The Challenge:
When Managed Medicare members were at risk of losing drug coverage and needed reminders about their past due premiums, problems ensued for this health plan client
- In-house agent teams were overwhelmed by the volume of calls required
- Compliance regulations stipulated multiple reminder contacts within 10-day timeframe
- Loss of coverage could jeopardize chronic condition treatments and long-term outcomes
- Potential decrease in plan incentive payments for covering at-risk population
The Solution:
ResultsCX created a strong outbound soft collections team focused on helping at-risk Medicare members maintain drug coverage:
- Agents offered multiple options for helping members get current on premiums
- Long-tenured agent team approached each call with empathy, focused on ensuring the best possible client outcomes
- Team size ensured client could achieve compliance with contact timeliness requirements
- Offshore and subsequent nearshore staff approached helping members with strong sense of responsibility and commitment to effectivenes
The Results:
Soft collections team consistently helps members maintain drug plan enrollment, protecting outcomes and client incentive payments:
- Contacted nearly 26,000 members during most recent calendar year of engagement
- Connected successfully with 7.42% of these members in past year
- 75% of lapsed members receive as many as three attempts within contact time window
- On average, 50% of members helped to immediately get current with overdue premiums
- 45 at-risk members assisted on average monthly, protecting client income from ongoing Medicare incentive payments
