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The Importance of Annual Wellness Visits for Providers, Payers, & Patients

Why The Annual Wellness Visit is So Important

The Annual Wellness Visit (AWV) is an incredibly effective tool for consumer health management and is key to keeping people healthy now and in the future. This valuable time spent between provider and patient gives space to check in on progress, discuss health issues, and create a care plan–not to mention it allows for the opportunity to order conduct needed screenings and preventive care, making it an easy way to close multiple gaps in care at once.

Research has shown that establishing a stronger relationship between provider and patient can positively impact health. There are also multiple indirect benefits to plans, providers, and patients, such as reduced network leakage and education on proper ER and urgent care use.

Annual Well Visit Statistics: Underutilized, Underestimated

Unfortunately, AWVs are surprisingly underutilized. Only 25% of Medicare Advantage beneficiaries receive an AWV (even though 45% of all Medicare beneficiaries have four or more chronic conditions). Many hard-to-reach populations within Medicaid and Medicare are not taking the time to schedule and attend their AWV, and many patients do not understand the importance of this visit at all.

But it is important–to both the patient and healthcare organizations. Beyond the benefit of catching and controlling health issues, the AWV is a critical component of Hierarchical Condition Category (HCC) recapturing.

In fact, an 85% AWV completion rate can result in an 80% or higher HCC recapture rate. This can mean a significant power over reimbursement dollars for plans and providers.

Learn more about improving HCC Recapturing through cutting-edge engagement strategy by watching our on-demand webinar »

Example Scenario

Our 75-year-old male patient can have two different outcomes determined by his AWV. With proper coding of his full health status in the second scenario, you see a significant increase in reimbursement–over $5,000 annually for this one patient. If you multiply that by over 500 patients, you will see an increase of $2.5 million annually (or a loss if you neglect to code correctly).

But what happens if this patient never schedules his visit or if his visit isn’t coded correctly? You’re leaving good money on the table.

Patient Demographics HCC (Hierarchical Condition Category) Risk Adjustment Factor
75-Year-Old Male   0.428
E11.41 Type 2 Diabetes mellitus w/diabetic mono neuropathy HCC18 Diabetes w/chronic complications 0.625
Total RAF   1.053
Payment Per Month   $684.45
Payment Per Year   $8,213.4

Example scenario: If this patient never schedules his visit or if his visit isn’t coded correctly. Good money is left on the table.

Patient Demographics HCC (Hierarchical Condition Category) Risk Adjustment Factor
75-Year-Old Male   0.428
E11.41 Type 2 Diabetes mellitus w/diabetic mono neuropathy HCC18 Diabetes w/chronic complications 0.625
K50.00 Crohn’s disease of small intestine w/o complications HCC35 Inflammatory bowel disease 0.279
M05.60 Rheumatoid arthritis of unspecified site w/ involvement of other organs and systems HCC40 Rheumatoid arthritis and inflammatory connective tissue disease 0.423
Total RAF   1.755
Payment Per Month   $1,140.75
Payment Per Year   $13,689
Example scenario: With proper coding of this patient’s full health status, you see a significant increase in reimbursement.

Using Technology to Unleash the Power of Annual Wellness Visits

Suppose your goal is to increase the number of members or patients you have going in for their AWV and to recapture their HCC codes properly. In that case, it’s critical to have effective outreach to educate, motivate, and drive behavior change in those hardest to reach–a challenging but attainable goal.

Behavioral Science

One of the most important tools available to increase motivation and inspire behavior change is your approach to the conversation. With behavioral science, we take what we know about human behavior and tendencies and use that knowledge to not only predict the response to our outreach but to sway people toward one action or another.

When we reach out to members and patients regarding AWVs, saying, “Hi, Susie. You’re due for your no-cost annual wellness visit,” has a measurable impact on response.

In this message, we employ the Endowment Effect, a behavioral science principle that assigns higher value to objects and tasks when consumers feel a sense of ownership and personalization. By telling Susie it’s her no-cost visit, we are making it more likely she will take action.

AI Technology

Let’s go beyond the planned messages, though. Not everything can be scripted when you start a real conversation with a real person. With Conversational AI and Natural Language Understanding (NLU), plans and providers can communicate with patients in a personalized, conversational, and real way.

Instead of one-way interactions where the healthcare organization is talking at the patient, AI and NLU broaden out your abilities into a fully-fledged two-way conversation where the patient can freely respond the way they would naturally speak, and the system can understand and carry the conversation naturally in an almost human-like manner.

If a plan is reaching out to encourage an AWV and the member says, “I don’t have a doctor,” NLU can easily recognize that response and follow up with a list of in-network doctors near the patient.

Health Equity

This technology and ability for two-way interaction opens the experience to so many more possibilities–an important one being barrier analysis.

With the ability of NLU to interpret barriers to access (such as not having access to a doctor or not having transportation to the appointment) and uncover possible social determinants of health (SDoH), the healthcare organization gains more information about the circumstances of each individual.

With AI and NLU capabilities, the healthcare organization can respond accordingly with resources, education, and support to break down the barriers tied to inequity and provide a more accessible healthcare experience.

mPulse Mobile's two-way SMS technology identifies barriers and effortlessly guides patients to schedule their Annual Wellness Visit
Revolutionizing Patient Outreach: mPulse Mobile’s two-way SMS technology identifies barriers and effortlessly guides patients to schedule their Annual Wellness Visit. Transforming care, one text at a time.

Instructional Strategy

One barrier to health equity that we often encounter is the issue of health literacy. Many health consumers need help understanding what an AWV consists of, why it’s important, or how to find a doctor to obtain one. This is where education becomes an essential part of any outreach strategy.

The video below features Dr. Archelle Georgiou, a leading physician, healthcare executive, and author, explaining why annual wellness visits are critical to preventing chronic disease and keeping a person healthy.

Including this short three-minute video can answer many questions the patient may not know they have, raise their health literacy, and increase their motivation to schedule.

Putting it All Together

These individual strategies ultimately come together to form one highly effective solution aimed at increasing the number of members and patients who schedule and attend their AWV.

mPulse Mobile’s Annual Wellness Visit solution incorporates these and can effectively drive behavior change, even among unengaged and hard-to-reach populations. With AI technology to uncover and address barriers, an omnichannel outreach method to ensure you’re reaching every member possible (no matter how hard to reach), and both behavioral science and streaming health content to inspire self-efficacy and build knowledge, healthcare organizations deploying this solution have seen up to a 61% visit rate for targeted members living near in-network clients.

mPulse Mobile's optimized patient journey ensures a seamless, informed, and empowered healthcare experience
Experience the Transformation: mPulse Mobile’s optimized patient journey ensures a seamless, informed, and empowered healthcare experience. Every step, reimagined for you.

And though this can have an impressive impact on the bottom line of healthcare organizations, it also significantly and directly impacts people’s lives and health.

The ability to catch early signs of disease and the chance to educate someone about their health and lifestyle makes the AWV one of the more powerful tools in the healthcare industry’s arsenal–so let’s make sure we are using it to its full potential.

Join 200+ leading healthcare organizations leveraging our cutting-edge solutions to improve Annual Well Visits attendance and ensure optimal health engagement through our digital health solutions. Explore how mPulse Mobile can transform AWV experiences, drive behavior change, and elevate health outcomes for your members.

Improving the Patient Experience: Solving the Top Four Healthcare Challenges 

Patients are currently going through a transformation in the healthcare system. They are less like the patients we’ve always known them to be and are starting to act more like consumers. And what is the primary trait of a consumer? Choice.

Patients today are fully fledged, active participants in their own healthcare and are making choices between different services and providers the way they make choices between brands. This changing dynamic requires that the healthcare system makes that shift right along with them. The goal of physicians, health systems, and accountable care organizations should be to ensure the patient’s experience is personalized, relevant, and on par with what they have come to expect from consumer experiences in all areas of their life. There are, however, some common challenges that we see healthcare organizations grappling with while moving toward this new normal, which can only be solved with the right mix of expertise and technology. But they can be solved for—with the result being a more valuable patient experience and relationship.

HealthCare is Challenging 

It is. And these challenges are pervasive across many organizations we work with. We’re talking about gaps in Data, Technology Capabilities, Engagement Strategy, and Organizational Alignment. 

Let’s dive into each one.

Data Gaps 

Do you have the right cell phone number? Do you know if the number you have is even for a cell phone? Is it a land line instead? Do you have the correct contact preferences? Do you have information on their social determinants of health (SDoH) and the barriers to care they’re facing? This data can make all the difference when outreaching to patients and attempting to drive them to a specific action. How can you reach out to someone if you don’t have the right number? How can you affect someone’s behavior if you don’t understand their circumstances?

Solving for Data Gaps 

In all aspects of your outreach, you need to be data driven. This starts with the ability to collect and harness your data. An SDoH Index like mPulse Mobile has is the kind of data that allows you to tailor conversations to a person’s circumstances. Specific capabilities, such as two-way automated conversations, allows us to understand what people are doing and why they’re doing it. By being able to ask people directly and receive an answer, we can take that information, record it as data, and do analysis on it to identify trends. The most valuable insights you can have will come directly from your patients themselves. Of course, this can only be done at scale with the right technology.

Technology Capability Gaps 

Having all the data in the world is little help if you don’t have the technology to use it at scale. You might be deploying one way messaging programs, which means you aren’t collecting information back from your patients to help personalize the conversation and further improve your interactions with themand forget trying to do this on a 1:1 basis without the ability for your technology to automate these conversations.

Solving for Technology Capability Gaps 

Conversational AI and Natural Language Understanding are two important foundational capabilities that can help close this gap. Conversational AI ensures you can tailor your conversation to the individual you’re speaking with, making it more likely you’ll connect with them and drive the desired action. With National language understanding, we can communicate with patients in a way that feels familiar, conversational, and natural. You get at the intent of what your patient is saying and account for humanness (such as typos or slang). At mPulse, we have linguists and computer programmers on staff who work together to come up with scripting that can interpret different combinations of languages, typos, and slang to get to the intention.

Gaps in Engagement Strategy 

Maybe you do have the means to connect with your patients with two-way automated conversations. But are you saying the right things? Are your engagements tailored and optimized to ensure maximum outcomes? How often are you messaging? What’s the tone? Do you have a team dedicated to refining all these different aspects of your strategy?

Solving for Gaps in Engagement Strategy

When you understand how people think and make decisions, you can craft your outreach in a way that predicts their response and uses that prediction to nudge them in the direction you’d like. This is the reasoning behind the behavioral science techniques we bake into our solutions. Humans are fairly predictable, and we mostly react the same. Let’s use that predictability to push them toward healthy behaviors! Many behavioral science techniques are used to build our programs: cognitive overload could determine the pacing of our program; authority bias may dictate who we have giving the information; and storytelling effect could dictations how we give the information;

Don’t know what these behavioral science techniques are? Watch our on-demand behavioral science webinar series to learn how they can transform your engagement strategy! »

Gaps in Organizational Alignment 

Your patient has gotten your messaging, they’ve made the appointment. Now, are you guiding them through transition of care in the most effective way possible? For example, ensuring they’re scheduling an appointment with a PCP after an ER visit.

Solving for Gaps in Organizational Alignment 

The goal is to produce trust-building patient experiences consistent across the entire experience with a brand. For this, we have enterprise engagement, which allows us to handle the scale necessary for organizations which can have 100,000+ patients.

We need experiences consistent across that member base while also personalized to match each individual’s needs. That’s a tall order. And this comes back full circle to data and technologyboth are needed to ensure this patient experience is protected.

The New Normal

Digital trends are changing the game. Patient expectations are changing the game. The choices they have and the experiences in everyday life they’ve grown used to are creating new rules of the road in healthcare. As it should. We have technology in the market today that allows these experiences to be exceptional, so why should they (and we) settle for anything less? 

Delivering Equitable Health Experiences Among Medicaid Populations

Earlier this month, four of mPulse Mobile’s best and brightest subject matter experts packed up and headed to sunny Florida to attend The Strategic Solution Network’s (SSN) 14th Annual Medicaid Innovations Forum. A huge topic of conversation was, not surprisingly, the FCC’s Declaratory Ruling on phone outreach for redetermination. Released in late January, this ruling opened the door for plans to utilize texting in their efforts to maintain coverage for millions of Medicaid members. 

Texting, however, has always been a big topic of conversation for us. 97% of US adults own a cell phone, and it seems everywhere you go people are glued to their devices. That is what makes SMS texting such an incredibly effective tool to add into your mix of channels. We spoke about just that during our session at the conference. 

Healthcare Experiences Powered by Technology

For that session, Reva Sheehan, mPulse Mobile’s Senior Director of Customer Insights, had the opportunity to present onstage with Sammie Turner, Quality HEDIS Manager for Maryland Physician’s Care. Maryland Physicians Care, a customer of mPulse Mobile and the third largest Managed Care Organization in the state of Maryland, administers healthcare services to Maryland’s HealthChoice enrollees. 

Maryland Physicians Care and mPulse partnered together to deploy a two-way SMS text campaign targeting multiple preventative care screenings, including Breast Cancer Screenings, Well-Child Visits, SSI, and Lead Screening in Children, and we delivered the results of that program to the audience.  

With reach rates ranging from 83% to 95%, we were able to target and communicate with thousands of their customers. The main metric we wanted to observe, however, was the success of texting compared to outbound calls. Is texting a more effective method of outreach to obtain scheduled appointments?

We focused on breast cancer screenings and found strong evidence that it was. After 30 days of outbound calls, 123 breast cancer screenings were scheduled. But with the texting program, we found that we were able to schedule 94 screenings in just four days.  

The texting program was able to get 76% of the screenings scheduled that outbound calling did in just a fraction of the amount of time and did so without the manual work of call center representatives. 

But why is this so? How is texting, which may seem less personal, able to have so much success so quickly?

Three Core Capabilities for Texting Outreach

Texting allows us to reach a large population in a single event and assists in reducing the volume of outbound calls and or letters. If you have the right technology powering your texting program, however, it turns into more than just a text but into a dynamic two-way conversation that can be used to connect with a member, break down barriers to healthcare, and deliver better outcomes.  

There are three core components that enabled this experience for Maryland Physicians Care’s members: two-way text capabilities, natural language understanding, and educational content. 

Two-way Conversations Identify and Address Barriers to Care 

When you have dynamic, interactive conversations with your members, you truly address the barriers they face when trying to get care. Lack of transportation, inability to get time off work, cost, and other factors all play a role in creating an inequitable health experience.

When a plan has the technology to have a real conversation with its members at scale, it can not only identify the reasons members aren’t scheduling screenings, but it can take it a step further to provide solutions and education for the member, such as helping them find a doctor like you see in the example below from Maryland Physicians Care’s program. When the door for care is opened a bit wider for one person, it makes the healthcare system a little bit more equitable for all.

Interested in these capabilities? Learn how these same concepts can be applied to outreach around the end of continuous enrollment » 

Natural Language Understanding and Culturally Appropriate Content 

Natural Language Understanding (NLU), a type of artificial intelligence, is the ability for our system to interpret the responses from the member (even if they are non-standard responses or slang) and respond back in an intelligent manner. mPule Mobile’s NLU is available in 7 languages with translation services for 13.  

One example of NLU in Maryland Physicians Care’s program focuses on creating a more culturally sensitive experience. For this program, the two-way SMS content automatically converted from English to Spanish if the member responded in Spanish. Their language preferences were then reported back to the plan for future interactions. The ability to communicate with your health plan in the language that you are most comfortable with makes it much more likely that they’ll keep communicating and take the desired action.

Leveraging Educational Content to Promote Health Literacy 

One thing we all know is how vital health literacy is to the concept of health equity. The ability to understand not only the care system, but your own body and healthcare needs is critical.  

Videos can leverage educational content to help overcome barriers and inspire action by delivering bite-sized stories and entertainment straight to the member’s phone during a text exchange. The below example was used for a diabetes eye exam program run with a large national health plan. There was a 274% increase in link clicks to scheduling when this video was used in the text outreach vs when it wasn’t.

Equitable Healthcare for All 

The dynamic conversational engagement used by Maryland Physicians Care enabled them to reach more members and deliver tailored resources and calls-to-action to empower members to act and deliver better outcomes at scale. When each member has the opportunity for a personalized and relevant conversation about their health with their plan, they’re receiving a more equitable experience.  

Interested in these capabilities for a redetermination program? Learn how these same concepts can be applied to outreach around the end of continuous enrollment!

Our Top Blogs of 2022

2022 has been an exciting year for mPulse! From the acquisition of HealthCrowd in January to our return to an in-person Activate conference in September, we have had a lot to share with you over the last 12 months.

As we close out the year, we want to revisit some of our blog highlights from 2022. From health literacy to our People of mPulse series, here are the five most popular articles of the year!

1. mPulse Mobile Acquires HealthCrowd

We are coming together to drive our shared mission of improving health outcomes through market leading health engagement solutions. This is a very exciting day for both organizations as our teams combine to bring an unrivaled passion and deep expertise in delivering health engagement that unlocks enormous value for our healthcare customers…READ MORE

2. The State of Health Disengagement

How do we unlock digital to get more people enrolled, lower costs to serve, and improve health outcomes at scale? That question sums up a major challenge and business imperative to lift programs and people. To frame up that challenge, three key gaps must be considered for meaningful innovation…READ MORE

3. Celebrating Achievement in Health Equity and Technology Innovation at the Activate 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…READ MORE

4. Longest. Unwinding. Ever. The Continuous Wind Down of Continuous Enrollment

912 days sit between the beginning of the Public Health Emergency (PHE) and today, July 26, 2022. The PHE has been renewed 10 times, with the latest extension set to expire on October 13, 2022. There has been no shortage of speculation around the last two extensions, especially after the Biden-Harris administration committed to providing states with at least a 60 day notice prior to its plans to terminate or allow the PHE to end…READ MORE

5. Seven Ways to Use Streaming Content in Your Health Communication, Part 2

In part 1 of this blog series, we looked at the power of Fotonovelas, Interactive Content, and Animations to drive action in health consumers. All this content does the same thing: it goes beyond just telling a member or patient that taking an action is important. It teaches someone why it’s important and what can be gained or lost by action or inaction…READ MORE

Like what we have to say? Subscribe to our blog below today to stay up-to-date in 2023!

6 Innovations in Streaming Health Content that Improve Member Experience

The logic behind streaming health content is simple. Just telling someone that it’s time to get a mammogram or renew a prescription isn’t always enough to get them to do it. There are numerous barriers to consider: social determinates of health (SDOH) factors, health beliefs, the health literacy gap, apathy, and more. Sending a well-timed, well-written text message can sometimes do the job, but often we need to go further and help the health consumer understand why taking an action matters and how they are benefiting from it. Or we simply need to get their attention for long enough to even hear us out.  

Streaming health education, when thoughtfully integrated into engagement solutions, can achieve all of these things. It infuses current and innovative types of content into member outreach in new ways. The same way we have seen the biggest brands integrate streaming content into the consumer experience, healthcare can mirror and change the way they interact with their populations and, more importantly, change the way their populations interact with them.  

6 Innovative Best Practices in Streaming Health Content


Innovation 1: Types of Content

The most innovative aspect of content in the last few years just may be the format it’s delivered in. Overall, there are four major content categories we’ve seen work well when brought into healthcare outreach. 


A lot can be said with a well-timed gif, and using humor to capture attention, as gifs usually do, are an effective way to focus the member on a very real issue, such as fall safety in our example above. 

Self-Produced Videos

Self-produced videos are often short, recorded in selfie mode, and have less focus on production value. These qualities make them more personal, fun, and more able to capture attention and connect the creator with the audience.  

Licensable Streaming Content

Spotify, YouTube, Netflix, and more! Streaming is the main delivery method for content today and used by a huge amount of the population. With the option of licensable libraries of streaming health education content now on the market, healthcare organizations can enter the game and have a better chance of meeting members where they are and in the ways they already live their lives. 


Started by Snapchat and copied by Facebook and Instagram, stories are now everywhere. Healthcare can take stories and use social media as another channel to communicate with their populations or repurpose them for SMS delivered solutions. 

Innovation 2: Making the Ask 

Now that you have your content format ready to go, you’ll want clear, robust calls to action embedded within the streaming health experience, which is our second innovative best practice. Think about it this way: all the content delivered quickly falls short if you aren’t ultimately making the ask. 

When crafting your call to action, make sure it is not only closely tied to the content being delivered but it is also specifically based on that recipient’s needs.  

Interested in learning more? Access the guide to get the full version of this content » 

Innovation 3: Integrating Your Content into Your Programs 

When you combine conversational AI capabilities with health content, you can uncover barriers to action through the consumer’s response and in turn deliver bite-sized educational clips to address their specific obstacle. This way, you are not only educating them on why they should take a certain action, but you are delivering tailored content which educates around the specific reason that individual is not complying. And because this is built on conversational AI technology, all of this is done at scale, yet individualized, for your entire population. 


Innovation 4: Creating Surround Sound

Most of the daily lives of health consumers is digital– emails, websites, apps, social media, text messaging, phone calls, streaming content, and more. This makes it easy to apply our fourth innovative technique: create surround sound by producing a digital omnichannel experience. 

In action, it might look like this: If we were heading into winter and you were trying to drive flu vaccinations, you might post an interactive FAQ to your organization’s social media story, send the mini lesson video through email or text message, and have the full vaccine lesson available through your website portal. Your audience would likely run into your content multiple times, which serves to reinforce the educational message and makes it more likely they’ll act on it. 

Innovation 5: Targeting Your Content to Clear Business Goals 

Your streaming health content is only as effective as it is in line with your goal. So, when producing and deploying content, you should tie it to the areas of your business you want to see an impact on—Health Outcomes Surveys (HOS), preventive screenings, diabetes prevention, and gaps in care just to name a few. Plainly, if your content isn’t addressing the action you’re trying to drive, you won’t drive that action. 

Innovation 6: Data, Data, Data 

Metrics regularly tracked still apply, such as text messages delivered, response rate, and completion rate of the desired action. Integrating streaming health content into your outreach, though, broadens the data you have access to for outreach performance and reporting. Now we can look at clickthrough rate to videos or activities, total views, engagement time, pages or lessons viewed per person, average number of course enrollments, average view time per piece of content, and so much more.

Integrating Health Content into Your Engagement Programs 

When healthcare organizations take the innovative approach of creating educational health content (videos, bite-sized content, interactive FAQs, polls, quizzes, and more) and incorporate it in their outreach, we see much longer engagement times, the underlying problem of health literacy improve, and the fostering of better relationships between healthcare organizations and health consumers. 

Our hope is this new frontier of educational health content creates a change in the health literacy of our society as a whole and improves the engagement and investment of individuals in their own health and well-being. 

Interested in even deeper insights into this new way of outreach? Download the guide, 6 Innovations in Streaming Health Content that Improves the Member Experience, to get the full version of this content.

2022 National Summit Recap: Scaled for Many, Tailored to One, Leveraging Data to Impact Member Engagement

We’re happy to announce our participation in the 2022 BCBS National Summit was a success! In early May, mPulse Mobile sent our strongest health engagement experts to The Orange State to attend and speak at the Summit, and they returned with valuable insights, new connections, and a reaffirmed belief in the power of health engagement designed for consumers.

Chris Nicholson, mPulse CEO, Magdalen Kmiec, Vice President of Engagement Strategy, Christian Bagge, National Account Executive, and Reva Sheehan, Director of Customer Insights, met and talked with leaders from many different Blues plans gathering stories from the front lines of healthcare and swapping viewpoints on the newest trends in healthcare engagement.

For us, the conference was a chance to meet with our current BCBS customers and have in-person discussions about their engagement programs and overall experiences with our platform. We also took the opportunity, however, to branch out and meet other BCBS leaders with whom we’ve not yet worked and have an exchange of information about our respective places in the healthcare space. These conversations gave us better insight into the landscape they’re navigating and confidence that the direction we’re taking for our customers is indeed the best course.

From Members to Consumers: Healthcare in the Digital Age

One reoccurring theme from our conversations at the summit was the age-old struggle to drive healthy action and meet requirements set by CMS, but many of these discussions showed the health industry could be looking at it all wrong. Magdalen Kmiec discussed this during our joint presentation with Aimee Viles, Vice President of Digital Solutions for Cambia Health, Scaled for Many, Tailored to One: Leveraging Data to Impact Member Engagement.

Her main message was that members are no longer just members. Our members live in an Amazon and Netflix world where their needs are anticipated and delivered on before they can even ask. Their digital and real world lives are now seamless and fluid. And they don’t shed these experiences and customer service expectations when they interact with their health plans.

Download our white paper, From Member to Consumers, to learn more about this phenomenon and how plans can adapt »

Yet the healthcare industry has not created that same experience for their health consumers – but they can. That’s where Magdalen overviewed the four essential pillars of engagement: rich customer data, channel optimization, empowering content, and robust behavioral science.

Rich Customer Data

Plans have rich data on file, but are they using it? From the results of the member’s most recent A1c test to the date of their last wellness exam, data can be harnessed to create a better experience.

Equally important, though, is to gain data through conversations with your members. Language preferences, sentiment toward the plan or program, social determinants of health (SDoH) factors, and more are valuable data points that can be added to the file for each member. Then your future conversations will become much more tailored.

Channel Optimization

Customer expectations are evolving rapidly, and our health consumers expect consistent, accurate, and timely information at their fingertips regardless of the channel they see it. Omnichannel is no longer a nice-to-have but a necessity to remain competitive.

The trick is to eliminate the silos between your channels and have them work together in a way that creates a single experience. So IVR, social media, SMS messaging, and streaming health content – it’s all working in sync to tell the same story.

Empowering Content

Low health literacy is a main driver of inaction. By delivering tailored, bite-sized streaming content in the moment based off insights gathered during conversational outreach, you are immediately addressing barriers and educating at the same time. Whether it by interactive stories, animations, or mini lessons to full courses, it gives the plan a chance to engage and empower in a more impactful way than can just be done by text message.

Robust Behavioral Science

There are two main questions for behavior change: Why would people want to do the behavior? Why aren’t they doing it already?

The ability to harness behavioral science , which tells us how people are likely to react and why, enables you to answer these questions and then leverage that information to drive behavior change. Put simply, people are irrational in predictable ways, so use that predicable irrationality to steer them in the direction of healthy behaviors. It’s the same methods used by companies like Amazon, Walmart, Target, and many other big major corporations – and it works.

Cambia Health: Gaps in Care and Rx Refill Program Outcomes

Cambia Health, our co-presenter at the summit and current client, is an ideal example of the members to consumers concept being effectively utilized, so Aimee joined Magdalen onstage to present two programs Cambia Health ran in partnership with mPulse Mobile.

The first was aimed at closing gaps in care for Cervical, Breast, and Colon Cancer screenings. Built on a foundation of behavioral science, the program outreached to 106,433 members across Commercial HCA, Commercial Non-HCA, Marketplace, and Medicare Advantage gather opt-in consent through SMS messaging (response required) before commencing.

Based on member reporting through this program, it was discovered the top 3 insights into why they weren’t completing the screening were:

  1. they already completing the screening
  2. they were too busy
  3. they thought the screenings were unnecessary

This is valuable information for a plan to have because it gives data with which to communicate further. For example, for those health consumers who think screenings are unnecessary, the plan could send streaming health content explaining the importance of the screening their missing (such as the breast cancer screening lesson you see below). And for those who already completed, the plan can use two-way SMS to collect more info on when or where that screening took place and amend their records.

The second program Aimee presented was an Rx Refill Engagement program with a 4-star goal for Part D medication adherence measures. This program included 48,980 MA members with active opt in and it was design as an interactive SMS program with conversational tailoring, follow up reminders, and barrier assessment. Refill rates with the solution were 85%, there was 72% positive feedback, and 20% of members requested additional reminders.

Looking Forward to More

We enjoyed the chance to join and network with all the Blues plans to discuss the future of healthcare engagement and how technology can play a huge role in it, and we can’t wait to return next year!

Shifting the Mindset: How Health Plans Can View Members as Consumers in a Digital-First World

What can health plans learn from the retail industry’s success with consumer engagement?  

A lot, it turns out. Leading retail organizations have been using important digital-first principles for a couple of decades now. This approach has not only transformed the expectations of everyday consumers for all organizations they encounter (including healthcare) but has also driven profits through the roof for these companies.  

Take a moment to think about it. When you sign into Amazon, everything you experience as an end user is seamless and customized. From the presentation of personalized recommendations on your homepage (which is different for every customer) to the fast and easy delivery of your items. It’s all frictionless and crafted for the consumer. 

Where does this leave healthcare? Well, even though health plans are not direct competitors of Amazon (or even in the same industry), their members live in an Amazon world and now have expectations set for this kind of consumer experience across all areas of their lives – food delivery, online retail, and yes, healthcare. The challenge for healthcare organizations now becomes leveling up to those expectations and harnessing these digital-first principles to improve their members’ experiences and inspire healthy behaviors. 

From Members to Consumers: How plans are adopting popular digital trends from leading consumer brands to drive better health outcomes » 

The first step toward that goal is understanding that members are no longer just members. They have become fully-fledged consumers of healthcare services and treating them as such is a critical way for plans to be competitive in a digital-first world. 

Beyond the Consumer Mindset: Implementing a Digital-First Experience 

Simply shifting your view of your members to consumers, however, is not enough. There are significant foundational and technological changes that must be implemented to truly realize this concept and transform the experience. 

  • Using Data to Customize the User Experience – Without data, customizing the experience in this way is impossible. Plans have more data at their disposal than you might think, though. From claims data and satisfaction surveys to engagement data from previous communications programs, it can all be leveraged to customize the experience. This results in tailored tools and resources at every point across their unique journey.  
  • Streaming Health Content – 5% of all Google searches are for health information. That is a lot of people turning to the internet for health education instead of their plan or provider. That also highlights the fact that health literacy is a prevalent issue and a contributing factor to inaction among members. Plans are in a unique position to increase health literacy by providing health education to their consumers with commercial quality streaming health content to sustain engagement, deliver the information that consumer needs at that point in time, and ultimately drive healthier actions at scale. 
  • An Omnichannel Approach – Combining an omnichannel approach with orchestration of resources and channels helps plans reach members in the way they prefer while allowing plan investments to perform with higher results and efficacy. Using a combination of 1 on 1 care coordination, interactive voice response (IVR), mobile web, resource triaging through AI short message service (SMS), multimedia message service (MMS) and rich communication services (RCS) channels are a few examples of digital ways to engage and activate more consumers. 
  • Behavior Science and Conversational AI – Behavior science is a foundational tool for large tech companies to drive specific behaviors in their consumers and ignite growth. It’s healthcare’s time now to take from those lessons and apply them to the health of their members. Health programs and services that seek to understand the intricacies of human behavior and leverage these techniques will significantly increase engagement. 

Want the full version of this content? Access the complete white paper, From Members to Consumers » 

The Members to Consumers White Paper 

By implementing digital trends that drive engagement in the retail landscape, health plans can replicate this success for their population. Leading brands have had to continually stay aligned to trends and keep a high-touch strategy in place to drive sales. Health organizations are in a unique position to leverage consumer insights to refine their strategy, inspire consumers to take action, and lower costs, because unlike Apple or Amazon, health is a necessity. Ensuring your health consumers continually have a positive experience and adopt healthier behaviors based on their individual health needs is critical to drive health outcomes.  

This article gives just a peek into the ways health plans can serve that experience to their members. To get the full version of this content, including case studies from plans who have implemented digital-first techniques, download the white paper, From Members to Consumers: How plans are adopting popular digital trends from leading consumer brands to drive better health outcomes.

mPulse Mobile Acquires HealthCrowd

We are coming together to drive our shared mission of improving health outcomes through market leading health engagement solutions. This is a very exciting day for both organizations as our teams combine to bring an unrivaled passion and deep expertise in delivering health engagement that unlocks enormous value for our healthcare customers. 

We are focused on reimagining health engagement, and HealthCrowd brings best-in-class health engagement expertise and leadership in the Medicaid market. 

“HealthCrowd has proven they can deliver effective engagement solutions to hard-to-reach individuals and communities,” said Chris Nicholson, CEO of mPulse Mobile. “By coming together, we combine mPulse’s unique conversational AI and rich streaming heath education capabilities with HealthCrowd’s engagement solution expertise to build highly tailored programs that put the consumer at the forefront of their health experience.” 

Unmatched Health Engagement Capabilities 

As one combined company, we have unmatched health engagement capabilities which enable us to deliver market leading solutions. We combine the power of our conversational AI platform, streaming health education and extensive team of industry expertstechnical talent, engagement strategists, government programs subject matter experts, behavioral scientists, plus many moreto deliver solutions that transform the way healthcare organizations improve outcomes and the consumer experience. 

“Demand is surging from members seeking a tailored, consumer-first health experience,” said Neng Bing Doh, CEO of HealthCrowd. The combined strength will unlock enormous benefits for health plans, their members and the larger healthcare ecosystem. We’re thrilled to join the mPulse team and leverage our cultures and capabilities to work toward this shared mission.” 

Scale and Agility 

Together we partner with over 180 leading healthcare organizations and reach 100 million plan members and patients across the US. In 2022, we anticipate having more than 1 billion tailored meaningful touchpoints with consumers. We will continue to leverage HealthCrowd’s expertise across Government Programs, as together we now partner with plans that manage the lives of over 75% of Medicare Advantage enrollees and cover over 60% of beneficiaries in Medicaid HMO enrollment. 

What isn’t changing? Our commitment to being an innovative, agile organization that partners exceptionally closely with our customers to unlock as much value as possible though our health engagement solutions. Our (now larger) team of world-class engineers and industry experts will be the key to staying on the cutting-edge and delivering on great health engagement. Our dedication to the best possible outcomes for our clients through innovative, market leading solutions will continue to be our mission. 

There’s more… 

Even though the partnering of two major players in the healthcare space is substantial news on its own, we are also excited to announce that we have received a growth investment from PSG, a leading growth equity firm partnering with middle-market software and technology-enabled services companies. 

With this funding, we will have a greater ability to make significant moves in the market and invest back in our platform and team in ways that directly benefit our customers.  

These two new updates are key strategies that empower us to reimagine health engagement and drive us in our mission to improve health outcomes through market leading health engagement solutions.

View the full press release.