Fix the moment,
not the volume.
Most calls, complaints and disenrollments begin with a small gap that nobody owns. We help your plan find that friction early and remove it before it reaches your members, your Stars or your budget.
How a small gap becomes a large cost
- A member who cannot navigate the portal becomes a call
- A member who cannot find urgent care becomes an emergency visit
- A member whose issue takes multiple transfers becomes a CAHPS detractor
- A provider who cannot resolve a denial becomes a complaint to Medicare
- A new member who meets enough of this in the first 60 days becomes churn
-
A member who cannot navigate the portal
becomes a call -
A member who cannot find urgent care
becomes an emergency visit -
A member whose issue takes multiple transfers
becomes a CAHPS detractor -
A provider who cannot resolve a denial
becomes a complaint to Medicare -
A new member who meets enough of this in the first 60 days
becomes churn
One problem, five scorecards.
Experience, Stars, retention, clinical outcomes and cost are measured separately and owned separately. To your member, it is one experience, and they move together because they start in the same moments. Choose the scorecard you own.
Retention
How many of your January members will still be with you in April?
Early friction raises your cost of sale and narrows the benefits you can afford to offer. The first 60 days are where retention is won.
Where we start
Reach first
Member experience
Which moments in your member journey have no owner?
Your members experience one plan, while your organization runs five. We connect the moments nobody owns.
Where we start
See it early
Contact center
What share of your calls should never have happened?
More scripting and more seats do not lower volume. Removing unnecessary work shortens calls and lifts satisfaction together.
Where we start
Resolve it personally
Stars and quality
The measures are leaving. The members are not.
As administrative measures leave the Star Ratings, the remaining ones depend on members being reached and persuaded to act. Transfers and repeat calls still cost you CAHPS.
Where we start
Reach first
Clinical and care
What does a missing piece of information cost you in admissions?
Experience gaps become clinical cost. A member who does not know about urgent care or the nurse line goes to the hospital.
Where we start
See it early
How many of your January members will still be with you in April?
Early friction raises your cost of sale and narrows the benefits you can afford to offer. The first 60 days are where retention is won.
Where we start
Reach first
Less to handle, not just better handling.
Most plans already know where the friction is. Adding seats, scripts and requirements absorbs the demand without removing it. Our member care teams work upstream, in three steps.
See it early
We identify the moments that drive churn, Stars and cost, flag pressure events such as benefit, network and PCP changes, and package what our frontline advocates hear every day.
Reach first
Welcome and first-60-day onboarding, benefit change explanations, gap closure, and adherence and screening follow-up, supported by a year-round licensed agent bench.
Resolve it personally
Persona-trained, bilingual advocates, with scripting stripped back to what resolves the reason for the call. RubrAIk Assist supports them in the moment, and coaching is measured by behavior change.
6
Medicare Advantage clients reached 5-Star Ratings with our CMS taskforce
2.8x
more member appointments at 70% lower cost for a Fortune 50 Medicare Advantage plan
54%
fewer member escalations during enrollment and benefit events
#1
ranked partner for 6 of 7 health plan clients
The first 60 days decide whether enrollment spend pays back.
January 1 brings a new member cohort, many with changed benefits, and opens measurement year 2027. Those members can still choose another plan until March 31.
See the work behind it
+12 points NPS
Analytics traced transfers, hold time and callbacks to their root cause for a Medicare Advantage plan, and scripting was refined to match.
2.8x appointments
Omnichannel outreach helped Medicare members schedule preventive screenings, at 70% lower cost over two years.
Case study · Resolve it personally
54% fewer escalations
Persona-based training built around top call drivers also shortened handle time by 12% for a managed Medicare plan.
Article The measures are leaving. The members aren’t.
Which moments in your member journey have no owner?
Speak with the team that has been solving this with health plans for three decades. Bring one journey that concerns you, and we will share what we see in plans like yours ahead of January 1.
Leader, Everest Group Healthcare CXM PEAK Matrix. Ranked #1 by 6 of 7 health plan clients.