Challenge

Chronic conditions pose significant challenges to individuals and healthcare systems alike. Back in 2021, a leading health plan client was concerned that their members were not getting adequate care for their chronic conditions, posing potential risks to member health and the plan’s financial operations. Facilitating patient education, empowerment, and care coordination was a top priority for the health plan but their current Customer Experience partner’s contact program was incurring substantial costs without delivering adequate impact.

• Benefits, preventive, and maintenance care were underutilized.
• Emergency care and hospitalizations were trending higher.
• Poor member experience could potentially lower the health plan’s CMS Star Rating.

The health plan wanted to limit the negative impact on plan’s financial performance, CMS incentive payments, as well as CMS Star Ratings and promote positive care outcomes. They decided to partner with ResultsCX to tap into our proven CXM expertise and solutions.

Solution

We collaborated with the health plan to design a comprehensive solution targeting members with pre-existing conditions to improve care utilization and member outcomes.

• Omnichannel communication: Deployed low-cost outbound campaigns via phone, email, text, and IVR, encouraging members to make inbound calls to schedule care appointments. This approach significantly reduced the effort needed for members to arrange direct appointments as they could instantly connect with a live advocate.
• Right shore support: Expanded nearshore live agent support to enhance efficiency and cost-effectiveness, reducing the high costs associated with domestic resource hiring. This enhancement facilitated improved supervision, positively impacting call quality.
• Data-driven engagement: Implemented a segment-focused approach targeting specific member needs such as diabetic eye exams, colonoscopies, and breast cancer screenings, resulting in expedited closure of care gaps. This strategy ensured timely preemptive care for vulnerable members, reducing healthcare costs and safeguarding member health.
• Targeted training: Revamped the client’s training curriculum and delivered specialized training for each distinct member group and health plan. This empowered agents to prompt members to schedule appointments at a notably accelerated pace.

Our team remains committed to building upon the success of the program deployed in 2021. We continue to expand the scope of the engagement and drive continuous improvements to achieve even better outcomes.