement, satisfaction and ROI.

Per MLR 42 CFR Sec. 422.2430, health promotion activities count as quality-improvement expenditures:

• Transparent compliance: Healthmine’s platform ensures regulatory adherence.
• Optimized cost allocation: Most engagement costs qualify under MLR.

Integrate these strategies and tools into your bid to boost engagement and outcomes while maintaining financial sustainability with QI write offs.

Why partner with Healthmine

Healthmine’s always on Saas platform gives health plans technology-driven engagement tools, data analytics and behavioral science. These capabilities enhance member engagement and experience, improve Star Ratings and improve compliance with MLR requirements.

"Healthmine’s scalable, omnichannel engagement solutions empower health plans to optimize CMS bids while improving member outcomes year-round. Our data-driven strategies are designed to meet rigorous compliance requirements, enhance quality scores and address social determinants of health—all while helping plans meet their MLR targets, maximizing value and cost savings."  Tracy E. Tracy, Vice President of Compliance, Healthmine.

Here’s how the right partner like Healthmine can strategically fit into your bid:

1. Robust member engagement tools:

Healthmine’s Personal Health Assistant (PHA) provides a dynamic and personalized member experience through an intuitive mobile and web portal. Members can manage health actions, manage rewards, complete surveys, learn with NCQA-certified health education and connect biometric trackers like fitness watches, ensuring continuous and meaningful participation in their own health outcomes. With omnichannel support, including email, text, and phone-based outreach, Healthmine ensures members receive timely and relevant communication, tailored to their specific health needs and barriers.

2. Smart incentives paired with behavioral science:

The right reward paired with the right message can encourage more members to close critical care gaps. Healthmine’s engagement experts and behavioral scientists partner with every health plan to develop a comprehensive rewards and communication strategy that optimizes budget, maintains CMS compliance and prioritizes the right measure-driven health actions.

3. Preventive and chronic care management, informed by social risk factors:

Healthmine enables plans to target preventive and clinical measures, with interventions and outreach informed by each member’s individual needs and barriers to care. For members with social needs like food insecurity, insufficient transportation or housing needs, Healthmine can identify these needs and trigger automatic intervention.

4. Comprehensive, consolidated data:

Quality Relationship Management™ (QRM®) provides near real-time analytics to identify member engagement opportunities, care gaps, optimize outreach and track ROI. Plans can bring traditionally siloed teams, like quality and risk, together into one platform to consolidate and prioritize engagement initiatives. As a bonus, this unification of data improves the member experience by reducing abrasion in overwhelming outreach that can hinder gap closure.

5. Continuous Member Engagement:

Rather than episodic outreach, Healthmine fosters continuous member engagement with automated reminders, personalized health actions, and reward-based incentives, ensuring ongoing participation and improved health outcomes.

With the right tools, insights and collaborative approach, your plan can strategically incorporate deductible member engagement costs in your bid, achieve stronger Star Ratings and deliver exceptional value to members.

Ready to get started with the right engagement partner? Contact us for a demo.