How More Coordinated Outreach Benefits Members and Plans

Deliver the right message at the right time to members by adopting a coordinated outreach strategy. Overlapping messaging leaves members confused, alienated and feeling stuck on their healthcare journeys, which contributes to open care gaps, increased claims costs, higher emergency room rates and lower member retention. By aligning data, outreach and analytics, health plans can reduce overlapping messages between departments and empower members to take the next best steps to living healthier lives.

Quality Relationship Management^TM (QRM®) use coordinated, digital-first member outreach to guide members on their health journeys while reducing health plan expenses. Data-driven, digital-only outreach conducted through QRM is 6.2 times more effective than non-digital at 60% of the cost.

What is Coordinated Outreach?

Coordinated outreach occurs when health plans engage members in a logical, orderly manner throughout their healthcare journeys to continuously guide them to the next best activity. Each message is delivered at a specific point in time in a member’s life to provide them with the right information at the right time. This organized approach to member engagement eliminates duplicative outreach and consolidates messaging to provide a holistic member experience while addressing multiple plan challenges at once. It also considers previous messages members have received and adjusts outreach frequencies to avoid overwhelming them with too many demands in a short period of time.

“With tighter budgets, more regulations, and arrival of the Health Equity Index, end-to-end dynamic and data-driven engagement platforms are now a must have for every health plan,” says Kimberly Swanson, Chief of Staff. “QRM was built by experienced 5 Star, risk adjustment and operational leaders who have first-hand experience using a combination of ineffective point solution vendors and in-house tools to manage member engagement. QRM is the only platform on the market that drives improvement for long-term success for health plan revenue, MLR, health equity, member satisfaction and retention goals.”

Strategically using touchpoints to guide members along their healthcare journeys with relevant information contributes to:

• Higher member satisfaction with their health plan
• Better healthcare experiences
• Stronger member retention rates
• Increased gap closure
• Higher Star Ratings
• Better health outcomes
• Increased digital health literacy
• Lower emergency room rates and claims costs
• Increased engagement
• Less waste from unread mail or missed phone calls
• Better control over medical loss ratios
• Reduced reliance on point solutions to engage members

Data Gaps Drives Uncoordinated Outreach

Members want to receive relevant communications in a familiar format and frequency that is convenient to them, but the fragmented nature of healthcare creates an uncoordinated reality. When outreach is conducted individually by department, members can become overwhelmed by multiple duplicative or conflicting messages.

Uncoordinated outreach is the result of gaps between outreach, member records and analytics. Teams lack insight into when other departments are messaging members, what information members are receiving and what activities members need to complete.

Consider AWVs. Almost every department needs members to complete AWVs to address departmental goals, including accurate coding HCCs to close risk adjustment gaps, facilitating screenings to improve quality scores and identifying social determinants of health to advance health equity goals. Fewer, consolidated AWV outreach campaigns could complete most of these goals, but when teams do not share the same data, they risk conducting multiple, overlapping campaigns. This leads to duplicative, overlapping and costly outreach that contributes to negative CAHPS and HEDIS performance.

Unify Data, Outreach and Analytics

Uncoordinated outreach is avoidable with the right insights, data, and technology. Investing in a coordinated approach ensures that members receive the right message at the right time to complete desired actions. This strategy enables plans to consolidate duplicate outreach, address plan goals in a holistic manner and maximize the impact of each message.

To start, plans should focus on aligning member data, outreach and analytics into a single platform. Increased visibility into member records and activities allows teams to quickly identify what messages members have already received and design strategies to move them onto the next stage of their health journeys. Based on these insights, teams can avoid sending overlapping outreach and focus on conducting member-centric messages that guide members to the right activities.

Consolidating analytics into an integrated platform also improves insight into campaign performance to help teams measure return-on-investment. By closely tracking open, click-through and conversion rates, teams can monitor how members are responding to messages. This data informs scalable, personalized campaigns that can continuously capture member data and refine outreach. Through this feedback loop, plans can measure the effectiveness of coordinated outreach and adjust strategies.

When monitoring coordinated outreach, plans should pay close attention to:

• Historic vs current performance: The easiest way to know if a new outreach strategy is working is to compare past campaign metrics to current ones. Look for trends in care gap closures, program registrations and mobile application usage following a campaign to determine if members are responding to the new strategy.
• Spend and resource management: Coordinated outreach can decrease costs by increasing the effectiveness of each message while reducing unnecessary messaging, such as missed calls or unopened mail. If budgets are less strained but performance improves, it means the coordinated strategy is effectively moving members to the right health action without increasing costs. Teams can also pivot strategies more easily with a waterfall approach, such as following up with text messages when members do not engage with physical mail.
• Staff challenges: Eliminating overlapping, ineffective outreach reduces burdens on staff and enables teams to focus more time on meaningful interventions. Check with teams to determine how effective the new approach is and if old challenges were eliminated.

Coordinated Outreach with a Single Control Tower

Aligning data, outreach and analytics into an integrated platform presents numerous opportunities for improving performance, but building and maintaining a new platform in-house is beyond most plans’ current resources. Rather than sticking with the status quo, plans can make the jump to coordinated outreach by working with the right member engagement partner.

QRM brings together all member data, outreach and analytics into a single integrated platform to support coordinated outreach strategies. Supported by a feedback loop between data and outreach, teams can scale personalization across member populations to continuously guide members towards the right health actions.

Coordinated outreach across health plan departments with the guidance of QRM and address key plan performance areas when you:

• Strategically engaging members at the right time to improve preventive care use, control medical loss ratios, reduce claims costs, increase retention rates and improve member satisfaction.
• Refine member engagement activities with the guidance of regularly updated dashboards and insights from behavioral scientists and content strategists.
• Personalized member outreach at scale to increase benefits usage, improve health literacy and address unique roadblocks in member journeys like CAHPS and social determinants of health.
• Reduce reliance on point solutions by giving teams greater control over data, outreach and analytics through a customizable suite of technology solutions.
• Break down data silos by automating the development of longitudinal member records and streamlining data collection efforts.

Get a first-hand look at the impact of a coordinated outreach strategy on plan performance. Contact us for a demo.