Member experience: The third pillar of payer data priorities
Data-driven strategies are essential for health plans to engage members and meaningfully address longstanding health inequities.
Health plans increasingly recognize the value of curating member data to optimize outreach and overcome challenges that can tarnish the member experience.
For example, targeted communications can inform members of benefits that often go unused or new benefits that can reduce their cost of care. Consider that as many as three in 10 Medicare Advantage (MA) members did not use any of their supplemental benefits like dental, vision, hearing or fitness benefits in the past year.
For the subset of MA plans known as dual-eligible special needs plans (D-SNPs), using member data to provide individualized support and resources to beneficiaries enrolled in both Medicare and Medicaid may be especially valuable to address social determinants of health (SDOH) factors that contribute to longstanding health inequities. As plans continue to target care gaps in the months ahead, they should ensure that member engagement is a top data priority.
Here are four data-driven strategies for plans to improve engagement and enhance the member experience.
Use a multichannel approach to inform members
Fewer than half of Medicare beneficiaries carefully read mail from their health plan, and even those who do still may be missing important information about their benefits. In addition, a recent survey found that 69 percent of Medicare beneficiaries don’t take time to compare their current coverage with other available plans during open enrollment. Among MA enrollees, more than 40 percent didn’t check for changes to services covered or their covered costs.
As many as 3 million people are eligible for a low-income subsidy to help them pay for drug costs, but they either don’t know about it or haven’t enrolled. Providing multichannel information and enrollment support to these senior citizens and people with disabilities could help them receive lower-cost drugs and other benefits that help close care gaps. To help eligible members enroll, one large national plan led a multichannel outreach program that included interactive voice response (IVR) and text messages. One-quarter of reached members connected with a live agent, and 56 percent of applications were competed via all channels. Overall, 80 percent of members found the outreach helpful.
Such multichannel approaches can also help MA plans meet the new requirement effective for 2025 to notify members in July about unused supplemental benefits. To ensure members get the information they need, plans can use IVR and text messages to alert members about important benefits information coming in the mail, including a call to action to contact the plan if they have questions.
Also new for 2025, Medicare Part D beneficiaries’ out-of-pocket drug costs will be capped at $2,000 as part of the Inflation Reduction Act of 2022. The change provides an opportunity for plans to reach out to members and shed light on which outpatient prescription drugs are covered and the potential savings they could realize.
Communicate to establish trust and rapport
The effectiveness of ongoing outreach was made clear following the recent Medicaid unwinding, during which more than 25 million people have been disenrolled and more than 56 million have had their coverage renewed. The plans that had the most successful renewal campaigns had laid the groundwork by proactively gathering digital consents and establishing a robust cadence of member communications throughout the year. These critical steps helped them build trust and rapport with their members before the renewal process.
To help drive better clinical outcomes, health plans should establish communication plans that include opportunities to engage members to complete health risk assessments, schedule health screenings and achieve other important goals. To better engage members, plans can initiate IVR outreach to members and then transfer them to a live agent, who can schedule provider appointments or connect them to other resources, such as transportation for their doctor visit.
By monitoring the progress of their outreach over time, plans can adjust their messaging and strategies so they are most effective.
Incorporate strategies to gather and use supplemental data
Beyond connecting with their population about enrollments and benefits, plans should aim to improve the member experience by gathering data on SDOH factors.
Plans are required to address disparities for HEDIS and Star Ratings performance measures, but focusing on inequities offers other advantages. With secure digital capabilities, plans can safely collect member-reported data and tailor their benefits and interventions to better address member needs and improve health outcomes. Plans can also direct members to preventative health services to improve access to care, such as telehealth appointments or community-based resources.
To gather SDOH data on their members, one large regional health plan conducted a secure digital survey combined with an IVR call for its 200,000 members. More than 90 percent of targeted members were reached; of those, 38 percent engaged and provided key insights on demographics, financial health status, mental health needs and other SDOH factors. More than one-third said they faced food insecurity, while 13 percent reported that they lacked reliable transportation. Such feedback helped empower care managers to provide personalized support and resources to concerned members.
Plans should gather information on member communication preferences from surveys to identify how best to interact with their more vulnerable members. Collecting income status and geographic data can help plans stratify and target populations living in under-resourced areas. Plans can also use this data for HEDIS race and ethnicity stratification measures and the new Health Equity Index for MA and Medicare Part D Star ratings. When reaching out to vulnerable populations, plans should ensure that each communication meets guidelines for low literacy or limited English proficiency as well as cultural competency.
Comply with the Telephone Consumer Protection Act
The Telephone Consumer Protection Act (TCPA) establishes rules for contacting consumers, such as providing ways for members to opt out of communications and sign up for do-not-call lists.
Using branded caller ID that enables plans to display their name or logo during outbound calls can help improve answer rates, especially as the volume of calls from unknown numbers increases during election season.
In addition, with the Federal Communications Commission (FCC) estimating that 35 million phone numbers are disconnected and aged each year, health plans should take advantage of the FCC’s Reassigned Numbers Database to avoid placing unwanted calls to the wrong individual.
In summary, using data strategically and judiciously can help leaders position their plan as a trusted source for members to improve their healthcare. With a proactive, multichannel approach to member engagement and the right communications infrastructure in place, plans can improve gap closure, member satisfaction and retention and plan growth through 2025.
Leah Dewey is vice president of clinical and consumer engagement operations for Cotiviti.