5 High-Value Use Cases for Outbound Calls

Improve plan performance with outbound call campaigns that deliver fast, high-touch assistance to hard-to-reach members. Live agent interactions help members address immediate challenges. When incorporated into larger omnichannel outreach strategies, outbound calls accelerate member engagement to fulfill member needs quickly.

Explore five areas plan can leverage outbound calls to fill gaps in care and maximize performance across multiple plan goals.

1. Create a welcoming onboarding experience

A smooth and informative onboarding experience sets the stage for better health outcomes, plan perception and member retention rates. Conducting welcome calls immediately establishes meaningful relationships with members and facilitates the completion of high-value health actions at the start of enrollment, including:

• Selecting primary care providers (PCP)
• Scheduling Annual Wellness Visits (AWV)
• Filling out health risk assessments (HRA)
• Understanding plan benefits and resources

One simple call can go a long way in reassuring members about their choice in health plan and encourage them to engage in future outreach.

2. Resolve member issues

Timely responses to negative member experiences are key for improving plan perception and performance on the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey. Live agents can provide the high-touch assistance these members need to avoid becoming negative CAHPS responders.

Plans can start by compiling survey results into outreach lists, then categorizing members based on risk levels. Members that are on the fence between positive and negative CAHPS responses should be the focus of outbound call campaigns to have the strongest impact on survey results. For members with more complex challenges or issues, calls can also set the stage for continuous CAHPS improvements.

When paired with a fast and targeted survey tool, plans can swiftly resolve negative feedback in time to impact plan performance. Leveraging a predictive analytics tool to categorize members by risk level can also help plans determine when to use high touch calls and when to focus on other channels.

3. Close care gaps

Time-sensitive health actions and quality measures require fast, targeted engagement to motivate members to get relevant care, especially hard-to-reach members. With outbound calls, live agents can gauge members’ willingness to see a doctor, determine if they need any assistance using transportation benefits and directly contact their PCP to schedule an appointment. These calls work well when paired with welcome calls, but they are also useful for year-round care gap initiatives to improve risk identification and in-year revenue.

A Blues Medicare Advantage plan saw results with this strategy when it partnered with Healthmine to maximize AWV completion rates before the end of 2023. Within one month, the call campaign motivated members to schedule up to 789 AWVs and increased in-year revenue by $500,000 through newly identified HCC.

4. Improve health equity

Addressing social determinants of health (SDOH) is difficult due to the lack of available data on which members need aid and limited ways to help them. These members need high-touch care to overcome complex scenarios, but outbound calls can simplify this process by aligning data collection and interventions. Performing social needs screenings over the phone can help plans quickly identify SDOH and immediately connect members with relevant benefits, such as transportation services, food assistance and housing resources, to fulfill the SNS-E measure.

Even for members who are not high-risk for chronic diseases or serious illnesses, these screenings can demonstrate that a plan is interested in helping members outside of their clinical care. By checking in with members, plans can build trust, increase CAHPS scores and improve retention.

5. Complete HRAs and provide post-HRA support

HRAs are an effective, year-round data collection tool for evaluating members for health risks and identifying opportunities to improve outcomes. Using outbound calls to help members complete surveys alongside digital and paper questionnaires can maximize data collection. For Special Needs Plans, live agents are particularly effective at increasing completion rates during the mandatory 90-day period after member enrollment.

Outbound calls are also valuable for post-HRA outreach to address newly identified risks. For example, if a member states that they have fallen in the past 12 months, live agents can connect members with their PCP to perform a fall risk intervention. This type of assistance improves preventive care usage, reduces emergency room rates and boost performances on the Health Outcomes Survey.

Trust in a Proven Solution

With Healthmine’s outbound call campaigns, health plans can quickly launch interventions in just four weeks without having to bring on extra staff or expend valuable internal resources. Our bilingual live agents follow standardized scripts to swiftly connect with members and fulfill campaign goals. This flexible member engagement solution is adaptable based on immediate plan needs and priority measurement areas.

Download the success story and discover how to use live agents to address key performance areas. Contact us for a demo.