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Member Communication for the Home COVID-19 Test Coverage Mandate and Other Rapid Response Programs

Beginning January 15th, the Biden Administration required health insurers to cover the costs of up to 8 at-home COVID-19 tests per month for their privately insured members. This not only helps reduce or eliminate up-front costs of Americans seeking an at-home solution to COVID-19 testing, but it also helps dull the pain points of finding testing facilities when needed.

The mandate, which quickly became breaking news, was a welcome announcement for health care consumers, but it threatened to strain insurers who were given official notice just days prior to its effective date. In the last two weeks, we’ve heard from many of our healthcare partners about the challenges this presents during an already busy season. Plans found themselves in a difficult position needing to communicate as quickly and accurately as possible while maintaining their current programs and managing their open enrollment period (OEP).

Easy Rapid Roll-out Practices for Your Members and Organization

Between call-center re-routes, at-home test kit availabilities, and managing the member experience, staying agile after this announcement can become both overwhelming and costly. This is not the time to trial and error communication with your populations.

Relying on the methods you have already been using for member communication is your best bet in yet another unpredictable turn during the pandemic, and there are several distinct best practices plans can follow to handle unexpected situations like this as they arise.

To start, use the quickest and most impactful means of communication with your members first. 3.8 billion people own a smart phone and SMS is a reliable source of fast communication. If that line of communication is already set up with your population, connecting them with resources after any sudden event will be much simpler. The minimum data requirements we recommend for our at-home testing mandate outreach or similar programs are the member’s first and last name, date of birth, mobile phone number, and address.

Channels like SMS are ideal for reaching consumers quickly but implementing a multi-channel approach by including email and even IVR channels is an option, too. For example, using a consumer’s preferred method of outreach, like IVR, to authenticate mobile numbers and direct them to two-way automated workflows can be an effective tool, allowing your organization to provide cost saving information within hours while still utilizing all lines of preferred communication.

Whatever the channels you choose, we recommend providing comprehensive education and resources by redirecting consumers to trusted information sources, such as an interactive FAQs page or links to valuable sites like USPS How to find a test site. This reduces the chance of them calling their plan for information that is thorough and easily accessible elsewhere. In the case of this at-home test mandate, providing them information on their pharmacy or a link to all in-network pharmacies near them can also help the plan save money on reimbursement costs.

Orchestrating this outreach early and getting in front of the member with the correct messaging before they reach out to your call centers can help mitigate costs in any situation, but it can be especially helpful after the at-home mandate announcement. It will not only help ease the influx of calls to a costly call center, but it will also lead your membership to the resources they need to secure their at-home tests at a more reasonable cost to the plan.

Another rapid roll-out best practice we recommend is partnering with a solution provider which has the technology in place to quickly deploy two-way messaging at scale. The ability to have bi-directional conversations to address the specific questions of each member individually (ideally through natural language understanding technology) will significantly improve the efficacy of your program. And with this partnership in place, you won’t need to focus on setting up member communications in the middle of figuring out execution. You can lean on your solution provider to build and deploy the program for you.

Interested in learning more? Watch our on-demand webinar on at-home covid-19 mandate best practices and rapid response solutions »

The most important factor, however, is acting quickly. If your outreach provider has contingencies in place for last-minute events like this, they will most likely be able to stand up a solution that has all our best practice elements included in a timeframe of two to three weeks or less.

How Does This Fit Into the Member Journey?

Though communication surrounding this mandate is trickier than other rapid responses, swift messaging to member populations is still essential. When a health plan reacts quickly to market changes and provides helpful information to ease members and patients through a complicated and cumbersome process, they become trusted partners throughout that member’s journey. The right communications from a trusted authority, reduce the complexity this new mandate has presented, and others to come, and will prevent misinformation that members face. If your organization has a communications partner with experience standing up programs quickly, then it can feel easier on the member to get common questions answered, find vaccine sites, and submit claims, etc. – further reducing barriers to crucial and accurate information.

And with CAHPS right around the corner, what better timing to solidify that spot as your member’s trusted source of information that is preventative and timely? Further strengthening trusted relationship between plan and member.

Understanding your membership and leaning on the information you have, such as their preferred language, the channels your healthcare consumers use, and the right contact information will go far when your organization needs to pivot and deploy information timely and most efficiently.

COVID-19 Home Test Coverage Takeaways

If your organization is currently using SMS to outreach to your populations, you are in the perfect position to outreach quickly and at scale, and you only have to switch out standard messaging with the right messaging for the moment. An easy framework for rapid rollout solutions your organization has at the ready, is a sure-fire way to communicate all new breaking information.

Then working with your solution provider to craft the perfect messaging or leaning on your solution provider’s behavior science technology will impact how swiftly your organization can easily respond in moments when messaging is not able to take the priority–like we saw just a few weeks ago many other times throughout the pandemic. The focus can remain on execution while your automated solution provides your membership with what they need to feel like they can come to you for the most reliable trusted resources at any time.

MHPA & mPulse Mobile Present: Using Fotonovelas to Increase Member Engagement and Reach Wider Populations

MHPA and mPulse Mobile will partner in an exclusive webinar May 26th at 11:00 am PST / 2:00 pm ET with Rena Brar Prayaga, Behavioral Data Scientist and mPulse Mobile consultant, to discuss fotonovelas. In this session we will cover:

  • What are fotonovelas?
  • How to deploy them
  • Why they were relevant then and how to leverage fotonovelas moving forward

We’re excited to present to the Medicaid Health Plans of America audience and introduce our learnings and successes from this innovative program we have launched with multiple clients.

Learn more about one of our fotonovela use cases here, and please follow us on LinkedIn to join the discussion!

Leveraging Technology to Meaningfully Impact the Member Journey: Key Takeaways

On March 23rd, we had the opportunity to sit down with one of our Medicaid partners, Peach State Health, at Whole Person Care for Medicare, Medicaid and Duals. In this discussion, we talked through the member journey and the impact tech and data can have on the holistic approach to population health. Here are our key takeaways: 

Establishing Trust In the Member Journey

Sheakeena Lamb opened the session with Peach State Health Plan’s focus group findings that spurred the need to engage their members in a meaningful way that made sense to each unique member and their preferred channel of communication. In order to overcome health barriers, you first must be able to reach the member. From there, health plans can outreach effectively with the appropriate resources needed to inspire healthy behavior change. Connecting with the member in a way that saves both the organization, and the member time and resources helps develop a trusting relationship. Having meaningful connections is what will encourage the member to see their health plan as more than just a payer and more like a trusted partner — a valuable source to discover key information they need to take control of their health management and live a healthier life throughout their health journey.

Challenge the Unknown and learn from Past Use Cases:

Peach State learned very early on they needed to refocus their outreach efforts to meet their members in the channels they said worked best for them. For Peach State, that was text messaging over mailers and IVR. Their member population simply did not have the time to pick up the phone during workdays and did not trust unknown callers.  And as many organizations know, mailers can be costly and time consuming. After deploying SMS well-child reminders, Peach State saw 170k unique members engage with their messages. Outreach through a trusted channel like text can also overcome the unknown caller barrier – we are all hesitent to answer when receiving a call from an unknown number. If the member is not aware their health plan is calling because they do not trust “unknown callers,” then the opportunity to engage is completely missed.

Member preferences matter:

Understanding the member journey is one step of a successful engagement solution. Understanding how and when to engage members, and then using in-channel communication to reach them in the language they prefer, at the time that is right for them, is what elevates a good strategy to a successful ROI engagement solution. mPulse has seen this time and time again when deploying bi-directional communication solutions for our clients. Engagement increases when members feel like their provider or plan are able to engage with a natural language understanding. And when the organization can  scale that communication with an automated solution, it becomes cost saving too. It enables plans to get  closer to the triple-aim and deploy efficiently at scale, reduce resources and increase trust between the member-plan relationship.

Data’s impact on future member engagement strategies:

Valuable data like member preferences, SDoH information, and experiental data can and should, affect a plan’s member outreach strategy. By employing a deep understanding of the member population, you are able to build better lines of effective communication and help your members navigate their individual health journeys. Working with the correct reporting tools and solution partner, can uncover communication barriers the plan may not have known posed an immediate issue. “If we can figure out where the barriers are for our members then we can address them early instead of falling behind,” said Sheakeena Lamb. With data on measure eligibilities and having visibility of a large part of a member population, plans can catch members that could develop care gaps, and use this data to drive quality improvement strategies.

Going Beyond traditional touchpoints:

After the data is collected, and the reports have been pulled, comes the need to reimagine an outreach strategy that works for each individual member. Using the right tools to send text messages in members preferred language, or at their preferred time impacts the level of engagement and provides a meaningful facet to the holistic health journey. And the right tools can store that information for later use when tailoring downstream conversations. Not only being able to respond with the appropriate information and connect members to plan or provider resources but to be able to remember important preferences can establish health plans as more than just a payer, more than just a resource, but as a invaulable healthcare partner.

Key Takeaways from the 11th Annual Star Ratings Master Class

mPulse Mobile’s Government Programs Strategic Market Executive, Reva Sheehan, discussed Keeping Momentum: Best Practices to Maintain or Improve Star Ratings, with Johns Hopkins, Ph.D., Director, Quality Improvement, Tejaswita Karve, at RISE’s 11th Annual Star Ratings Master Class. Here are our Key Takeaways:

Member Experience Depends on Meeting Member Communication Preferences

Newly weighted star measures capture anything from call center measures to HOS measures and more, and all will tie back to member experience in some way. Analyzing sentiment from interactions will be an area that plans, and providers will need to focus on more heavily as those weights start to take effect. Asking such questions such as, what resonates with the member? What do members respond to? And then measuring such data and using it to meet members communication preferences, is vital to star ratings moving forward. For instance, plans will want to know which and how many members prefer IVR over text message, or email over mailers. Reva Sheehan from mPulse made an interesting point, that CMS, and others, expect plans to reach out to their members using multiple forms of communication. That means the data the plan uses to see who prefers what kind of communication should be segmented appropriately and used in addition to other touchpoints. A plan can see high engagement from email outreach, but they cannot forget or ignore the members who prefer IVR, or link-to-web. Using an omnichannel approach to execute dialogue between member, plan, and provider, is key to guiding the plan’s entire population to the right resources and messaging. Understanding what outreach works best for each member and keeping them at the center of the plan’s communication strategy will also build that trust and long-lasting relationship with their member. So, when it comes to value-based care, truly tailoring touchpoints to each member’s preference is one of the first steps to maintaining an effective and trusting ongoing dialogue.

Leveraging Communication Tools to Shift back into In-Person Care

Although star ratings will see its largest shift towards member experience, plans will still need to prioritize other HEDIS measures in addition to experience, such as preventive screenings and care for example. And plans may need to focus on those clinical quality of care measures even more so due to precautions from stay-at-home orders in 2020. With a new drop in preventive screenings alongside star ratings shifts, plans and providers have strong reasoning to leverage communication tools even more to get the message out about the importance of preventive screenings, among other health management tools and benefits. When we enter a post-pandemic phase and members start seeking out digital and in-person care, vaccine information, or following up on screenings they have postponed, providers will need to work within their systems to manage what may seem like a cascade of sudden requests. On the plan side, though it may be more difficult to directly affect what kind of care a member receives, they can help educate and set up the right expectations for the member to help ease that transition, so the member is less likely to experience an unpleasant surprise when reaching their appointment. Plans can leverage their communication tools and partners to make sure that end-to-end member experience is accounted for, which can also translate into positive CAHPS survey responses.

Scalable Solutions that Work for All

Member Engagement should encompass what works for everyone and segment that outreach accordingly to work effectively. Special populations such as hard-to-reach members and the underserved communities hold a bit of the focus in terms of member engagement, and as they should, but as the weights change over the next two years, the focus will need to widen to members that are also mildly engaged. The mildly engaged members are those who don’t need ongoing care or who have readily available access to their healthcare and don’t feel like they need to be in continued conversation with their plans. So, when it comes to scaling an engagement solution, it means using tailored content that reflects each member’s level of need. Like  Tejaswita Karve mentioned in the panel, “One method won’t work for everyone – one size does not fit all.” Understanding the nuances in the way communication formats are used is important to tailoring content to fit the member’s preferences, rather than the other way around. Capturing those preferences as useable data will give the plan an opportunity to scale their solutions more effectively than strictly going off what works for most.

Proactively Educating Members Will Continue to Make a Big Impact

Educational outreach will become even more important as we head into the vaccine phases of the pandemic. Plans and providers will also need to continue informing members about tools and benefits the plan already offers, creating more positive touchpoints and improving overall plan-member experience. For example, when the plan reaches out to members proactively, to educate them about cost savings when adjusting their medication refills, they inch closer to that triple-aim for the member and the plan. The member is more likely to adhere to their health goals and benefit from a cost saving, and the plan benefits from member adherence. Providing benefits education proactively gives the plan the opportunity to set up a positive experience for the member right from the start.

Innovation through COVID-19

COVID-19 pushed plans and providers to become more creative and innovative in the way they educate members and provide care delivery. Tools like mail order prescriptions have become more of a norm because it allows members to follow COVID safety protocols while maintaining their care. These newer habits will probably remain post-pandemic. Now that members understand how easy it can be to jump online to see their doctor, CMS quickly lifting those restrictions, and plans beginning to umbrella those costs, members are less likely to fully transition back to pre-pandemic health visit practices. Those practices often included longer wait times, requiring more resources and time from more health care workers, etc. Through all this innovation, plans, providers, and the entire industry will feel pressure to show their adaptation to changing expectations. As adoption of new virtual care platforms, digital therapies, or other tools increases, so will the need to inform members, so will the need to guide them through that adoption, and engage them to keep them connected over the long term.

As we look forward to this new year, it is a good reminder that plans should inform their members about benefits that are available to them in an ongoing, conversational manner. It establishes trust that goes beyond the higher weighted Stars measures. Ongoing communication establishes a trust that builds a long-standing relationship with members, which has proven time and time again to bear the most value for everyone.

Key Takeaways from AHIP: Conversational Member Engagement Session

mPulse Mobile is a leader in conversational AI solutions for the healthcare industry. We work with 100+ healthcare partners and have deployed over 300 million messages to healthcare members. mPulse’s CTO, Ram Prayaga, sat down with VP of Marketing, Brendan McClure at AHIP’s Consumer Experience & Digital Health Forum 2020 last week to discuss how we execute Conversational Member Engagement: Data, Experience, and Outcomes. Here are our key takeaways:

Orchestration of AI Conversational Engagement

At any given time, plans have multiple departments that are prioritizing topics of interest for their members, so how does a plan coordinate those touchpoints and maintain a relevant member-centric strategy? The answer is data. Plans that utilize the data collected from conversations and interactions with their members and leverage tools that incorporate that data to tailor content and frequency will be more successful at reaching large populations with an approach that meets each plan and member needs. While it may be difficult to curate messaging for each member, with an omnichannel and AI-enabled system, plans are able to implement tailored content and promote a more coordinated outreach cadence for each member or population segment.

How do Plans Gather Conversational Engagement Data?

Although conversational data is a newer type of data, it has become a valuable tool when reaching out to members at scale. Brendan mentioned in the session that insights from conversational outreach can be used in a number of ways to “Give the plan an important read on experience.” A plan can analyze member responses to understand sentiment and intent, as well as see how members navigate through interactive programs to identify opportunities to optimize future outreach. Ram guided the audience through primary touchpoints that conversational engagement data impacts in the member experience. He talked through mPulse’s barriers assessment, which allows a plan to learn the why behind a member may not be meeting their health goal and the plan’s target outcome. He talked about mPulse’s analysis of sentiment and intent of member responses, which can scale from positive to neutral to negative, which gives a plan more data to tailor messaging and meet preferences. All of this information is gathered by engaging in a natural dialogue via interactive messaging – such as text messages – versus deploying a full off-cycle CAHPS survey, for example. The plan can also glean this experience data needed from conversations, rather than relying on survey questions asking the member for it directly.

How Can Plans Engage at Scale?

Utilizing artificial intelligence in text conversation allows plans to deploy messages to millions of members with  a more natural, conversational experience. In order to maintain a good connection with thousands of people at the same time, plans need to understand what people are saying, measure it and store that information for future touchpoints. Conversational AI, integrated with an omnichannel approach, is the perfect tool for that goal. Most members have access to a mobile phone and text regularly, including senior populations, but for the members who are most engaged through IVR, mailers, and other alternative routes of communication, plans will still need to consider meeting their members where they are. Adding an automated conversational solution can help support a multi-pronged communication approach to reach members in the channels they prefer with impactful dialogue.

How Do you Maintain the Human Touch?

The best engagement feels natural and easy for members. A simple act like listening to the members preference on the best time of day to initiate a conversation, or starting the conversation with content that is relevant to the individual will make a difference in the members response. How a plan manages members preferences is vital. When thinking about member-centric outreach, a plan can look at different ways to engage a member in a dialogue that listens versus putting them on a one way automated track. When we think about human conversations, we do not converse in a linear manner. Often times the conversation will jump from one topic to the other in a short period of time. A truly conversational solution should be able to listen to those pivots in the dialogue and accommodate its workflow to respond with relevant information that follows along with what the member is saying in real time. This means having a deep and well-indexed library of content for each conversational solution, as well as a thorough response-handling process – whether via Natural Language Understanding, or human support of automatically-launched programs.

Tailoring Outreach Once a Plan Has the Data to Work With

It is important to understand the challenges that members are facing, and then to target their outreach to address those barriers. Making sure to account for the hard-to-reach members in any population is vital to the approach as well. Outcome data that shows what works and what does not within certain demographics based on their SDOH impact gives the plan more insight into how to build trust within that plan-member relationship. For example, if a plan only reaches out about its benefits to their members right before they need to renew their plan, it is much less effective and meaningful than had a plan been initiating those conservations all along. But if a plan engages in those conversations about what benefits may be a good fit for that particular member based on past experiences and their demographic, then when the time comes to renew, the member is more likely to trust and value the reminder because the plan has shown to have their best interest at the core of their outreach. The member will feel more compelled to stay because they know they can rely on their current plan to address their immediate and long term needs. Maintaining the trust between plan and member is probably one of the most valuable ways conversational data can help impact the plan-member relationship.

COVID-19’s Pressure on Digital Experiences

Plans were forced to evaluate and evolve their digital outreach approach quickly with the onset of COVID-19. For a lot of plans, they had to adopt strategies to pivot into virtual care as quickly as possible. They also had to provide additional resources to help their members navigate through virtual platforms that they themselves may have been adjusting to. When a plan is able to curate a digital journey, they have an opportunity to build awareness around solutions that are relevant to members specific needs. Curating the journey helps hold their hand, helps them navigate a new digital landscape in addition to sustaining the relationship. During the pandemic, mPulse positioned the need for digital therapy to our client’s members suffering from social isolation. Before initiating an ask to the member to engage in the program, we communicated the value. This strategy was effective because we were able to educate around the need for digital therapy and gauge the members interest, which gave the member the opportunity to come to the plan on their own instead of pushing them to sign up for a new virtual care program.

As we look ahead to 2021, what we have learned in the past year and throughout our most successful programs, is that trust between member, provider, and plan is crucial, especially as we transition through one of the most pivotal moments in healthcare. But the better prepared a plan is to respond to members and their immediate needs that also doesn’t burn a lot of resources on the plan’s end, the better relationship between member and plan will be. Focusing on approach, collecting all data from those use cases, and keeping the member at the center of all strategic communication is key.

Key Takeaways from the 6th Annual Star Ratings and Quality Assurance Summit

mPulse Mobile’s Government Programs Strategic Market Executive, Reva Sheehan, had the opportunity to discuss Member Engagement, Now and Post Pandemic, at the 6th annual Star Ratings and Quality Assurance Summit alongside Noreen Hurley, from Harvard Pilgrim Healthcare, and Bill Gaynor, from Change Healthcare on Wednesday December 2nd. During their discussion they reflected on how plans engaged their members at the early stages of the pandemic, but also what worked well and what is here to stay as we move into 2021.

The Pandemic’s Impact on Member Engagement and How It Changed Some Processes for the Better:

The pandemic highlighted many longstanding member engagement challenges and created new ones. Health plans had to think about services and resources that were impacted and how to communicate with their members as quickly as possible. An omnichannel approach was crucial in deploying messaging for many health plans that needed to reassure and inform members quickly. Information regarding COVID, CMS changes that affected members access to care, telehealth services, and impacted resources and  programs were all vital pieces of information that members welcomed and appreciated. Plans relied heavily on the communication channels and strategies they knew their members would engage with, and adapted as the situation and member engagement levels evolved. As we look forward to 2021, plans will need to continue to double down on the channels their members respond to at scale so they are able to meet the challenges of the next phase of the COVID-19 pandemic.

Using Data and Internal Agility to Adapt to Member Needs

One of the panelists Noreen Hurley, from Harvard Pilgrim Healthcare, shared how the situation at the beginning of COVID-19 forced their team to look inwardly at their own operations. “Urgency drove us to some internal coordination and to look inside our own organization and find what resources, what technology, we can use…to smash through the silos and reach as many people as we can quickly.” At mPulse, a major concern for our customers centered on getting member feedback and data quickly, to make better decisions in an evolving situation. Collecting engagement data, member responses to outreach, and analyzing member sentiment and intent all helped get actionable feedback to plans that were trying to understand how best to reach at-risk or underserved populations.

Noreen also noted that plans had to constantly monitor their engagment efforts and change strategies quickly. In mPulse’s case, we had deployed our COVID Rapid Rollout toolkit but still had to adapt as programs launched as stay-at-home orders extended beyond the original three-week timeline. We also experienced a higher need for social isolation education solutions which addressed the need to stay active, as well as resources for easily accessible healthcare options. mPulse deployed several solutions to address what we thought would be the need for COVID-19 related challenges and needed to pivot quickly when some solutions become more important than others.

Member Engagement Will Become Personal

A number of factors are converging to shift member communications further away from a one-size-fits-all strategy for Medicare plans. The emphasis on CAHPS as part of Stars going forward means that every member touchpoint, no matter how transactional, needs to be assessed through the lens of member experience.  Just as there is no copy-and-paste solution for gaps in care or med adherence, plans will have to think about what will work best for their specific member population when it comes to experience-focused engagement. No matter what population you’re looking at, personalizing content to make it relevant and useful to the individual member is always important. Technology is helping plans to pull in real-time data on experiences and sentiment and member interactions with providers, pharmacies, member services, etc and build a better picture of what their happy and dissatisfied members look like. This allows them to tailor content and align resources where they can make the most potential impact.

Placing members in context is vital in ways that go beyond CAHPS scores. For example, even with the newly added accessibility to telehealth, many members still faced language and technology resource barriers that made it nearly ineffective for hard-to-reach members to manage their care virtually. A generic “sign up for our telehealth portal” email or text message would have resulted in frustration or inaction for those members. So gathering those barriers up front via conversational outreach, and tailoring follow-up with education and support resources to help overcome them was crucial for many of mPulse’s clients’ telehealth success in 2020.

A Vaccine and 2021 is Right Around the Corner. What will Plans do Differently to Improve Member Engagement?

Aside from OEP and the more-normal member engagement strategy that plans will be rolling out next month, plans face the challenges of vaccine communication and navigating another Stars Measurement Year that will be impacted by the pandemic.

A vaccine will take time to distribute to the general public and the lines will be long when it gets here. Plans will need to focus on continuing education around the fallout of the pandemic, vaccine distributions, and what regulatory changes will mean to member’s health management. Educating members swiftly and timely must remain a permanent change within the industry. Using data and insights about what worked and what did not during 2020 will become necessary when planning future communications. So will having tools readily available to collect new data and adapt as the vaccination effort continues. Plans need to show members that their health plan is listening, concerned with keeping them healthy, and ready to address whatever the new year presents.

One key strategy we’ve seen throughout COVID-related outreach is the success of quick, actionable touchpoints with members, supported by richer educational materials when necessary. mPulse is already adopting this strategy for communication about vaccines and the FAQs that will be vital to driving vaccine uptake in large populations. We use data and member responses to tailor content to different personas – from “ready and willing” members who just need to know when and where to go get vaccinated, to “unsure and uneasy” members who need more information from authority figures and richer content to help drive them to act. We think this approach is vital, as polls continue to show a very divided population when it comes to attitudes around the vaccine heading into January.

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

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

Get to Know Your Members and Their Experience with Their Plans

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

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

Discover the Differences Between High Utilizers and the Mildly Engaged

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

Measures with Increased Weights – Moving forward with CAHPS

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

Combat Survey Fatigue

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

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

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

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

The Challenges and Opportunity for Technology and Health Equity

We know that COVID-19 has amplified many underlying issues in healthcare and beyond. Health equity was already an important topic in healthcare, but COVID-19 has brought it into sharp focus as cases, hospitalizations, and deaths from the virus disproportionately impact disadvantaged groupsTechnology use in delivering healthcare is another long-time trend catalyzed by the pandemic, as millions were left with virtual care as their only option for the first time. Iseems apparent that these advances in technology use create the capacity to meet people where they are with information and care that is quickly and easily accessible. But it will take careful effort and consideration to ensure that access is improved for those that most need it in an inequitable system. And with new technology, there will also come new challenges and barriers that may not have existed in the past. 

Understanding Technology Across Segments 

At mPulse, we naturally look closely at technology adoption rates in healthcare’s most important populations. When we look at the disparities in technology use and access, they tend to line up with the negative outcomes we see in healthcare. Black and Hispanic communities have faced a disproportionately higher fatality rate than other races due to COVID-19 and suffer from higher rates of chronic conditions. The Pew Internet Research Center’s statistics show black and Hispanic communities more than twice as likely to be dependent on smart phones for internet access than white Americans. This means that they are more likely to rely on smartphones as their sole access to the internet, as opposed to a tablet, laptop, or desktop computer. Telehealth platforms that are optimized for desktop/laptop use and not mobile phones could disadvantage these groups disproportionately. Furthermore, populations who may not have access to stable and high-speed broadband in their homes would only be able to interact with telehealth that is mobile-optimized and can be supported on a cellular data connection 

Though smartphone dependency and internet access disproportionately impact minorities and low-income groups, mobile phone adoption presents an opportunity to connect hard-to-reach populations with tools and information to access and maintain their healthcare. Overall cellphone adoption rates in the US have converged across demographics, with Black, Hispanic, and white Americans equally likely to own a cellphone (over 96% of all adults do). So while internet and broadband-reliant technology may create new barriers hat must be overcome if telehealth is to become a long-term solution for improving access, engagement solutions that focus on cellphones have the potential to reach oft-neglected populations just as effectively as any other 

The role technology can plan to help address health disparities will be a key area covered by our keynote speaker – Dr. Gail Christopher- at our Activate 2020 virtual conference. Dr Christopher is the Chair of the Trust for America’s Health. 

Language Barriers: A New Version of Old Challenges

Telehealth and virtual care in general must be able to support multicultural and multilingual populations effectively. According to a poll from the Associated Press-NORC Center for Public Affairs Research, “half of these Hispanic adults age 18 and older rely on family or another health care provider to help resolve language or cultural difficulties in the health care system, while more than a quarter have relied on a translator, public resources in their community, or online sources for assistance. Understanding that language barriers in traditional care delivery may have been managed more than successfully bridged will be vital as systems and plans roll out new models. Beyond language, there can be significant cultural differences in attitudes and use of the healthcare system across populations.  mPulse has seen in cases with several multi-cultural populations that tailoring content to account for language as well as culture can be just as important as tailoring based off of health status or age. In cases like the COVID-19 pandemic, where organizations need their entire populations to understand important prevention and system navigation information, closing gaps between language and cultural groups becomes critical. Configurable and engaging content that can be fully adapted to different languages or populations, such as the fotonovelas we’ve used with some of our customers are just one example of the effort required to get key information to people in these diverse populations equitably.    

Preconceived Notions of Telehealth 

Studies have shown Black and Hispanic communities may feel more uncomfortable interacting with health professionals via camera and having facial pictures taken – practices that are common in telehealth appointments. This discomfort could be a factor for low engagement, or appointment no-shows. So while these two communities are likely to be among the most at risk for negative health outcomes, if they do not feel comfortable engaging with their plan in the new virtual or telehealth environment, they may be a lot less likely to move forward or seek out careBuilding trust becomes crucial. One of the advantages to the kinds of asynchronous and automated conversations that the mPulse platform supports is that the patient or member can engage on their own time and terms. Whether through solutions like ours, or other types of outreach, organizations should find opportunities to create meaningful touchpoints with the people they care for that do not initially require new technology navigation, app downloads, or unfamiliar forms of interaction. In fact, some of our leading plan partners have used mPulse as the primary means of driving awareness and adoption of their telehealth platforms. The key has been that members who are used to getting important and relevant engagement from our solutions about their benefits, medications, and preventive care, are being directed to telehealth by an established and trusted line of communication with their plan. Helping to meet members at their comfort level and introduce new technology with compassion and understanding will be vital to ensuring the widest access.  

How can healthcare achieve the triple aim of managing cost, access and quality of care when it comes to virtual care and other new technologies? How can we embrace connected health and the power of the Internet of Things when smart device use is not embraced or even feasible across all populations? And how can technology create opportunities to solve disparities and inequities in healthcare? These questions will take a central role as we move toward an end of the pandemic and the healthcare system reckons with its long-term impact on how we deliver healthcare in the US. And while we can’t always expect definitive answers, being aware of challenges and watching for opportunities is the first step to making that impact as positive as humanly possible.

Digital Fotonovelas for Flu Engagement: A New Approach for a Unique Year

The 2020-21 flu season poses new challenges in addressing COVID-19 alongside traditional challenges driving flu vaccination. Flu season for most adults typically begins around November and plans push reminders to have members schedule their flu vaccination. However, with COVID-19 as an ongoing concern, healthcare experts are suggesting getting the flu shot as early as September 2020, to at least quell the brunt of one virus while trying to manage the other. In addition, members who take precautionary measures early-on will alleviate pressure on hospital systems that have been carrying the weight of COVID-19.

Organizations must enhance their flu engagement strategies to address new concerns and barriers to vaccination this year and educate members quickly on new topics. With the right tools, health plans can take a multi-angled approach to member outreach that will help address and overcome several barriers at once. mPulse has been working with our customers to roll out new content and technology to help handle the challenges of this flu season—read about our 2020-2021 Flu Engagement Solution here. The solution incorporates digital fotonovelas. These are typically a 6-frame comic-style story portrayed with lighthearted graphics, that deliver important content to across demographic segments at scale. The story-style graphic can deliver vital educational flu resources directly to members’ mobile devices, through SMS and link-to-web, using members’ preferred language. This tool has been used in key healthcare use cases in the past, (e.g., value of HPV vaccines and diabetes self-management) and has proven to be a complementary route of communication when utilized with a text messaging approach to member outreach.

mPulse Mobile first deployed fotonovelas as a bi-lingual visual tool during the onset of COVID-19 as a part of the COVID-19 Rapid Rollout Toolkit solutions. The goal was to adapt a traditional and effective style of print media into digital format delivered through SMS, to help overcome health literacy barriers during a time when the spread of healthcare information was urgent and needed to be disseminated quickly at scale. The 6-frame graphic style of communication, paired with a series of check-ins via SMS, helped our plan and provider partners build health literacy around social distancing, basic hand hygiene, and keeps multi-lingual populations informed with accessible and coordinated outreach via mobile channels. The goal of this capability was to successfully assess members’ health risk and respond through text dialogue and educational fotonovelas appropriate for each member’s situation, in their preferred language. We’ve seen that when matched with strategic member outreach, fotonovelas can be a tool that offers an access point to fill in gaps in knowledge that drive healthy behavioral change even during a time when many are hesitant to seek out healthcare in person.

Fotonovelas also present an opportunity to address individual-level barriers and inaccurate health beliefs related to COVID-19, and flu vaccines in general. They can help address education gaps surrounding available flu vaccination resources during the pandemic while promoting health literacy. Paired with text message dialogues, plans and providers are able to uncover new barriers that may have prevented members to seek flu vaccinations early and match members to follow up content, including fotonovelas, that addresses those specific challenges.

During the 2019-2020 flu season, mPulse powered over 15,000,000 flu vaccination touchpoints across Medicaid, Medicare and commercial plan populations. The solution achieved a 2x increase in recorded flu vaccination rates in a large Medicaid population*. This year, as the flu season approaches with the added layer of COVID-19, plans and providers will need to more agile and responsive than years before.

For that reason, fotonovelas have become one of the core capabilities in our Flu Vaccination Solution for 2020-21. Fotonovelas engage a range of core population groups, including key multicultural segments with configurable content and versioning that enables matching to specific personas and demographics that can be updated over time. They can be a touchpoint that alerts members of appointment reminders, vaccination site locations and educational services. But the most powerful aspect of this form of outreach is the ability to tailor content based on an understanding of members health beliefs, in members’ preferred language and through their preferred channel. By listening to member responses to automated text conversations and understanding what they need to hear in order to get vaccinated, health care organizations can gather insights and deliver tailored and engaging outreach at scale. Because the solution is available on SMS and Link-to-Web it has the ability to reach a wider population at scale, meeting members where they are, taking pressure off of the member to seek out information during the height of the pandemic and flu season.

In a year of “unprecedented situations” the 2020-21 flu season is yet another that will require healthcare to evolve its approach. The reach, engagement and rich content provided by our fotonovelas strategy is a natural fit for the unique challenges of this flu season. Healthcare organizations know they have to do more this year than a strategy of 1-way reminder outreach and reliance on employer, church, or school vaccination drives. By creating conversational touchpoints around flu vaccination and supporting members with differentiated and rich content, they can elevate their engagement strategy to support the populations they care for.

5 Key Takeaways from Speaking at the 11th Annual Medicare Market Innovations Forum

On Thursday, July 16th, 2020 our VP of Marketing, Brendan McClure, Bill Jenson from Independent Health Care, Linda Roman, and Brenda Mamber from Cenaturi Health, spoke at the 11th Annual Medicare Market Innovation Forum. BrendanBillBrenda, and Linda explored designing unique member experience and how leveraging data can build loyalty. 

Here are our 5 Key Takeaways:



 Bill and Brendan both noted that the COVID-19 pandemic has accelerated a number of existing trends in member engagement. Telehealth access outreach, check-ins with members about their wellbeing, and conversational engagement to both inform and uncover insights all took on much greater importance. For plans where these member-centric touchpoints and engagement procedures were already in place, the trust between member and plan was greater once the crisis started. Early COVID engagement strategies from the plans already engaging conversationally have given plans a unique advantage to build even deeper connections with membersBrendan gave a real example where an automated check-in with a Medicare population prompted a response from one member who said that he had not heard from anyone in two weeks and deeply appreciated the care and concern from the plan.  



When a plan can ask the right questions and supply the proper resourcesmembers are more likely to engage and leave the conversation feeling heard. Plans often have underutilized resources and interventions due to a lack of member awareness, or because plans do not know who needs what. But simply asking members in conversational channels if they are experiencing issues like social isolation or food insecurity both create the opportunity to connect them with resources and identify members who may need follow-up. By asking the right questions, a plan can uncover barriers to action such as transportation, health literacy, language, and the like. Asking and then providing the member with the appropriate resources will not only drive engagement and drive behavioral change, it will help build the trust needed to engage in future conversations. 



Loyalty is a product of building trust. A member is more likely to engage in future conversations when they feel like the plan is invested in their health as much as they are. Brendan noted that trust comes from a plan who communicates accurately, timely and quickly. In addition to the example of COVID-19 outreach from plans that were already having conversations with members regularlythe panel noted how important building trust over time was when it came to SDOH barriers. Members are more likely to share barriers and more likely to accept help and interventions when there’s trust in an established relationship. The stronger that relationship, the more confident a plan can be in retaining that member over time, and counting on them to engage in the future. 



 Because trust is established during ongoing conversations over an extended period of time, when a member is ready to transition into Medicare they are more likely to accept information and resources from their planThat level of trust will keep members open and willing to communicate with their plan on a regular cadencemPulse has found that members who received text outreach from their plan previously about health or services were much more likely to request information on their payer’s Medicare plan options via text. Leaning on the trust built throughout the relationship to continue to ask questions about their experiences with their healthcare and using that data from past conversations with the member to tailor age-in outreach can be a winning combination for both retention and member experience. 



Brendan reminded the audience that the data you get from engagement depends on the questions you askThere is value in all variations of member responses. Discovering whether a member is happy or unsatisfied with their plan creates the opportunity to tailor further engagementSentiment and intent analysis of member responses to automated outreach provides valuable feedback to the planAsking member directly how they feel about their plan, or measuring positive and negative responses to questions about their health or the COVID-19 pandemicgives plans insight on retention risks, hotspot geographies that may have provider network issues, or topics where members seem to be dissatisfied. Uncovering these potential blind spots and quantifying members’ expressed feelings toward their plan gives payers actionable data to impact everything from future engagement strategies to benefit design.