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How to Maximize Health Plan Member Experience Through Communication

When members think of their health plan, they don’t typically think of a bunch of separate departments with different goals and initiatives. They think of a single entity. To maintain a positive relationship and strong member experience, it is important for plans to act as much like a single entity as possible.

For example, a call or message about the importance of blood testing for a diabetic member on the same day as a claims update, vaccination reminder, and a customer service survey provide a confusing, often frustrating experience for members. Making matters worse is when this cross-communication also comes from a variety of channels. When multiple departments use multiple tools that allow for easy email, IVR, or mobile outreach, the convenience of self-service can mean haphazard outreach for the member, causing abrasion and confusion.

The move toward mobile and digital outreach requires intelligent coordination to fully deliver on its potential and avoid dangerous pitfalls around member experience and compliance. The first step is to fully audit the member communication experience from both the entire organization’s and a member’s perspective. Understanding the topics and needs that different departments have, as well as how often a member is getting letters, emails, calls, texts or portal messages in a period of time, helps frame the member/plan relationship more accurately.

Learn more about mPulse Mobile’s omnichannel solutions

To address this challenge, it is important that departments and communication strategies are aligned. This requires either incredible communication throughout the organization, or more simply a single platform that coordinates and orchestrates outreach. This platform must consolidate engagement efforts into a single hub that gives you a clear idea of performance, engagement, and volume for each channel at the population, segment, or individual member level. From the member’s side, it means that their engagement on one channel doesn’t occur in a vacuum – responding to a text that you received a flu vaccine means you will not have to receive a phone call reminding you to get one two days later. For the plan, channel selection is no longer a limiting factor in launching programs – letting your team and ours focus on maximizing outcomes through the most effective mix. The platform also centralized preferences for channel, frequency, and language while also maintaining key compliance functions for opt-outs.

If your mission is to provide a positive member experience that builds trust, consolidating your engagement outreach in a single source is likely your best option.

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3 Steps to Listen to your Members at Scale

Are you having meaningful conversations or talking at them?

There are certain human experiences everyone can relate to. One we have all felt is someone talking at you. It’s not a conversation. There are not two participants. You are just there to absorb whatever they say, and if you respond, they don’t listen. They just wait for their turn to speak again. We all know this feeling. It’s frustrating and leaves you looking for an exit.

Fortunately, people can become better communicators. They can learn to slow down, focus, and listen. They can learn to have a conversation instead of just dumping their message on an unwitting volunteer. And when they do, the rewards are clear. Two-way dialogues allow for feedback and new information that, when listened to, can drive the conversation deeper or take it in new directions that teach both parties something new.

The key difference between a one-way dump of information and a meaningful conversation is the ability to listen and have empathy. For healthcare organizations that aim to have these meaningful interactions with hundreds of thousands of people, the question is how to listen at scale.

Step 1:

Start Conversations at Scale

The easiest way to engage people in conversation is to find topics they care about then ask them about those topics. Most of us do this intuitively. Doing this at scale requires determining content / topics that are relevant to specific segments across large populations and leveraging technology that allows you to start and maintain thousands of conversations at once across communication channels. We call this member-centric outreach.

To properly conduct member-centric outreach and begin conversations, there are a few things you need to have in place.

  • Ability to deliver messages on high-reach conversational channels, such as SMS
  • Population segmentation to tailor content / topics
  • A way to track engagement and responses to verify and update population segmentation and tailoring

Using automated conversations with the ability to listen to member responses and handle those responses appropriately is crucial to making interaction between a plan and its members natural and easy

Step 2:

Orchestrate Engagement Across Channels

Imagine having a great conversation with someone at a party. You found a common interest and dove deep into it. Then days later you read an article your friend might find interesting, so you email it to them. A few days later, they text you a link to a related video. You are communicating across channels to maintain and deepen your relationship, all connected to that initial conversation.

Orchestrating engagement across channels is relatively simple to do at scale when your engagement channels are all hosted on a single platform. Think of your engagement platform as the person at the party – it’s easy to keep track of what content has been shared across channels when it’s all coming from and to the same place.

Digital communication occurs in real-time more often than traditional healthcare outreach. When you consider the outreach strategies of Pharmacy, Clinical, Quality, Care Management and Marketing, it’s vital to orchestrate engagement over mobile channels. And if a platform is not listening to data from member actions and adjusting appropriately, it is falling short of true omnichannel orchestration.

Step 3:

Use data to listen and empathize

During in-person conversations, people gather all sorts of valuable information in real time. We gauge sentiment based on vocal tone and body language that is not typically available with digital conversations at scale. To compensate for real time empathy, digital conversations rely on new types of data to listen and inform an appropriate, tailored response. To listen well, there are some important focus areas when it comes to data.

  • Focused Data: Determine what information you are trying to capture before launching a digital conversation program. Are you hoping to learn about channel preferences or something like barriers to care? Determine that and engage in line with that goal.
  • Sentiment: Leverage technology or a team to understand the sentiment of member responses.
  • Preferences: Analyze what channels, message frequency, language, topics, and content individuals and persona populations prefer.
  • Target Insights: If there are specific insights or answers you need, use your trusted relationship to have conversations about those topics.

Asking members questions on scalable conversational channels can create a wealth of new data that is almost impossible to gather otherwise. This data provides a fuller understanding of populations which allows for more informed decision- making.

Meaningful conversations and experiences are core to human relationships. The better you can create and maintain relationships with all of your consumers through conversations, the more aligned you will be about their care.

If you would like to have a conversation with us about how we can help you build more positive relationships with all your members, please contact us here.

mPulse Mobile Celebrates Health Equity with Third Annual Activate Awards

UPMC, Priority Partners, Premera Blue Cross, Inland Empire Health Plan and others receive awards recognizing their innovation and results in improving health consumer activation and health equity.

mPulse Mobile announces winners of the Activate Awards each fall during its annual Activate conference. The Activate Awards recognize customers and partners that have driven impressive results like most significant outcome, best use of Conversational AI and achieving health equity.

Winners of the Activate Awards are on the forefront of healthcare consumer engagement, leveraging Conversational AI and omnichannel engagement solutions to build meaningful relationships with their consumers and activate them in their health. Award submissions were evaluated on both qualitative and quantitative results.

2020 Activate Award winners include:

UPMC – Most Significant Outcome (tie)

A world-renowned health care provider and insurer, Pittsburgh-based UPMC is inventing new models of accountable, cost-effective, patient-centered care. It provides more than $900 million a year in benefits to its communities, including more care to the region’s most vulnerable citizens than any other health care institution. UPMC Health Plan, the largest medical and behavioral health service insurer in western Pennsylvania, offers health insurance to all Pennsylvanians regardless of their life situation, including employer-sponsored plans, Medicare, Medicaid, Children’s Health Insurance (CHIP) and plans offered through the Affordable Care Act.

mPulse’s solution supported a 10-week Home Run for Health program to over 2,400 Health Plan members who signed up through their employer group plans. After kickoff messaging, members received weekly check-ins and surveys with an end-of-program survey after completion of touchpoints, all via interactive text message. Outreach connected members to curated content around healthy eating, exercise tips, and other weight-loss topics.

Member engagement rates were very high, with over 72% of members engaged during the program. Program retention was strong, with only a 1.5% opt-out rate in spite of the challenge faced with the growing concern surrounding COVID-19 and the nationwide shutdowns.

Priority Partners – Most Significant Outcome (tie)

Priority Partners is a Medicaid Managed Care Organization that serves individuals throughout the State of Maryland.

Priority Partners sends out notices to Medicaid members to remind them it is time for them to complete their renewal (Redetermination) with the State of Maryland. In previous years, notices have been sent by mail and email, but this audience is often transient and hard to reach.

The mPulse Mobile solution engages members about renewal through mobile channels and was able to reach an average of 78.9% of members who were due for redetermination. Combined with the other traditional methods of communication, an average of 75.9% of members renewed their eligibility each month and kept their membership with Priority Partners, a significant improvement that helped more members maintain continuity of coverage.

Premera Blue Cross: Most Innovative Solution

Premera Blue Cross is a leading health plan in the Pacific Northwest, providing comprehensive health benefits and tailored services to about 2 million people, from individuals to Fortune 100 companies.

Premera’s main goal is to make healthcare easier to use. Premera’s messaging mission is to provide members with information about their healthcare and benefits quickly, educate them about Premera tools to navigate their health, empower them with actionable messages that lead them to self-service tools that lead them to solutions, and ultimately change their members’ behavior so they get the most out of their health plan while decreasing the need to call customer service.

The mPulse Mobile Engagement Console provides an avenue for 2-way communication between Premera and members via text. The Engagement Console became the communication channel that allows customer service representatives to text back and forth with members from these plans to assist them with booking appointments with high quality providers as well as answer questions within privacy and legal constraints.

The Engagement Console was also used to send confirmations via text when a member uses the Premera mobile app or the Premera Pulse website to schedule an appointment.

Since deploying the program to 5 top plans, a significant portion of members have scheduled appointments with top providers and have an average of 1.5 appointments per member who engages with the Premera team via the program.

Inland Empire Health Plan: Achieving Health Equity

Inland Empire Health Plan (IEHP) is a not-for-profit Medi-Cal and Medicare health plan located in Rancho Cucamonga, California. With a network of over 4,000 providers and more than 2,000 employees, IEHP serves more than 1.3 million residents in Riverside and San Bernardino counties who are enrolled in Medi-Cal, Cal MediConnect Plan (Medicare), or the Healthy Kids Program.

IEHP launched an important solution with mPulse Mobile aimed at addressing social isolation over 6-7 weeks with 92,000 Medicare and Disabled members of IEHP. The Conversational AI solution was used to identify self-reported social isolation levels and challenges of staying at home during the COVID-19 pandemic.

The solution consisted of 15-30 automated conversations that offered support and provided tips and resources to combat social isolation and “stay at home” challenges. These included the use of Fotonovelas to communicate a visual story on the challenges of staying at home. Members received an average of 20 tailored, conversational touchpoints. Program satisfaction was very high; over 86% of members found it helpful, with higher satisfaction in Spanish-speaking segments than English speakers.

Midwest Medicaid Managed Care Plan – Best Use of Conversational AI

This Medicaid Managed Care Plan worked with mPulse to increase and improve the number of well-child, dental, and lead screening visits required to achieve quality, state, and plan operational goals. Since a large number of members are under 18, these EPSDT and HEDIS gaps are very important in managing the preventive care and overall health of the population.

Using mPulse’s conversational AI solution, members were targeted to remind them to complete their visit with a series of automated touchpoints. Outreach was orchestrated to match the best reminder content to each individual member. In total, approximately 100K gaps were targeted by the mPulse solution, successfully driving over 65,000 provider visits and making significant improvements in screening and visit completion rates.

Southeast Medicaid Managed Care Plan – Most Improved Customer Experience

This Medicaid Managed Care Plan leveraged a mobile outreach strategy that included implementing 2-way, automated text messaging solutions to improve overall health engagement as well as improve a hard-to-reach population’s completion rates of Health Risk Surveys. They use mPulse’s platform to reach these members using a new channel (SMS + Secure Survey). The new solution uses high-reach channels and optimized content, resulting in significant improvements to completion and member satisfaction. With ongoing optimization of content and conversational flow, completion rates have more than doubled and initial member engagement rates have improved by 75%.

“On the other side of these solutions are meaningful outcomes that are really impacting people and their health,” said Chris Nicholson, Co-Founder and CEO of mPulse Mobile. “Seeing so many wonderful partners leveraging our solutions like Conversational AI, the Engagement Console, and Fotonovelas to engage their members in meaningful ways to build valuable relationships that in turn lead to positive outcomes motivates our team every day. The Activate Awards are such an important reminder every year why we do what we do.”

Key Takeaways: RISE 10th Annual HEDIS and Quality Improvement Summit

mPulse Mobile’s Government Programs Strategic Market Executive, Reva Sheehan, sat down with John Hopkin’s Director of Medicare STARS at Advantage MD, Tejaswita Karve, and Molina’s Regional Manager of Risk Adjustment, Ryan Dodson, to discuss New HEDIS Patient Experience Measures and Weights at the RISE HEDIS and Quality Improvement Summit. While the summit focused primarily on HEDIS and Star Ratings changes affecting the 2021-23 years, there were a few key insights we thought stood out during the panel. Here are our Key Takeaways:

Get to Know Your Members and Their Experience with Their Plans

The Annual Open Enrollment period is an important time of the year for both health plan and members. Health plans have the opportunity to re-engage members with new and important information and hopefully retain membership while welcoming new acquisitions. Members also have the opportunity during this time to reevaluate their current plan and benefits and voice what is important to them and what they felt was lacking throughout their interactions with their plan. It is a crucial time for member outreach.

Because CMS requires some materials are delivered to members before the beginning of the Annual Enrollment Period (AEP), if plans experience returned mail or unopened digital messages it can be a good indicator of who is or is not  receiving the plan’s communications because the bulk of members will get some form of touchpoint from the plan during AEP. This presents an added opportunity to engage members the plan may not have known they were missing all while strengthening continued outreach to members who voiced their pain points with the plan.

Discover the Differences Between High Utilizers and the Mildly Engaged

Understanding engagement differences from in-between members, those who the plan does not hear from often enough, from high utilizers will help guide what touchpoints are most effective for that mildly engaged population. Perhaps one method of communication results in a high feedback but is less successful for an entire smaller core demographic. What does the plan do with that data? Using encounter data or claims compared to communications with the plan can uncover communication barriers that will help the plan hone in on the right outreach for each member. For example, when mPulse deployed our Fotonovela Solution with one of our managed care partners, our data reflected that our partnered plan had a 37% engagement rate from the Spanish speaking population vs. 17% from the English-speaking population. Fotonovelas proved to work more effectively with one population over the other. Without that response data with specific language points and outcomes, mPulse may have seen a successful use case but would not have had the valuable data that prompts the plan to segment their outreach appropriately. Being able to capture those data points and incorporate them into future outreach strategies alleviates some of the unknown factors that affect the overall member experience from outreach to appointment.

Measures with Increased Weights – Moving forward with CAHPS

CAHPS carries much more weight in the coming years and with that plans will need to rethink how they deploy off cycle surveys and related communications, while trying to sift through the stagnant data they have now. During the RISE panel, John Hopkins’, Tejaswita Karve, touched on the efficacy of NPS scores and how to collect that feedback and utilize those data sets. Plans can use that data to keep their members in the loop while waiting for the 2021 survey results. Educating members and empowering them with the knowledge that their feedback matters and why it matters and how the plan makes changes based on the data collected from these surveys will have a positive impact on member perception. Being proactive helps engage the member in future communications because the member is more aware of what to expect and how their input directly impacts their care management.

Combat Survey Fatigue

Deploying short surveys throughout the year to collect information on what resonates with the members shows that the health plan is listening to members’ feedback and are taking action. One of the panelists mentioned that her past organization deployed a “We Heard You” campaign that worked well by engaging members of new changes all throughout the year, keeping them informed of new programs and benefits that in some cases were a direct response from the members. Advisory boards and focus groups can be a good tactic when gathering data for outreach, but it also makes the member the centerpiece of the conversation. It is an opportunity to ask if they have everything they need, all while building a relationship and ambassadorship. The data collected right from the source is a valuable tool when engaging in future outreach.

Sometimes Perception is More Important than Experience. Go Above and Beyond Ahead of the Visit.

Taking action to inform and engage members on what to expect from their doctor visits, providing information that is important to them, like billing and what is covered and what is not, will help build a more trusting relationship between provider and member, but it will also eliminate any future mistrust due to lack of information. Utilizing automated touchpoints to prevent minor backend mistakes and miscommunication with the member can go beyond the annual survey. For example, the provider and plan have the opportunity to explain the terms of Annual Well Visits within the defined value sets ahead of the member booking their “free AWV” that could prevent any mistakes about co-payments and billing. Explaining the terms ahead of the visit and providing a list of what falls under annual well visits, not only informs the member and prevents coding errors on the provider side, but it creates a relationship and line of communicative trust.

Including members in the conversation ahead of outreach goes above and beyond the standard level of communication between plan and member. It is important to keep the data collected from past surveys and NPS scores close to engagement strategy, and above all, prioritize the ongoing relationship between member and provider and plan as member experience will make up over one-third of the overall Star Rating for 2023.