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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!

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!

Recognizing Innovation in Healthcare at Activate2021

We recently hosted our annual conference, Activate2021, which featured a keynote address from Nick Webb, healthcare futurist and best-selling author, along with a number of exciting sessions, panel discussions, and of course–Activate2021 Awards!

The Activate Awards shine a light on healthcare organizations who are delivering excellence in health engagement to meet and exceed the needs of an evolving healthcare landscape. Never has this proven to be more fitting than in the past year when organizations have had to alter their consumer outreach strategies in response to Covid-19. With the disruption caused by the pandemic, it is now more important than ever to address gaps in communication and low utilization of services. 

These companies demonstrated how innovative ways to activate their populations can improve access to healthcare and significantly enhance the consumer experience.

Winners were decided based on qualitative and quantitative results across five categories: Health Equity, Conversational AI, Innovation, Outcomes, and Consumer Experience. In case you missed it, we’ve recapped for you the ways these 6 different healthcare organizations are making a powerful impact on health engagement, health equity, and health outcomes.

CalOptima – Improving Health Equity

CalOptima is a large, county-based health system that offers health insurance for low-income residents of Orange County, California. The plan sought a solution to uncover barriers to getting the Covid-19 vaccine and to increase vaccinations of its diverse Medi-Cal population. CalOptima rolled out a Covid-19 vaccine engagement program across 6 languages that geo-targeted highly impacted groups and delivered over 1.4 million tailored messages to members. 389,648 members received vaccinations with health equity efforts among populations of color resulting in CalOptima’s Black Medi-Cal population reaching a 45% vaccination rate compared with only 40% of Black Medi-Cal members vaccinated statewide. Similarly, 56% of their Hispanic Medi-Cal members are vaccinated versus 54% of Hispanic Medi-Cal members statewide.

CareSource – Best Use of Conversational AI

CareSource is a health plan, headquartered in Ohio, dedicated to member-centric insurance coverage for its 2 million members. Looking to combat vaccine hesitancy, the plan implemented tailored SMS messaging, member surveys, and streaming health content to educate and uncover member barriers to getting the Covid-19 vaccine. The campaign delivered over 3 million automated tailored dialogues to 664,000 members, with members self-reporting as “Non-Believer,” “Unsure,” or “Ready.” By tailoring communication based on member preferences, CareSource was able to impact more than 650k members nationwide. At the end of the program, 57,000 out of 107,000 “Unsure” members moved into the “Ready” persona.

Magellan Rx Management – Most Innovative Program

Magellan Rx Management, part of Magellan Health, is a national pharmacy organization that serves complex populations. Magellan Rx engaged their specialty pharmacy members with two-way messaging and digital fotonovelas to address loneliness and anxiety experienced by their members during the pandemic. The use of fotonovelas was an innovative approach to deliver easily digestible and educational content in an engaging, story-based format that is relevant across diverse populations. After incorporating conversational dialogues and fotonovelas, the most impacted populations were younger members and members most impacted by social determinants of health. Overall, the program yielded over a 38% engagement rate to go along with a 90% member satisfaction score.

CountyCare Health Plan – Most Significant Outcome (tie)

CountyCare Health Plan is a large Medicaid managed care organization offering no-cost health insurance to eligible members in Cook County, Illinois. The plan wanted to uncover obstacles preventing members from getting vaccinated while increasing awareness and readiness. CountyCare launched a vaccine engagement program that targeted members significantly impacted by social determinants of health. The program utilized digital fotonovelas to address vaccine hesitancy and lift health literacy. After over 2.6 million tailored messages sent, 18% of members replied or clicked a link and 72% said they are more likely to get the vaccine.

Providence Health & Services – Most Significant Outcome (tie)

Providence Health & Services is a nonprofit health system, based in Washington, that operates in seven states and serves millions of individuals. The health system sought to increase sign-ups for their MyChart eCheck-in Program, which centralizes appointments, prescriptions, bills and other important patient resources all in one place. By partnering with mPulse and optimizing their patient engagement strategy, with the SMS solution, they grew patient activation rates from 9.9% in December 2020 to 27.4% by August 2021.

A leading Health Services provider – Most Improved Customer Experience

This organization is a nationally recognized leader in technology-enabled health services with over 100,000 employees worldwide. The company needed to transition a wellness coaching program from telephonic to a fully digital experience. A focus of the program included delivering a tailored, content experience that scales across populations. The health services company partnered with mPulse to build 11 custom content courses that drove 120k enrollments, and it yielded a 75% completion rate along with an average engagement rate of 51 minutes per enrollment. The organization used digital tools to deploy a robust program that kept their health consumers more engaged with their health content for a longer period and moved them into a space that allowed for more meaningful engagement in the future.

These 6 healthcare partners harnessed the value of innovative engagement solutions and streaming health education to positively impact their populations. The programs illustrate how rapidly health engagement is evolving to meet the needs of a shifting healthcare landscape and through adoption of new capabilities that create more meaningful touchpoints with members. For more information about the Activate Awards or any of the capabilities used in these programs please email us at

About mPulse Mobile: mPulse Mobile is reimagining health engagement to inspire healthier lives and deeper relationships between healthcare organizations and their consumers. Healthcare’s leading Conversational AI platform combines with award-winning health education for the streaming age to deliver tailored educational health engagement that nurtures, educates, and activates healthcare consumers.

With more than a decade of experience, 125+ healthcare consumers and 500 million conversations annually, mPulse Mobile has the data, expertise and the solutions to drive healthy behavior change.

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.

Key Takeaways from RISE West and the mPulse Mobile Roundtable

During the RISE West conference earlier this month, there were a lot of conversations about the changes that face healthcare in the new year. 2020 brought on a lot of changes to CAHPS measures and weighting that will not only affect the new year, but transform the way Medicare plans will be evaluated and rewarded for the foreseeable future. mPulse Mobile focused on 4 strategies to prepare for 4X CAHPS ratings during our roundtable at RISE West, and it fell in line with what the conference presented overall. Here are our takeaways from the event both the roundtable and the conference.

Focus on Creating a Relationship

Plans will need to keep up with the changing quality guidelines, including the change of CAHPs survey scores to 4x weighting. Everyone knows running a successful Stars program has always been more of a marathon than a sprint. Plans do everything they can to improve member experience and health outcomes on a daily basis, year over year, in an effort to maintain and attain high performing status. It comes as no surprise, COVID 19 has thrown a wrench in those plans and now the marathon has become a decathlon – hurdles around each corner, new sprints to the finish, jumping over and through an ever changing regulatory landscape while throwing everything you have left at anything you can hit.

What’s interesting about these changes are how plans will have less focus on traditional priorities as they are weighted differently. The opportunity here is to think beyond traditional HEDIS and medication adherence improvement strategies and deploy solutions that will engage members in a way that builds a rapport between member and plan or provider.

Creating new touchpoints with members where they can respond and feel heard is critical. mPulse uses automated “check-in’s” and follow ups after customer service interactions to create scalable conversations with members. By listening to member responses and answering back, we both gather key data and give members a chance to have 2-way interaction with their plan on their terms.

In the roundtable, we noted that all of those best laid plans for 2021 Stars don’t have to fail or be seen as all for naught. Even though CMS has recycled last year’s CAHPS and HEDIS rates for 2021 Stars, the hard work and efforts put in over the last few years are likely still improving member experience and health outcomes, it just won’t be displayed as such on Medicare Plan Finder.

Be Proactive

Engaging members about their experience with their plan via automated message helps gather necessary data to respond to the member, but also provides an opportunity and touchpoint to share good news about plan changes. Sharing new information that may affect the way the member interacts with their plan will build trust and help further establish that onboarding process that will lay the groundwork for future conversations. A proactive approach around potentially negative news or changes helps eliminate surprises for members who may not be otherwise aware of a formulary change until they get to a pharmacy.

Act on the Experience Data You Have

2021’s changes require MA plans to listen to what members are saying more than ever before: the good, the bad, and the in-between. Taking stock of every member touchpoint and the data it generates is key to tailoring communication with the member. And while plans usually think of experience information as call center or appeal/grievance data, virtually any information the plan has can be used to create a meaningful interaction or make an existing one more impactful. Just member date of birth and date of joining the plan create opportunities for birthday reminders, health plan anniversaries, or milestones and shows that the plan is interested in the member. mPulse takes member responses to surveys or automated outreach and applies sentiment and intent analysis. This takes a strong initial data point and enriches it so that the plan can see, for instance, how members respond to gaps in care outreach, as well as those who are consistently negative or positive in their interactions with the plan. And by building personas around trends in experience data, plans can better predict “look-alikes” who may be more likely to have a neutral or negative opinion of the plan but have not filed a grievance or complaint.

Understand the Member Experience Impact of Telehealth

Plans can implement CAHPS improvement strategies and customer service operations to optimize member experience around digital care. The last six months have essentially forced beneficiaries, carriers, and providers to embrace innovations and technology. Now there is a need to improve member experience with digital and remote care and how its value is communicated to members. Plans who engage and support their membership through this new and ever evolving space will come out on top. It takes more than just letting a member know they have coverage for telehealth visits, it takes an extra effort to educate and encourage them. Creating interactions where members can share barriers, hesitations or concerns with telehealth will be key to an effective CAHPS strategy in 2021.

Plan for a Second Wave of COVID-19 and Strategies to Close Gaps in the Meantime

It is difficult to predict the lingering impact of COVID-19 in late 2020 and early next year. However, when plans begin to shift towards post-COVID strategies, they will need to remain agile and ready to accommodate shifts in public health guidance and CMS rules. In general, plans should not wait to encourage members to complete key preventive care visits and screenings if possible and stay adherent with medications. Knowing that more changes from CMS are coming, plans should continue both maximizing their performance now, and putting processes in place to be successful when Stars returns to “normal” and COVID-19 rule changes no longer protect ratings.

Plans who make an effort to build stronger connections with members and execute a deeper CAHPS strategy now will be more likely to see a successful Stars season in 2022. Since better relationships with members do not necessarily reset every measurement year, it’s also the area where plans can see the most value for their quality improvement efforts now.

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.