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Navigating New TCPA Regulations: A Guide for Healthcare Communications

In the ever-evolving landscape of healthcare communications, staying compliant with regulatory changes is paramount. One such significant transformation occurred on July 20, 2023, when new requirements under the Telephone Consumer Protection Act (TCPA) came into effect. These changes directly impact how healthcare organizations engage with their patients and members, including significant implications for HIPAA-related calls. Understanding the intricacies of these regulations is essential to avoid hefty fines and legal complications.

At mPulse, we recognize the challenges and complexities that healthcare organizations face, which were previously mostly exempted. With our expertise and innovative solutions, we are well-positioned to help healthcare organizations navigate these changes seamlessly and ensure they remain compliant, safeguarding both their reputation and financial well-being. 

In this blog post, we’ll explore the key aspects of the TCPA changes that took effect on July 20, 2023, and shed light on how mPulse can assist healthcare organizations meet these regulatory demands through our digital health solutions, especially as they relate to HIPAA-related communications.

Three notable impacts of the Telephone Consumer Protection Act on healthcare pre-recorded voice calls

  1. The TCPA now sets a call limitation on healthcare-related calls without prior express consent, allowing for one artificial or pre-recorded call per day and up to three artificial or pre-recorded calls per week. This is a significant change, as there was previously no limit on calls without prior consent. However, even with these TCPA changes in effect, if recipients have willingly provided their prior express consent—often obtained through providing a telephone number or completing a registration process—there is still no limit to the number of calls that can be made.

mPulse solutions are thoughtfully designed to make an impact with the fewest touch points possible, well within the call limits, to comply with the TCPA changes when there is no prior express consent. With consent, we can also offer configurations involving multiple solutions that may need more touchpoints, enabling healthcare organizations to achieve their communication goals. 

2. The callers* must provide the following to help recipients opt out of the artificial or pre-recorded healthcare-related call:

  • State the identity of the entity*
  • State the entity’s phone number* that allows the recipient to make a do-not-call request during regular business hours. 
  • The message must include an automated, interactive voice and/or key press-activated opt-out mechanism within two seconds of the identification message. 
  • Brief instructions on how to use the mechanism.
  • If the recipient elects to opt-out, the mechanism must record the recipient’s number to the do-not-call list and immediately terminate the call. 
  • If the call is left on an answering machine or a voice mail service, the automated message must leave a toll-free number that leads the recipient to the opt-out mechanism above. 

mPulse diligently adheres to these requirements in our IVR scripting, ensuring that all information is provided, including contact information and instructions for opting out using our key-press-activated mechanism. Moreover, our technology enables the management of do-not-call information at an account level for do-not-call requests made directly to mPulse.**

3. Ensure that the entity* making the healthcare-related calls has a do-not-call policy. The do-not-call policy must be in writing, and the personnel must be trained on do-not-call practices. As for the specifics, consumer do-not-call requests must be honored within 30 days of receipt. The party seeking to be placed on the do-not-call list must provide their name (or their entity’s name) and number(s) for inclusion on the do-not-call list. Furthermore, companies must maintain records of do-not-call requests for five years.

It’s important to note that while mPulse offers a robust platform for managing these communications, the responsibility for creating a written policy and training personnel on the do-not-call list primarily lies with the healthcare organization. We understand our partners’ needs and procedures may vary, and we aim to provide the necessary tools and support to facilitate compliance. With mPulse software, we ensure that do-not-call requests are promptly recorded and retained for five years, which is vital to regulatory adherence. However, it remains our partners’ duty to maintain a holistic list that captures all do-not-call requests – especially ones made directly to their call center.

Navigating the complexities of TCPA regulations can be daunting, but with mPulse, healthcare organizations can find a reliable partner to help them navigate these intricacies seamlessly. We understand the nuances of TCPA and are well-equipped to guide healthcare organizations toward compliance while ensuring that their digital engagement remains robust and effective. Moreover, mPulse offers diverse health communication solutions, including text messaging, email, and mobile web, providing healthcare organizations with a comprehensive toolkit to engage consumers and achieve the best possible outcomes. With our expertise and multifaceted approach, we are here to support healthcare organizations in delivering top-notch services while adhering to regulatory standards.

Please visit the Code of Federal Regulations website to learn more about TCPA changes.

*Refers to healthcare organizations mPulse partners with

**mPulse is not liable for a complete do-not-call list as the healthcare organizations we partner with may have multiple lists from historical vendors, direct requests from members, or other various do-not-call requests in the healthcare organization’s database. To comply with TCPA, it’s imperative that the healthcare organization manages and owns the holistic do-not-call list with or without mPulse technology and that the correct list is sent to mPulse prior to the launch of the solution.

Navigating the Changing Landscape of Medicare Advantage Star Ratings in Healthcare

In the ever-evolving world of healthcare, the importance of Star Ratings cannot be overstated. These ratings, issued by the Centers for Medicare & Medicaid Services (CMS), have a significant impact on a health plan’s reputation, member enrollment, and financial performance. However, the landscape of Star Ratings is undergoing a transformation that requires health plans to adapt and implement new strategies to maintain their competitive edge. 

 Now that the 2024 Medicare Star Ratings have been released and AEP is underway, let’s delve into the recent and upcoming changes in the Star Ratings program and explore strategies and best practices to mitigate risk, overcome challenges, and improve member engagement and experience.

Want more information upcoming changes? Watch the webinar to get the full download »

Understanding the Changing Star Ratings

The 2023 Star Ratings saw a fundamental shift, with an increased emphasis on patient experience and access. The CMS introduced a weight adjustment, elevating the patient experience component from a weighting value of two to four. Even though the weighting value will move back down to 2 for 2026 stars, health plans still need to focus on delivering exceptional member experiences.

Quality ratings, particularly those related to Consumer Assessment of Healthcare Providers and Systems (CAHPS®), member experience and access, are now more critical than ever. Health plans must focus on providing positive experiences to their members to maintain high scores in this domain.

One of the most significant changes on the horizon is the introduction of the Health Equity Index (HEI), along with the removal of the Reward Factor, which was previously a vital component in Star Ratings. It’s no longer enough to provide high quality care to the general population. The HEI will require health plans to pay closer attention to the healthcare experiences of vulnerable populations, including dual eligible, low-income subsidy, and disabled individuals.

There are also some new Part D measures on the horizon around concurrent use of Opioids and Benzodiazepines, polypharmacy use of multiple anticholinergic medications in older adults, as well as polypharmacy use of multiple central nervous system active medications in older adults too. So it’s important to work with your pharmacy and clinical teams to help make sure you’re getting messaging out to providers and support to members to help manage these drug classifications. 

While the final rule changes will impact plans very differently, knowing how you will be impacted will determine your path forward. Why not apply each proposed change to your overall Stars 2023 and see the effect they have on your final results, assuming no performance change whatsoever. We’re sure you’ll find the results surprising, but more than that, it’ll arm you with the information you need to mitigate risk and adapt your strategies to ensure your continued success.

So, how can you impact and influence these measures across the Stars landscape moving forward? 

Member Experience is Paramount 

The recent changes and the introduction of the HEI emphasize the importance of member experience across the board. Now, Quality Ratings and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) ratings gauge the member’s experience and satisfaction with their healthcare providers and health plan.

Health plans should therefore view every interaction with their members as an opportunity to enhance the member experience, from appointment scheduling to care coordination. Take the time to understand not just where there’s room for improvement, but also what’s working well through the use of event-based check-ins, surveys and benefits. Implementing a three-pronged approach to behavior change that includes behavioral science, learning strategy, and a focus on health equity can help health plans drive better outcomes.

With the HEI coming into play, health plans must pay special attention to vulnerable populations. Member populations are anything but homogenous and represent a wide array of ethnic, racial and linguistic backgrounds, as well as being impacted by a variety of SDoH factors. 

NCQA started adding socioeconomic stratifications to a number measures some years ago, and this trend is expected to continue. Strategies to manage these populations should include addressing barriers to care, providing transportation options, and offering culturally sensitive content and language options to improve engagement and outcomes.

The Role of Digital Engagement 

Contrary to popular belief, Seniors, who make up a significant portion of Medicare beneficiaries, are increasingly receptive to digital channels, such as SMS messaging. While they might struggle with new digital technologies, 98% own a mobile phone (81% own a smartphone) and 94% use text messaging regularly. This shows that they are very comfortable with the simplicity and consistency of the text channel interface.

Interestingly, Seniors have some of the highest levels of engagement across population segments within programs. In fact, they have the highest levels of “conversational turns”. This means that when a plan sends a message, Seniors engage in the conversation and send responses back. Health plans should leverage these channels to connect and engage with senior members effectively. 

The Art of Conversation

There are a number of proven strategies health plans can employ to address these changes in Star ratings measures, such as leveraging best practices across behavioral science, instructional strategy and culturally sensitive and relevant content when it comes to the streaming content.

Members should feel heard, valued and informed throughout their healthcare journey. Two-way conversations are a powerful tool in this regard. These interactions, often facilitated through SMS messaging, allow health plans to engage with members effectively.

While standard two-way interactions are unable to provide tailored responses to potential barriers members might reply with, personalized two-way conversations can identify potential barriers to care or even members who may need specific screenings. Making use of Natural Language Understanding (NLU) and AI, they’re able to respond appropriately, provide real-time assistance, and enhance the member experience. In this way, health plans are able to close the intention gap and increase motivation to take action.

Furthermore, delivering culturally sensitive streaming health content that addresses health literacy gaps in a member’s preferred language can significantly impact the outcomes of outreach campaigns, improving preventive screenings and member engagement. By offering compelling, culturally relevant content, health plans can resonate more deeply with diverse populations.

The consumer experience should be at the heart of every health plan’s strategy. By leveraging best practices, like two-way conversations, personalized messaging and streaming health content, health plans can connect and resonate with their diverse member populations, and so differentiate themselves in a crowded market.

Charting a Way Forward

The changing landscape of Star Ratings requires health plans to adapt and embrace new strategies. As the industry places more emphasis on member experience, health equity, and quality ratings, health plans must prioritize these aspects to thrive in the competitive healthcare market.

By implementing behavior change methodologies, and leveraging digital engagement, health plans can not only maintain their Star Ratings but also improve the overall health and satisfaction of your members.

mPulse Creates Ongoing Momentum and Revenue Growth in Q3 2023

mPulse continues to address growing market demand for innovative healthcare engagement solutions tailored to hard-to-reach populations.

LOS ANGELES–(BUSINESS WIRE)–mPulse, a leader in conversational AI and digital engagement solutions for the healthcare industry, today announced strong momentum and growth year over year in Q3 2023 with 34% new and upsell revenue growth. This progress is driven by the company’s new platform licenses for omnichannel engagement and programs that drive outcomes for hard-to-reach populations across more than 220 leading healthcare organizations.

This past quarter, mPulse hosted its annual Activate2023 conference with over 200 participants across the healthcare ecosystem. The theme of this year’s programming was focused on the need to combine innovative technology, novel data, and creative digital content that create consumer journeys that demonstratively improve health equity.

At the conference, mPulse presented the company’s new generative AI capabilities that deploy large language models (LLMs) to interpret consumer messages and stage responses for health plan support staff to utilize in member communication. mPulse technology leaders led discussions on the utilization of generative AI models and the role they play alongside determinist language models for a range of digital engagement applications.

“Generative AI is poised to disrupt the healthcare space,” said Sanjeev Sawai, mPulse’s Chief Product and Technology Officer. “With the rapid adoption of this technology, we need to consider how it may impact the way individuals seek out or follow through on their care to leverage it safely and responsibly. We are glad to help spearhead these important conversations at events like Activate. Honest, transparent discussion is an important step toward developing this technology in ways that ensure patient privacy and equitable health outcomes. mPulse is on the forefront of using Generative AI in healthcare digital engagement solutions.”

Healthcare organizations are highly focused on applying generative AI capabilities across the ecosystem as they also weigh the value of these solutions against the complexity of deploying them. In a research report, U.S. Payer and Provider CIOs: Apply AI in Care Management Programs, Gartner ® outlines the role AI solutions can play in supporting AI strategies and lists mPulse as a Representative Vendor.

mPulse Mobile recently completed a survey of healthcare executives assessing the focus of their health equity strategies and the challenges they are facing. The survey report highlights the most common areas of focus for health equity strategies: improving access, leveraging digital outreach and capturing data, and managing data completeness around race, ethnicity, and language. The results indicate that healthcare executives face common barriers when implementing health equity initiatives, including connecting members to resources, the availability of actionable data and access to funds overall.

“We are at a crossroads, as emerging AI technologies are showing very real potential to drive progress in health equity initiatives,” said Bob Farrell, CEO of mPulse Mobile. “We are constantly collaborating with innovative healthcare leaders who recognize the importance of technology-driven engagement programs that best serve hard-to-reach populations. There is an urgent need to deliver innovative solutions that address health equity barriers at scale. Our partnerships with leading healthcare systems continue to drive our growth and support our mission of improving individual healthcare outcomes.”

Read the full press release on Business Wire »

Gartner, U.S. Payer and Provider CIOs: Apply AI in Care Management Programs 13 October 2023, Amanda Dall’Occhio

GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally and is used herein with permission. All rights reserved.

Gartner does not endorse any vendor, product or service depicted in its research publications and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Garnter’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

mPulse Recognizes Innovative Healthcare Organizations in the Sixth Annual Activate 2023 Awards

mPulse Mobile recently wrapped up its fifth annual Activate conference with the Activate Awards, which provided yet another celebration of healthcare leadership, innovative program design, and improved health outcomes amidst various health engagement challenges.

The theme of Activate2022, The Power of Behavioral Science to Drive Health Action, was reflected throughout the conference with captivating speaker sessions and expert panel discussions. Networking inspired exciting conversation around innovative technology, behavior change design, and consumer experience, and the Activate Awards surely brought those conversations full circle.

The awards help illuminate health plans, health systems, health service providers, PBMs and other types of healthcare organizations that utilized new strategies or unique tools to activate their consumer populations. The companies highlighted each year typically face barriers with engaging a certain population or driving specific health actions, so they search for innovative solutions to tackle those challenges. 

For example, in 2019, CountyCare saw drastic rates of members losing Medicaid coverage, so the managed care organization (MCO) implemented automated text dialogues and saw their Redetermination rates improve by 3.3 percentage points in just one month, subsequently running away with the Most Improved Consumer Experience award. Last year, CareSource incorporated secure surveys, SMS, and streaming video to significantly impact their hard-to-reach members – they won 2021’s Best Use of Conversational A.I.  

The same story is true for this year’s winners.   

The remaining 3 award categories are Achieving Health Equity, Most Innovative Solution and Most Significant Outcome. Like the teamwork and critical thinking generated from breakout workshops and Q&A during the conference, the awards are a celebration of two companies that partnered together to overcome consumer barriers or gaps in care by building uniquely tailored engagement programs. 

Here are the winners of the 2022 Activate Awards: 

Achieving Health Equity

 
Program Goal
Increase Colorectal Cancer Screenings

AltaMed Health Services is one of the largest Federally Qualified Health Centers (FQHC) in the United States and provides a range of health services to Latino, multi-ethnic and underserved communities in Southern California. After seeing a steep drop in colorectal cancer screenings during the COVID-19 pandemic, the health center sought a solution that could help patients overcome barriers like language and lack of awareness of services. 

AltaMed partnered with mPulse to deliver multi-lingual, educational health content to patients using mobile fotonovelas tailored to both males and females who had not completed a screening. Patients received and digested vital communication about getting screened, where to find the nearest screening site, and more through culturally sensitive stories delivered in a familiar format.  

A randomized control study found that 63% of patients who responded to the fotonovelas either liked or loved it, and 39% reported it positively impacted their willingness to act. By educating patients with curated content, AltaMed closed a key screening gap, lifted health literacy and perhaps most importantly – made significant progress toward health equity.

Notable Outcome
Patients that viewed the fotonovelas (19%) were more likely to submit a sample for cancer screening than patients in a control group (11%)

Best Use of Conversational A.I.

 
A Technology-Enabled Health Services Company
 
 
Program Goal 
Promote smoking cessation among teen vapers 

This leading health services organization employs over 210,000 employees globally and utilizes technology-enabled solutions to promote consumer wellness and population health. A major public health problem facing young adults, particularly teens, across the U.S. is the use of e-cigarettes, or vaping. The company sought to promote smoking cessation among teen vapers, a cohort still widely understudied, by implementing intelligent conversational solutions and educational content.

They collaborated with mPulse to build a personalized SMS program, lasting 4-6 months, that leveraged Natural Language Understanding (NLU) to deliver automated, interactive text dialogues to a targeted teen population. Individuals were also provided custom-built streaming health videos that offered tips on quitting and even an option to connect with an SMS coach. 

The use of NLU enabled the delivery of automated messaging based on text responses, which helped the organization direct each individual to the appropriate resource. The program yielded an 85% engagement rate, and ultimately 69% of participating teens completed the program. The key result, that 73% of teens in the program set a date to quit vaping, demonstrates the value in utilizing automated text conversations and on-demand content to promote smoking cessation in vulnerable teens.

Notable Outcome 
73% of participating teens set a quit date
 
 

Check out a new streaming health course for smoking cessation. »

 

Most Improved Consumer Experience

 
CalOptima Health
 
 
Program Goal 
Increase Awareness of SNAP benefits (CalFresh)

CalOptima Health is a County Organized Health System that provides health insurance coverage for low-income children, adults, seniors and people with disabilities. As Orange County’s largest health plan, the organization includes a network of over 10,000 primary care doctors and serves over 900,000 Medi-Cal beneficiaries. The health system looked to address a gap they had identified with low-income families enrolling in the state’s food assistance program, CalFresh, federally known as SNAP.

CalOptima and mPulse partnered to launch a two-way texting campaign, which utilized interactive SMS powered by NLU and tailored to 7 different languages. The health plan addressed language barriers by delivering vital information about CalFresh’s food security benefits to underserved families and Medi-Cal members in their preferred language.  

Through automated text workflows, members could respond in their native language with answers like: “I already have CalFresh” or “I want to apply.” The program has continued to expand, having delivered over 5 million messages in 2022 already. Communicating with members according to their preferences about important CalFresh benefits helped CalOptima both improve consumer experience and reduce food insecurity for an at-risk population.  

 
Notable Outcome 
Over 5 million messages delivered to members in 2022 about CalFresh benefits

Like what you’re reading? Join us next year for Activate2023! Secure your spot now. »

Most Innovative Solution

 
 
Program Goal 
Drive members to schedule a diabetic eye exam

Humana is one of the five largest health plans in the country according to member enrollment and has been partnered with mPulse for over 10 years. With more than 20 million members, including over 5 million Medicare members, the plan looked to close a gap with their members scheduling the annual diabetic eye exam.

The plan worked with mPulse to launch an SMS texting campaign to increase awareness around the importance of the eye exam and to drive members to schedule an exam. The program featured A/B testing, in which one half of members was provided a 30-second streaming health video in the initial message while the other half received only text.  

The educational video enabled a learning experience that was easily accessible and familiar, concluding with a URL for members to learn more about scheduling the eye exam. Humana saw a remarkable 270% increase in clicks to schedule an exam when outreach included the streaming video. The test demonstrates that using streaming health content alongside two-way conversational solutions can significantly help activate hard-to-reach members with diabetes.

Notable Outcome 
270% increase in clicks to schedule a diabetic eye exam when outreach included 30-second streaming video

Most Significant Outcome (tie)

 
A Technology-Enabled Pharmacy Services Company
 
 
Program Goal 
Improve member experience and pharmacy engagement

The leading PBM and pharmacy services company is nationally recognized and fills over 1 billion prescriptions annually for millions of healthcare consumers across the country. With a rapidly growing population, the healthcare leader sought a solution to improve pharmacy patient engagement by utilizing a new communication channel for its home delivery pharmacy and prior authorization programs. 

The pharmacy leader partnered with mPulse to roll out more than 50 outbound-dialer Interactive Voice Response (IVR) campaigns. The IVR messages notified members about prior authorization approvals/denials, refill reminders, shipping details and doctor responses.  

Ultimately, over 5.8 million IVR records were exchanged and the outbound dialer launched over 5.1 million total calls. By offering a new avenue for members to complete a healthy action like ordering medications, the pharmacy enterprise initiated meaningful conversations to help enhance member experience, improve self-service capabilities, and close pharmacy engagement gaps.

Notable Outcome 
Reached over 2.2 million members with 55,000+ members giving SMS consent

Most Significant Outcome (tie)

 
 
Program Goal 
Improve refill adherence for HIV patients 

MetroPlus Health Plan is a subsidiary of NYC Health & Hospitals, the largest municipal health system in the country. The insurance organization serves a diverse group of over 600,000 New York residents across Medicaid Managed Care, Medicare, D-SNP, MLTC and more plan types. A big challenge for the plan was getting HIV patients to refill medications that are pivotal to managing their condition and avoiding complications.

MetroPlus partnered with mPulse to educate the vulnerable population through interactive text messaging about the importance of medication adherence and reducing their  unmedicated days. Texts were delivered one week apart and provided members with vital resources like phone numbers of a pharmacy or a member of the HIV care team.

The plan measured results based on whether or not a patient completed a refill within 7 days of initial outreach. The program yielded a 69% improvement in medication refills when SMS text reminders were deployed, indicating that text nudges inspire self-efficacy and action within this vulnerable population. Through targeted, mobile intervention, MetroPlus helped positively impact medication adherence for over 1,000 patients living with HIV.

Notable Outcome 
69% improvement in medication refills with mPulse text reminders

Health Challenges in 2023

The 6 winners of this year’s Activate Awards showed that even when a new barrier is identified with engaging a population, healthcare organizations must adapt to adhere to their consumers’ needs. Whether utilizing a new communication channel, adding streaming video or incorporating multiple languages, the awards demonstrate that providing healthcare consumers with tailored, learning experiences can significantly impact how they engage with a program. 

As the needs and preferences of healthcare consumers continue to evolve, so too should the capabilities of the healthcare organizations that serve them. Next year’s awards ceremony will surely exhibit a new string of engagement challenges with complex populations and niche use cases – let’s see what type of healthcare innovation surfaces in 2023!