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What Type of Healthcare Chatbot Do You Need?

Posted on by mPulse Team

Chatbots play an increasingly important role in healthcare. In addition to improving member and patient satisfaction, many chatbots gather data through conversations, providing rich, new sources of health data that can inform care at the individual and population level.

This post walks through nine different types of healthcare chatbots, the role chatbots play in healthcare, and recommendations to consider when using a chatbot to help serve your patients or members.

Types of Healthcare Chatbots and Their Value

Appointments

Scheduling (and rescheduling) healthcare appointments is a relatively simple process that has historically required at least one staff member for each appointment and been very time consuming. This is where appointment scheduling chatbots come into play. These chatbots make It easy for a patient to schedule an appointment on a website, inside a portal, through an app, or even via text message while including valuable information like reason for appointment, symptoms, etc.

In many cases, appointment scheduling chatbots need to be integrated with an EHR system to be most effective, which allows for automatic scheduling and re-scheduling with little to no human intervention. And when PHI is properly managed, these chatbots may also be able to deliver valuable information like lab results directly to the right patients.

Symptom Checker

At their best, chatbots provide more valuable and relevant information than a web search. They are able to do this because they are siloed; if a user is within a healthcare chatbot’s ecosystem, it can be assumed their questions are all healthcare related. When a user searches on the web, results often need to be broader to address a variety of intent.

In addition to an improved experience, as chat often feels more personal than search, symptom checker chatbots rely on a blend of healthcare experts to provide reliable data and Natural Language Understanding to analyze patient and member symptoms, return helpful information, and recommend care.

At their best, symptom checker chatbots align with appointment chatbots to help patients and members get necessary care with limited barriers.

Health Tracking

Many patients and members have ongoing health needs such as care prior to, day of, and following a procedure. These chatbots typically feature timely check-ins, medication / care reminders, and the ability to understand if a patient or member is reporting an adverse condition. These chatbots need to be able to log a record over time to be most effective and relevant.

Chatbots that help users with fitness or diet goals often fall into this category as well.

Chronic Condition Self-Management

Properly managing chronic conditions is an ongoing challenge for healthcare organizations and their consumers as chronic conditions require a blend of ongoing tracking and specific care as challenges related to the condition shift. Whether coordinating care, reminding people to take medication, providing valuable information or many other uses, these chatbots need to be able to both provide tailored information and react to changing individual needs.

Similar to Health Tracking chatbots, Chronic Condition Self-Management chatbots help users track and manage their condition on an ongoing, long-term basis. They typically require a more specific medical knowledge base than Health Tracking chatbots.

Engagement

Everything people do impacts their health. One challenge healthcare organizations face is getting people to engage with their health and healthcare. Afterall, there are so many other things that fill time and mindshare. Patient and member engagement chatbots create meaningful experiences and find valuable ways to connect with people and engage them in their health, whether by providing an important health reminder, uncovering some new healthcare information / status, getting a mental health update in real-time, or many other uses.

Engagement chatbots typically focus on consistent touchpoints and a long-term relationship with patients and members.

Digital Front Door

Chatbots are a key component of many successful digital front door applications. Digital front doors provide a virtual experience similar to a really great waiting room where a nurse collects key information to help optimize your visit and route care accordingly. Chatbots play a vital role here as they act as a combination receptionist, nurse, and source of information.

Digital Front Door chatbots must be personable and useful to consumers while gathering key information that helps healthcare organizations optimize care resources.

 FAQs

While a symptom checker chatbot helps address patient and member questions about their health, FAQ chatbots help address questions about healthcare. The goal of FAQ chatbots is to provide a better experience and easier access to answers than scouring a healthcare organization’s website or portal in search of answers. Similarly, they reduce the burden on call centers by reducing inbound calls to find answers to common questions.

A smart FAQ chatbot is able to ask the user questions to refine and deliver the best answers.

 Inbound vs Outbound Chatbots

Like any conversation, an interaction with a chatbot can be started by a consumer (inbound) or by the chatbot (outbound). In most cases, chatbot conversations are inbound as they trigger when a consumer visits and app or website and begins a chat. The challenge with inbound chatbots is they require a consumer to take an action (sometimes a few actions) before the conversation can begin. Outbound chatbots are less common as they require an existing, open channel to work. The best example of outbound chatbots is those that communicate through SMS or RCS, reaching consumers directly in their text message inbox.

mPulse Mobile offers a variety of solutions that feature outbound chatbots.

How Chatbots Need to Work Together

The overall goals of healthcare chatbots are to improve patient and member experience, optimize healthcare staff, help people stay healthier, gather valuable data, and make organizations more efficient. While specific chatbots can help address specific needs, a holistic approach is needed to accomplish all of these goals.

Learn how mPulse Mobile is combining omnichannel patient and member engagement with streaming health education to help solve many of healthcare’s biggest engagement challenges.

Solving Two Big COVID-19 Vaccine Challenges

Posted on by mPulse Team

The world is undertaking the largest vaccination program in history. It comes as no surprise that a number of logistical and cultural challenges have arisen. After all, there are around 8 billion people with different backgrounds, beliefs, and access to care on the planet, almost all of which should be vaccinated rapidly. Let’s look at the challenges and the solutions required to meet them.

Challenge 1: Supply Strain and Processes

There is not a uniform vaccine distribution approach. Each state and county is constrained by limited vaccine supply and faced with different populations’ needs. This lack of a broad, consistent process creates a lot of questions about who is eligible for a vaccine, how to book an appointment, and where to go for information.

What do people do when they have questions and can’t find clear answers? They reach out to the organizations and people they assume have the answers. The first issue: if people reach out to the wrong source, they may get the wrong information. The bigger issue: a huge surge of calls and other communication with their healthcare organizations, overwhelming staff and resources.

The solution is proactive outreach.

One of the biggest keys to proactive outreach is simply getting started. Establish the line of communication with members and patients to build awareness and establish trust. Then it’s all about reaching out quickly and thoughtfully. Provide updates as soon as possible, answer questions before they are asked, and share access to resources. The more reliable Covid vaccine information patients and members can easily access, the more empowered they are.

Pro Tip: Tailor Covid vaccine outreach based on eligibility. This reduces questions and improves patient and member experience as they do not try to schedule a vaccine appointment before they are eligible.

Learn more about the mPulse Mobile Ages 5-11 Covid Vaccination solution »

Challenge 2: Vaccine Education

According to Pew Research, about 40% of Americans say they do not plan to get the vaccine, though nearly half of this group cited the need for more information. At first, these stats can be a little surprising; Dr. Fauci has become something of a celebrity and the CDC is constantly sharing information. But for a range of reasons, these national campaigns aren’t convincing this segment of the population.

The solution is tailored education.

The first step in providing tailored education is understanding what personas and population segments are questioning or are doubtful of current Covid vaccines. Any healthcare organization that does not have a clear idea of who in their population falls into this category should begin with simple outreach to find out. This can be as basic as a short survey, maybe even just a single question asking whether they intend to get a Covid vaccine.

Once this population is identified, the trick is to deliver education through channels and formats they prefer. Some ideas include videos of doctors or other healthcare experts from nearby or similar communities discussing vaccine safety, digital fotonovelas featuring identifiable characters, and other streaming media like podcasts or video courses that address their specific concerns. People resonate with different messages and formats; it’s all about relating to them.

Pro Tip: Begin with basic outreach to better understand your population and their sentiments. This also opens a valuable communication channel that can be used for education.

A holistic Covid vaccine engagement solution must be able to impact both of these challenges to help your organization achieve the widest possible vaccine distribution possible this year.

mPulse Mobile Acquires The Big Know

Posted on by mPulse Team

The acquisition combines mPulse’s proven ability to reach and engage vital member populations with The Big Know’s learning expertise and rich media health education experiences, enabling health innovators to deliver personalized conversational experiences in preferred member channels and streaming content formats. Click to read the full release.

Hear from mPulse CEO, Chris Nicholson, and The Big Know President, Allison Gage

A Tale of Two Companies

mPulse Mobile

One thing we’ve learned from over a decade of experience and more than 400 million conversations annually is the power of education in self-efficacy and how that leads to activation. Our solutions excel at reaching and engaging diverse member and patient populations on their healthcare journey, helping customers to measurably improve outcomes. We are on a path to power over half a billion digital interactions in 2021, through a combination of engagement channels, behavioral science strategies, analytic insights, and industry expertise. Combining our engagement expertise with streaming health education creates a holistic member and patient engagement experience for our customers.


Chris Nicholson, CEO, mPulse Mobile

The Big Know

The Big Know creates health education for the streaming age. Through video courses and podcasts taught by inspiring health experts, the company drives health literacy and member engagement through powerful learning technology. Launched in 2015, The Big Know is recognized as an industry-leading learning experience platform and health education provider.


Allison Gage, President, The Big Know

Looking Forward

As consumer expectations and preferences continue to change, healthcare organizations must adjust to meet their needs and maintain strong relationships with their consumers. Quality member and patient engagement is a vital and unavoidable part of the healthcare journey. The acquisition of The Big Know empowers mPulse to meet consumer expectations with streaming health content, including podcasts and video courses. Additionally, this acquisition increases our ability to create new content and engagement experiences as consumer and organization needs evolve. We aim to always be up to date with consumer interest and behavior so our customers can provide best-in-class experiences to their members and patients. We are now able to do that better than ever.

Full Release

mPulse Mobile Acquires The Big Know To Add Streaming Health Education Experience

Pivotal industry partnership reimagines health engagement and sets forth path to drive greater health outcomes

LOS ANGELES, January 19, 2021 – mPulse Mobile, the leader in conversational AI solutions for the healthcare industry, today announced its acquisition of The Big Know, a prominent digital learning company transforming how healthcare educates consumers. The partnership combines mPulse’s proven ability to reach and engage vital member populations with The Big Know’s learning expertise and rich media health education experiences, enabling health innovators to deliver personalized conversational experiences in preferred member channels and streaming content formats.

“One thing we’ve learned from years of healthcare engagement is the power of education in self-efficacy and ultimately health activation,” said Chris Nicholson, CEO and Co-Founder of mPulse Mobile. “Healthcare organizations need to provide meaningful and relevant education to their consumers in a way that is both familiar and impactful. We realize that streaming health education experiences are the best way to meet that need.”

mPulse Mobile solutions excel at reaching and engaging diverse member and patient populations on their healthcare journey, helping customers to measurably improve outcomes. They are actively engaging nearly 50 million Americans and are on a path to power over half a billion digital interactions in 2021, through a combination of engagement channels, behavioral science strategies, analytic insights, and industry expertise.

The Big Know adds a superior ability to captivate, educate and activate individuals through award-winning cinematic content that is proven to sustain deeper relationships. The company’s unique approach to personalization allows for delivery of content when and where members need it most and supports their learning journey.

Both companies combine to set a new standard for health engagement and experience. The result is a holistic approach to digital health engagement with integrated conversational AI and rich content streaming, a major development for the industry that helps address gaps in how healthcare organizations educate and activate their members.

“We have a mission to improve health equity and health outcomes for the populations that we serve. Building on a foundation of knowledge through demographically appropriate learning strategies will help our clients and us achieve these goals and reduce health disparities,” Nicholson continued. “Our combination with The Big Know is a perfect synergy. Our legacy of engaging with hard-to-reach patient populations combines with their dedication to health literacy and formative learning experiences to ensure more educational engagements and greater outcomes.”

A deeper entrenchment in the streaming age and shifting consumer expectations demand a shift in the healthcare industry’s approach to care delivery and experiences. Quality patient engagement must be acknowledged as a vital and unavoidable part of the healthcare journey. Through this acquisition, mPulse and The Big Know will not only address these emerging industry demands but will pave the way by reimagining what patient engagement and experience should accomplish.

“When we think about healthcare delivery, member and patient engagement must include education,” said Allison Gage, current President of The Big Know, and mPulse’s new Chief Engagement Officer. “We must help consumers better understand and learn the skills to activate their personal health journey and give them the confidence and motivation to seek the best possible care. Only then will they take the necessary action to be healthier and happier. Our collaboration with mPulse allows us to accomplish this and so much more, and our investors, such as LFE Capital are excited about this new direction for The Big Know.  This is a most meaningful year in healthcare and a time for transformational health engagement.”

How to Maximize Health Plan Member Experience Through Communication

Posted on by mPulse Team

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.

Explore mPulse Mobile’s solutions

3 Steps to Listen to your Members at Scale

Posted on by mPulse Team

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

Posted on by mPulse Team

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.”

CAHPS: How to Plan for 4x Weighted Stars Measures 

Posted on by mPulse Team

Earlier this month, we noted that October is the month for Medicare advantage in our discussion of the 2021 CMS Star Ratings release. Last week saw the other major Medicare Advantage event of the month, with the start of the Annual Election Period. As plans enter the member acquisition and retention season and all efforts are focused on maximizing plan growth, they hope to finish 2020 in a strong position ahead of OEP and to start 2021 with more returning and new members.  

 That period of time, when plans traditionally begin onboarding new members and welcoming returning ones, will be more important this year than ever before.The reason why is simple: the impression new members get of your plan, and the validation (or lack thereof) that returning members feel about their decision to stay, will now impact a lot more than retention. The 2021 CAHPS survey for Medicare will feed into Stars measures that are 4x weighted for the first time ever, and those Member Experience measures will comprise the largest component of plans’ overall ratings.  

Returning members, who are receiving marketing materials and outreach right now, will be responding to questions as soon as February 1st 2021 on the CAHPS survey. Those questions cover 6-month periods. This means member experiences occurring right now may impact these high-weight measures for the 2021 survey and 2023 Stars. 

From Campaigns to Relationships 

All plans understand new member onboarding and returning member outreach is crucial during the months of AEP and OEP. But the changes coming in 2021 mean following the traditional playbook this year could hurt performance, as members receive high touchpoints and support from October to January, only to have the cadence of plan communication go “back to normal” just before CAHPS surveys begin to be fielded. Viewing enrollment, retention, and onboarding as discrete “campaigns” misses the opportunity to see this time period as the beginning (or new chapter) of a relationship between the plan and member.  

That relationship must be nurtured and supported all year to maximize member satisfaction and experience, not just these traditionally-important months.  

 mPulse helps many of our Medicare partners with new member onboarding and navigation, but our plan experience solution also supports ongoing, year-round touchpoints and conversations to continually connect members with relevant benefits, resources and tools to keep the member connected to their plan, and maintain that relationship. Whether you work with us or not, this year-round approach is increasingly becoming the standard for MA plans as member experience and orientation becomes a priority for quality teams as much as it is for member services, marketing, and retention departments.  

Connecting with members about their benefits year-round is one part of the relationship-based approach to member experience. But like any relationship, it has to be a two-way street. That means plans must find ways to listen more to members and help them feel heard. Many have already started, going beyond grievance/complaint tracking and proxy CAHPs surveys to create more conversations with their members.  

Several MA plans we work with use automated check-ins – sometimes related to an event like a provider encounter or a customer service call, sometimes just because they haven’t heard from the member in a while – where they can get the pulse of large populations. With strong Natural Language Understanding and response handling, they can hear common questions and concerns then serve up relevant resources and tools – connecting a member who waited on hold with a call scheduling tool, for instance. And asking for feedback at scale on conversational channels means that member feedback can be analyzed for sentiment, intent, or keyword to help make more informed and member-centric decisions.  

The changes to the CAHPS measure weights mean that every member touchpoint, or lack thereof, is now a key opportunity for Quality Improvement as the relationship between members and plans takes a central role in performance. Your strategies and communication plan for member onboarding is likely finalized. But now is the time to think about “what’s next?” to continually strengthen that relationship and keep members engaged with their plan throughout the CAHPS season and beyond.  

Want to learn more about how we can help? Check out our CAHPS Solution.

Release: mPulse Mobile Adds Brendan Miller as Chief Commercial Officer and Reva Sheehan as Government Programs Strategic Market Executive

Posted on by mPulse Team

New strategic roles to drive growth and deepen relationships with government health plans.

mPulse Mobile, the leader in Conversational AI for healthcare, today announced Brendan Miller as Chief Commercial Officer and Reva Sheehan as Government Programs Strategic Market Executive.

Miller’s leadership position in the rapidly growing organization includes teams responsible for sales, partnerships, sales enablement, and marketing, driving toward meeting strategic business initiatives and proactively addressing health plan, health system, business partner, and government needs. With more than two decades of experience transforming healthcare delivery and scaling start-up to mature healthcare companies, most recently on the executive leadership team at Amwell, Miller is tasked with executing mPulse’s growth strategy and evolving go-to-market channels.

“Our long-term relationships with enterprise customers and pushing ourselves to innovate to meet the needs of incoming customers has been key to our growth, and we are eager to build on those relationships,” said mPulse Chief Executive Officer, Chris Nicholson. “Digital health is transforming care delivery, which is the future of healthcare. We continue to invest in solutions that focus on engaging every healthcare consumer as part of this new system of healthcare, with a special focus on health equity and engaging historically underserved populations. In this new era, we’re confident Brendan’s proven record of leading companies to growth and his deep healthcare experience will be a major asset to our organization.”

In addition to Amwell, Miller served in leadership roles for MultiPlan, HealthMine, Wellness Corporate Solutions-LabCorp, and America’s Health Insurance Plans.

Sheehan is an experienced government programs subject matter expert with more than 15 years of industry experience ranging from long-term care and compound pharmacy management to health plan quality and operations, most recently leading Medicare 5-Star Quality initiatives at Priority Health. She is tasked with enhancing mPulse’s support of government plans through technology, relationships, and subject matter expertise.

“We have been so excited about our partnerships with Medicare and Medicaid plans throughout the country, as well as the important impact we have helped make on those key populations,” said Nicholson. “Reva’s experience, expertise in government plans, and passion for member experience is a perfect fit for our organization and will help us continue to build solutions for this segment.”

2021 Medicare Star Ratings: What it Means for Member Engagement

Posted on by mPulse Team

The wait is over! Today 400 Medicare Advantage and 55 Part D plans received the final 2021 Star Ratings from the Centers for Medicare and Medicaid Services (CMS). This is always a milestone day for every Medicare organization. Plans who perform well receive higher quality bonus payments and rebates, and have been shown to outperform lower-rated competitors in member acquisition and retention.  

This is also a big day for mPulse as we look at the role of member experience and engagement in determining a majority of each plan’s summary rating. Even in this year’s release where CAHPS and HEDIS data is carried over from the 2020 ratings, we see how CMS changes and increasing Part D competition make a major impact on performance. So, as our team looks at the 2021 data, we are always looking at the implications for the dozens of Medicare plans we partner with and member engagement overall. 

Here are some themes that stand out to us: 

Mostly Neutral and Negative Movement for Plans 

The Medicare quality landscape got even more competitive this year, continuing a trend we’ve seen from CMS in recent years to push for more stratification between plans in ratings. While the number of 5-star plans increased by one, the overall number of plans at or above 4 stars declined by a net of 16. While the 2020 ratings saw an impressive 52% of contracts at or over 4, this year’s group will drop to 49% of MA-PD contracts. With many data sources remaining static, a lot of the negative movement plans experience will be due to cut point shifts, weighting updates, and the measures that weren’t impacted by COVID-19 changes.  

This year’s data aside, the number that jumps out the most at us today is 212. That’s the number of MA-PD contracts appearing as “too new to be measured” this time, compared with the 400 actually measured. Established plans have to prepare for these newer contracts to pursue higher ratings with intense focus, knowing that a poor start can be difficult to recover from.  

mPulse is working with both long-standing plans that are evolving their quality strategy to protect high rating, as well as newer contracts that want to compete with high–rated plans immediately. The common theme we’ve heard from both types of teams is that they know they need to do more than the standard quality improvement playbook. They’re going beyond traditional engagement channels and provider-relations-centric approaches, using partners like mPulse to differentiate member experience and activate each of their members. Today’s news will only accelerate those trends.  

CAHPS Weighting Adjustments Have an Impact 

Member experience is a major topic in Medicare and these 2021 ratings are a reminder of why. This year was supposed to be a transitional period where non-flu CAHPS measures move from 1.5x to 2x weight before eventually moving to 4x in 2022 and 2023 ratings (the measurement year of 2021, coincidentally). But since CAHPS data was carried over from last year’s ratings due to COVID, plans are in the unexpected situation of seeing the same data impact their overall rating more, with good being better and bad being worse.  

While many plans will be frustrated to see CAHPS improvement efforts not reflected today, the work they have done and strategies they put in place now will have a huge impact soon. Plans that have relied on meeting call center requirements and fielding proxy CAHPS surveys are moving towards dedicated CAHPS/HOS strategies and member engagement solutions focused on Member Experience. As we see what a 25% increase in measure weight looks like today, plans are thinking about how they can understand and improve member satisfaction next year, where the weight will increase by another 100%.  

We’re working with our partner plans to create new, conversational touchpoints with members and feed critical experience data back to the entire organization – helping them make decisions driven toward improving CAHPS and HOS scores before the next major weight jump.  

Medication Adherence Is Even More Competitive 

As expected, the measures least impacted by the COVID changes were the ones to experience the most cut point movement. These measures represent an important area of focus for plans heading into next year. The Medication Adherence measures were at the top of this list with their traditionally narrow cut points and triple weighting. These measures saw a uniform drop in average MA-PD rating of .1 to .2 stars, and the SUPD measure, 3x weighted for the first time, dropped .4 stars on average. Plans that did well in these Part D measures will be very pleased today since they faced strong headwinds this year.  

Medication Adherence is one of the key measure sets for plans that work with mPulse since so much of success depends on member action. It’s another area where intense plan competition is only going to increase as more plans look to improve adherence in their entire populations and go beyond simple refill reminders. Connecting members to initiatives like 90-day supplies and mail order pharmacy, as well as gathering data on barriers to adherence helps plans improve their measures and make better decisions about pharmacy quality strategy.  

Understanding why an individual member isn’t adherent helps us get the right resource to them immediately via mobile channels while helping build a better understanding of what we need to do to help the entire population improve. That sort of understanding is critical as plans look to deal with ever-higher cut points and even more competitors going forward.  

The 2021 ratings are going to be remembered for all of the unusual circumstances impacting them. But for all of the carried-over data, impending weight shifts, and large number of new contracts, we think they tell a consistent story. Medicare Advantage plans will continue to succeed in large part by how well they engage their members to deliver a differentiated experience and drive vital actions to improve their health. We join our MA-PD customers in looking forward to a more “normal” 2022 rating set, and are excited to deliver solutions to help them reach their organizational goals, create innovative experiences for members, and ultimately better serve the people they care for.  

3 Key Points: Member Engagement and the 2021 Medicare Star Ratings

Posted on by mPulse Team

October is, in many ways the month for Medicare Advantage plans. The Annual Election Period begins on the 15th, following the release of final Star Ratings early in the month to help members make informed decisions on staying or switching plans. This year’s set of Star Ratings will be different than any previous iteration. The adjustments from CMS in the wake of COVID-19, combined with the previously-announced changes to measure weighting for future measurement years, creates a unique moment for plans looking to maintain strong ratings and improve in key areas. As the leader in Medicare member engagement, mPulse has some key points to keep in mind from a member engagement perspective as we look forward to the 2021 ratings release this month.

1. Many measures dependent on engagement will not reflect change… this year

The CMS decision in March to carry over 2020 Stars for many measures means that a large portion of this month’s final release will not bring a lot of surprises. Key measures that depend on members taking action to improve their health – such as the HEDIS gaps in care measures – are traditionally critical area for quality team efforts. Those efforts back in the 2018 measurement year won’t be reflected this year. Plans already understand that what CMS chooses to do for the 2022 ratings (and possibly 2023) may have big impacts on the numbers and are preparing for volatility.

The immediate impact for member engagement is that plans won’t have a more recent benchmark against their competitors’ gaps in care efforts for at least another 12 months and that the next release may see broad swings in these measures. So the work that plans do right now to reach and activate more members around preventive care will be crucial to competing in a very different Stars landscape going forward. Plans can’t afford to wait for CMS to announce how the measurement year 2020 and 2021 HEDIS data will used. No matter what, the plans that have scaled and robust solutions to drive screening completions and better preventive care outcomes will be best positioned going forward.

2. The measures that did change will make key Part D measures even more competitive

We know from plan previews that the 2021 measures unaffected by the COVID-19 changes saw significant movement, especially in Part D. Medication adherence measures particularly saw higher cutpoint movement – and many plans will be negatively impacted by the combination of the “frozen” Part C measures and these more competitive Part D ones. There is reason to think that the Part D measures – which have long been highly clustered and competitive – will maintain these high cutpoints going forward. This means that plans must find ways to reach more and more of their population in order to improve or maintain good ratings. The traditional model of thinking – some members will always maintain adherence, some will never have a chance, and a narrow percent are on the borderline and should be the focus of engagement – has to change.

At mPulse, our Part-D solutions are typically focused on improving adherence among non-adherent or borderline non-adherent members, to try and expand the pool of members who can become adherent and join the numerators of the adherence measures. Our plan partners prefer this approach because our automation and ability to have conversational interactions on high-reach channels means they can keep their teams focused on the QI activities where human-to-human interaction is required. They work with us because we have been shown to reach more of those “denominator-only” members that traditionally don’t act on basic Rx refill reminders. That approach, whether with a technology partner like mPulse or not, is vital to success in these increasingly competitive measures.

3. The 4x weighting of CAHPS measures looms large

Perhaps the biggest topic for Star Ratings this month is the one that isn’t going to show up in the release this month. The 2020 measurement year will be the last one that will not have CAHPS and member experience measures comprising a majority of the summary ratings for the foreseeable future. Member experience moves from a 1.5x weight to 2x in the 2021 ratings, which means that older non-flu CAHPS data will play a stronger role in summary ratings – but the 2021 measurement year’s doubling of that will begin a new era for Medicare quality.

Plans are already doing the weighting math to see how their summary ratings would have changed if the 2023 methodology was used this past year, and many will need to adjust their strategies to fit what will change in measurement year 2021. The focus on member experience in stars demands dedicated strategies to build and improve relationships between plans and members – mPulse is working with plans to deploy innovative and scalable solutions that gather insights on member satisfaction and experience and create meaningful touchpoints to connect with members. Our CAHPS solution is the leading option for plans that are looking to understand and improve their relationships with members.