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How to Use SMS to Transform Healthcare Communication

In an era where communication is king and technology reigns supreme, SMS (Short Message Service) has emerged as a pivotal tool in healthcare outreach. With nearly 6 billion text messages exchanged daily in the United States alone, the potential of SMS in healthcare consumer engagement is unparalleled.

However, harnessing the full power of healthcare SMS for outreach requires more than just sending generic messages. It demands a nuanced understanding of best practices to truly connect with members and drive positive health outcomes. From personalized messaging to maximizing call-to-action completion rates, mastering SMS best practices is essential for any health plan striving to optimize member engagement and deliver impactful healthcare outcomes.

Join us as we explore the intricacies of SMS best practices in healthcare outreach and delve into five key healthcare SMS strategies proven to

  • enhance SMS engagement,
  • optimize member interactions, and ultimately
  • drive better healthcare outcomes.

Understanding the growing potential of SMS

From its humble origins in 1992, SMS has evolved into a cornerstone of connectivity, facilitating billions of daily interactions across the country. In fact, SMS is today the most common and widely used form of communication in the United States, and it has been since 2007 when the number of text messages surpassed those of phone calls.

Within healthcare, SMS has reshaped how healthcare organizations engage with patients. With the advent of multimedia messaging services (MMS) and rich communication services (RCS) functionality, the capabilities of SMS have expanded exponentially, offering personalized and interactive touchpoints for patients.

One significant advancement in recent years has been the integration of artificial intelligence (AI), which marked a new era in healthcare communication. Healthcare organizations can now deliver tailored support and guidance to patients by leveraging AI-driven conversational interfaces. This has revolutionized the member and patient engagement landscape and realized remarkable outcomes for engaging hard-to-reach and diverse populations.

Navigating Engagement and Outcomes

Despite so many technological advancements, the essence of effective SMS communication for healthcare remains the same – its ability to engage members and patients meaningfully. Generic messages often fail to capture recipients’ attention, resulting in low engagement rates, and it’s clear that personalization is key to driving meaningful interactions.

On average, text messages have a 99% delivery rate, with 95% being opened within 5 minutes. However, receiving a text from your health plan isn’t quite as exciting as receiving a text from your best friend or significant other. This is why it’s imperative health organizations schedule health SMSs that are personalization and meaningful dialogue to maximize engagement.

An example of a tailored SMS conversion between a healthcare provider and a patient to remind them of their mammogram screening.
An example of a tailored SMS conversion between a healthcare provider and a patient to remind them of their mammogram screening.

Imagine receiving a text message from your healthcare provider addressed to you by name, offering tailored guidance based on your specific needs and preferences. Going even further, picture being able to respond and converse through text messages with your health plan or provider and being sent helpful videos and lessons in response to your concerns. This personalized approach enhances engagement and fosters a sense of trust and connection between patients and the healthcare organizations serving them.

Furthermore, the impact of personalized healthcare SMS content extends beyond mere engagement metrics. Healthcare organizations have witnessed tangible improvements in health outcomes by delivering targeted messaging. From a 10pp improvement in colorectal cancer screenings to enhanced access to care measures, the power of tailored SMS content is undeniable.

Embarking on a journey of best practices

As healthcare organizations navigate the realm of SMS communication, embracing best practices becomes essential. It’s not just about SMS templates for health insurance or other medical solutions but crafting meaningful interactions that resonate with patients.

Five key practices to optimize healthcare SMS outreach efforts

  1. Establish trust for effective communication

Trust is the cornerstone of effective SMS communication for healthcare. By introducing yourself and explaining the purpose of the message, you lay the foundation for a meaningful dialogue with patients.

To do so, begin by addressing recipients by name and introducing yourself, then explain the purpose of the message clearly. Not only does this approach confirm the message is intended for the recipient, but by letting the consumer know you care about them and their health, you begin to lay the foundations for a meaningful relationship that will improve the likelihood of health action and, thus, member retention.

Another important consideration, although somewhat more technical in nature, is your “sender number”. Be consistent with this. Using a standard shortcode will establish trust with the service provider, preventing your messages from being blocked as spam. You can also send your members a virtual contact file (VCF) card, a great way to get all your information into your members’ phones and ensure your messages are automatically directed into their “known inbox”.

  1. Empower members to take action

Healthcare messages should be structured to enable members to take immediate action. Provide clear instructions and mechanisms for them to follow through on desired actions, such as scheduling appointments or accessing resources.

SMS allows you to use clickable links, making it easy to direct members to relevant materials or services. These branded links enhance trust, as members can see where they’ll be going before they tap on a link, but they also mean you’ll be able to track interactions at the member level for valuable, near-real-time insights.

Beyond that, you must enable your members to continue interactions. This will allow you to address any barriers preventing them from taking action and empower patients to navigate their healthcare journey seamlessly.

Conversational AI and Natural Language Understanding (NLU) enable members to reply with questions and for the technology to read a message and provide a relevant response that addresses their concern and motivates them to engage in the health action you’re driving by providing the tools they need.

By responding in a natural conversational way, you can continue the conversation, uncover barriers, and get the member or patient one step further toward taking the desired action. In turn, your members will feel seen, heard and valued, resulting in a far more pleasant consumer experience overall.

  1. Give your content a boost

Personalizing your content not only builds trust but also allows you to tailor messages to the specific needs and preferences of each recipient. By tailoring content to address demographic information and social determinants of health, you can enhance engagement and drive positive health outcomes.

Incorporating multimedia elements into SMS, such as streaming health content, further boosts member engagement. Visual and narrative communication, particularly through video, captivates recipients, fostering a deeper connection and understanding of healthcare information.

A recent A/B test including embedded streaming health content in SMS resulted in a 270% increase in click-through rates and engagement. At the same time, the neuroscience around narratives shows that people retain about 7-12 times more information when it’s told as a story.

A patient accessing streaming health content on her mobile phone in the convenience of her home
Using streaming health content is a convenient way to reach people with relevant health education content.
  1. Speak the same language as your members

Health plans often cater to diverse populations with varying language preferences, which can present a challenge. However, there’s no denying that effective communication involves speaking to your members in their preferred language.

Example of using SMS in healthcare communication and adjusting to a member’s preferred language
Adjusting to a patient’s language encourages positive engagement and valuable relationship creation.

Communicating with members in their native language is one of the most high-value things you can do for positive engagement. Fortunately, with NLU, it’s possible to identify and respond to your members’ language choices.

Adjusting to a patient’s language encourages positive engagement and valuable relationship creation

For example, if someone responds to you in Spanish, respond to them in Spanish to let them know they can change their language from English simply by replying with the word “español”. Once you’ve confirmed their language, you can update their language preferences automatically to ensure that all future communications with them will also be in Spanish.

  1. Check the compliance box

Managing opt-ins and opt-outs is not just a best practice; it’s a legal requirement under the Telephone Consumer Protection Act (TCPA).

Ensure compliance with regulations by promptly honoring requests to opt-out. We all know what it’s like when you’re inundated with messages – sometimes people may reply “stop” simply because they’ve received one text message too many that day or because they don’t understand who the sender is. To overcome that particular challenge, make sure you always provide a way for members to opt back into the communication channel if they change their minds.

Understandably, healthcare organizations may have concerns about TCPA compliance, but if you’re looking to use messaging for the first time, rest assured that text messaging programs offer some definite advantages over other forms of communication.

Elevate your SMS strategy for better healthcare outcomes

In the evolving landscape of healthcare communication, healthcare SMS stands out as a versatile and effective tool for health plan outreach. Adopting SMS best practices is essential for any health plan aiming to unlock the full potential of this powerful communication tool, transform member engagement and drive positive health outcomes.

Our recent webinar on “Leveraging SMS for Health Plan Outreach provides even more in-depth insights and practical strategies.

To delve deeper into the world of SMS best practices and get to the bottom of some common myths about the TCPA, download the full webinar, where industry experts discuss real-world outcomes and practical tips for success.

To learn more about mPulse’s digital health solutions and outcomes, contact us at


Digitizing Equity: Transforming Medicaid with Technology and Empathy

Medicaid is a vital safety net for millions of low-income and vulnerable individuals across the U.S. However, glaring health disparities persist within the program.

The pandemic underscored the stark health inequities among marginalized communities, including BIPOC (Black, Indigenous and People of Color), LGBTQIA+, people who are neurodivergent, and people with differing physical abilities. These challenges are especially pertinent to Medicaid, since more than half of Medicaid enrollees are people of color, and an estimated 20 percent are considered disabled.

Although tackling health inequities is a massive, multi-stakeholder undertaking, innovative solutions and strategic changes can have a significant impact, especially in the realm of digital health technology.

Digital health tools play a crucial role in eliminating health inequities and improving care for all. But technology alone isn’t the answer. Investing in technology without a clear strategy to advance equity can actually exacerbate existing inequities. Instead, health organizations need to address health equity by combining data-driven practices with a whole-person approach that grounds services in humanity and ensures all people receive the care they deserve.

Why Medicaid has Vast Health Disparities

Health organizations are undergoing a reckoning about the ways the insurers, providers and the greater healthcare community have failed marginalized communities. Tangible steps must be taken to fix systemic problems.

That includes viewing health from the whole-person perspective. It’s estimated that about 80 percent to 90 percent of health outcomes can be attributed to social determinants of health (SDOH) – non-medical factors such as socioeconomic conditions, environmental factors, race, ethnicity, language, sexual orientation and gender identification (SoGI).

It can be all too easy for providers to make assumptions. For example, some providers may write off a Latino patient as non-compliant when they don’t take prescribed medicines without further investigation or may ignore a female patient’s pain because it was seen as common period symptoms. However, a Latino patient may not take medication because it’s cost-prohibitive or they don’t have a pharmacy near them, while the other patient’s pain could be a symptom of a more serious illness that requires medical intervention.

If a provider has more time to connect with patients, listen to their perspectives and treat them as individuals, they can better identify their needs and identify solutions, such as prescribing a lower-cost formulary or scheduling a follow-up appointment with a specialist.

While these SDOH-related health disparities exist for all individuals, Medicaid members face another unique hurdle that affects their healthcare experiences – stigma and negative stereotypes about their use of government services. Although individuals must meet stringent criteria to qualify for Medicaid, organizations and even providers themselves may perpetuate stereotypes about people who need government services — increasing barriers to care rather than eliminating them.

It doesn’t help that there are significant data gaps among Medicaid populations that hinder organizations from understanding and addressing the myriad factors impacting people’s health outcomes and access. Approximately one in five Medicaid beneficiaries are missing information related to their race and ethnicity. These gaps make it even more challenging to pinpoint and prioritize areas for health equity initiatives.  

So, with all of this in mind, what can health organizations do to address these complex challenges and bridge the health equity gap?  Advancements and innovations in digital technology create new opportunities for health organizations to identify and track health disparities, and target services and medical interventions for vulnerable populations.

But to make progress on health equity goals, organizations need strategies and structures that put people at the center of the health care experience.

3 Ways to Reduce Health Barriers

While digital tools and data-driven strategies can streamline processes, reduce friction and enhance consumer experience and engagement, effectively using these tools to serve and support vulnerable populations poses a unique challenge.

The following considerations can help organizations focus their technology strategy to better support those who are most in need.

Focus on establishing trust.

Trust is often the determining factor when it comes to a patient refilling their prescription, showing up to a follow-up appointment or making a healthy change in their behavior. But establishing trust among Medicaid beneficiaries can be even more challenging in light of the historical medical discrimination and mistreatment of marginalized populations, as well as government recipients’ current experiences with medical bias.

Building trust requires empathy, transparency, and an in-depth understanding of individuals and their unique needs. Robust data analytics can help with this. By collecting and analyzing data on race, ethnicity, language, sexual orientation and gender identity, healthcare organizations gain actionable insights that can help identify disparities and tailor interventions to meet the unique needs of diverse populations.

With a better understanding of these needs, organizations can treat Medicaid beneficiaries as individuals and begin to rebuild the critical link of trust with their beneficiaries.

Meet people where they are. 

Another way health organizations can increase access to care is by providing beneficiaries with meaningful interactions and tailored personalized engagement. In fact, nearly two-thirds of consumers would access additional care if their healthcare experiences were more personalized.

In particular, health plans should focus on improving accessibility to healthcare information and communicating with Medicaid members on channels they already know and use. For 85 percent of Americans, that’s on their smartphones. Digital health programs that use text messaging and other mobile channels can deliver personalized health information, reminders and resources to individuals in a convenient setting.

Programs like the national Affordable Connectivity Program (ACP) are helping close the digital divide (the inequitable access to computing devices and stable high-speed Internet) that can alienate Medicaid recipients, especially in rural communities.

Texting and other mobile technologies can not only provide timely updates and appointment reminders; they can also offer valuable educational materials. For example, health plans and providers can inform members of the importance of mammograms while removing common fears or provide members with limited literacy skills with high-quality videos that utilize best practices in learning strategy. By meeting beneficiaries on their terms (without condescension or stigmatization), health organizations can remove points of friction and make services more accessible.

Build for scalability. 

It’s not enough to build digital experiences that only work in a single scenario or specific moment. Health organizations need to build processes that scale across operations and alongside organizations as they continue to grow. Artificial intelligence and automation are valuable tools to help organizations achieve these goals.

Administrative costs comprise a majority of health system waste, with at least half of administrative spending deemed wasteful. Automating manual tasks and supercharging data-driven decisions enables organizations to streamline burdensome administrative processes and enhance the overall efficiency of healthcare delivery at scale, ultimately improving care for patients.

While artificial intelligence technologies have vast potential to improve healthcare delivery, it’s crucial to ensure AI tools are used responsibly and avoid perpetuating existing disparities or biases in data sources. To minimize the potential negative effects of AI, set rigorous safeguards and standards that adhere to best practices established by trusted entities, like the Coalition for Health AI.

The Imperative for Digital Innovation

“Healthcare as usual” isn’t optimal for Medicaid enrollees, health organizations or anyone for that matter.

Programs that fail to address underlying disparities lead to greater inefficiencies and higher costs for organizations. In fact, treatment of chronic conditions such as asthma, cancer, diabetes and heart disease costs the U.S. $320 billion a year resulting from health inequities — and unaddressed health disparities costs could balloon to $1 trillion by 2040.

Technology adopted in a vacuum won’t solve deep-seated health disparities. But by pairing digital investments with meaningful conversations and support for Medicaid beneficiaries, we can begin to break down barriers and accelerate progress toward a more equitable healthcare system for all.

This article was originally published on on December 20, 2023.

Medicaid Redetermination: 180 Days After the Return to Regular Operations

Three years after the start of the COVID-19 pandemic and after over two years of continuous Medicaid enrollment, we finally saw the return to normal operations in April 2023 as the national public health emergency (PHE) was officially decoupled from Redetermination.

Now, almost 180 days out from the start of the unwinding process, it’s time to look back at how states have handled this massive undertaking, how Medicaid beneficiaries have fared, and the strategies of those plans who have been successful with the redetermination process these last six months.

The 2023 Medicaid Redetermination Process So Far

Having been in Phase 1 of the unwinding process (outreaching to members for updated contact information) for the majority of 2022 and into 2023, the market finally saw a shift into phase 2 in April 2023 when states officially began the process of redetermining eligibility for millions of members

Sourced from Of all people who were disenrolled, 73% were terminated for procedural reasons, as of October 2, 2023.

While it’s true that it was expected many people would lose their coverage, we are unfortunately seeing large numbers of people losing coverage for procedural reasons rather than due to a lack of eligibility. Recent data from the KFF Medicaid Enrollment and Unwinding Tracker shows that of the over 7 million people who have lost their Medicaid coverage since the start of the unwinding, 73% of those fall into this bucket of people losing coverage not as a result of merit or financial requirements but rather on a lack of replies, incomplete information, and the like. 

In light of this, Congress has paused the redetermination efforts of 30 states due to their exceedingly high numbers of procedural disenrollments. Nearly half a million individuals will be reinstated after CMS found some states processing eligibility checks at the family level thus leaving out children who have lower or fewer requirements for coverage.

These 30 states have had to return to Phase 1 and 2 efforts to reach out to individuals to update their contact information and process their eligibility. Some are taking action to re-enroll everyone they presume might no longer be eligible, while others are asking their members to re-enroll based on their initial enrollment month. 

An All Hands On Deck Approach 

There’s been no shortage of assistance from state and federal organizations providing guidance and resources on approaches to drive the redetermination process and encourage people to re-enroll and maintain as much coverage as possible.

Furthermore, to reduce some of those procedural issues, health plans are now also allowed to help individuals fill out enrollment forms, which we hope will drastically reduce the amount of procedural disenrollments.

Another game-changing move was a declaratory ruling by the FCC earlier this year that health plans can now leverage SMS texting and IVR calls to conduct outreach and support continuation of coverage efforts.

This brings us to a discussion around digital strategies and asking the question, will doing the same thing deliver different results? If states are encountering issues around procedural disenrollment, what other approaches can they adopt? 

Digital Strategies to Tackle Medicaid Redetermination 

If traditional outreach methods haven’t been as effective as we hope in some states, it only makes sense to consider alternate strategies when it comes to member outreach. One channel we have seen work very successfully in redetermination efforts is SMS texting. A widely adopted channel, it can produce engagement rates of up to 60% for the most valuable and tailored programs sent to engaged populations.

To employ the SMS channel in your redetermination efforts, there are four best practices to consider.

Deliver Outreach Aligned to Language Preferences

Be sure the messages you are sending are personalized and relevant to the member. Reaching your Limited English Proficient (LEP) members can be difficult, especially when you don’t know who they are or what their preferred language is. Even if you are using pre-approved language for your redetermination outreach, an easy action to implement when leveraging a text channel is to ensure you align your messaging to the language preferences of your members. For example, mPulse technology allows for you to go beyond typical language challenges or compliance required taglines by automatically transitioning between English and Spanish in our two-way SMS conversations.

Include Educational Content to Address Health Literacy Gaps

Streaming health empowers behavior change and overcomes member barriers in 60 seconds or less.

Use captivating and engaging content in these outreach programs that educate individuals on why they should reapply. While creating awareness is the first step, educating members on why it’s important to reapply in an effort to maintain their coverage is vital. Think about it: if you don’t understand the benefits of Medicaid and how it contributes to your long-term health, why would you spend the time and energy filling in forms to prove your eligibility? Providing members with educational tools designed to build knowledge and confidence will increase the likelihood that they’ll take action.

Incorporate Behavioral Science Strategies into Messaging

Behavioral science has become a crucial component of health engagement programs and has been proven to directly impact health outcomes. Loss aversion, a cognitive bias that describes why the pain of losing is psychologically twice as powerful as the pleasure of gaining, or social proof, the phenomenon where we look around us for clues on how to behave, are examples of behavioral science strategies you can incorporate into messaging to foster greater trust, dispel concerns and increase the likelihood that your hard-to-reach members will engage and respond to outreach materials. This will help create a need for members to act.

Use Conversation AI Outreach to Identify Barriers

Leverage conversational AI and two-way texting to uncover barriers and encourage action. These AI powered, bidirectional texts allow automated, tailored responses to address individual barriers. If members reply to the texts, conversational AI uses natural language understanding (NLU) to “listen” for known barriers and other expected replies and provide relevant, automated responses to create logical conversation flows to address these barriers. This is also an opportunity to build health literacy and raise awareness about the need to maintain coverage. You can imagine how helpful these kind of capabilitiies are when trying to determine barriers to reapplying for coverage and encouraging action among your members. 

An Activation Solution 

While organizations may feel hampered by the requirement to use pre-approved state language, there’s no reason you can’t use it as an interim solution or in tandem with additional, tailored outreach. 

This is exactly the approach that one health plan adopted in preparation for the unwinding. Their goal was to activate Medicaid members with high-impact messaging and content to educate, set intent, and reduce the perceived effort of completing the redetermination process.

They achieved this by utilizing automated two-way programming to uncover and address member barriers, integrating fotonovelas, in multiple languages, into the outreach messaging. They delivered relatable stories to members that leveraged the endowment effect and loss aversion to build intent to keep coverage, and they used natural language understanding (NLU) to uncover and address common barriers and address members’ issues at scale. 

As a result, 33% of targeted members engaged with the program and by leveraging NLU, 18% of targeted members responded to the program which uncovered and addressed common barriers.

So, what does this prove? SMS is an effective channel for member outreach. It allows for delivering messages via a high-reach, high-touch channel and gives people something they can either act on in the moment or return to after the fact.

In the example above, the outreach was delivered in both English and Spanish, and made all the difference in overcoming barriers to action. Considering the best practices for member outreach that we mentioned earlier, it’s clear that addressing people in their own language, at the right time, on the right channel is key. 

Looking Ahead to Better Health Coverage 

While procedural disenrollment is a concern, several systemic issues have been identified, and the administration is taking steps to address them to keep people connected to care. Better processes and partnerships are expected to come into play, enabling easier approvals and ways to share data between states and health plans.

This includes partnering with managed care organizations, community health workers, walk-in centers, and more to raise awareness and assist enrollees in completing and submitting their renewal forms, even over the phone.

And while state-based content and language is a great starting point for communication, if you’re looking for ways to enhance your outreach efforts, start by considering what’s worked, what hasn’t worked, and where you can integrate these best practices to produce better outcomes.

How can you improve the content, add more languages, or add additional outreach modalities such as phone, email or SMS? Most importantly, how can you include streaming content and facilitate two-way conversations to overcome barriers and inspire your member populations to take action?

Not sure where to start? Reach out to learn more about the power of SMS and how you can establish a robust redetermination solution to reduce coverage loss and create high-value member touchpoints. 

Improving the Patient Experience: Solving the Top Four Healthcare Challenges 

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

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

HealthCare is Challenging 

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

Let’s dive into each one.

Data Gaps 

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

Solving for Data Gaps 

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

Technology Capability Gaps 

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

Solving for Technology Capability Gaps 

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

Gaps in Engagement Strategy 

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

Solving for Gaps in Engagement Strategy

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

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

Gaps in Organizational Alignment 

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

Solving for Gaps in Organizational Alignment 

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

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

The New Normal

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

The Return to Normal: Medicaid Redetermination Edition

By the time the end of March rolls around, we will have seen just over 1,100 days of continuous Medicaid and CHIP enrollment. Federal guidance within the 2023 Consolidated Appropriations Act effectively decoupled continuous enrollment provisions from the Public Health Emergency (PHE) and will allow states to resume their redetermination process as soon as April 1st. 

Most states and many plans have already completed the first phase of the unwinding by encouraging enrollees to update their contact information to ensure they receive their renewal paperwork when it arrives in the mail. And while most all of us reading this piece are well aware of where we’ve been over the last year and what the next one might look like, a recent Urban Institute study in December 2022 found 6 in 10 adults in Medicaid-enrolled families were not aware of an upcoming return to the regular Medicaid renewal process.

You’re probably thinking, “How is this possible? It’s all we’ve been talking about and planning for months and months!” Well, maybe we shouldn’t be so surprised. Medicaid/CHIP enrollment increased by 20 million individuals since February 2020 accounting for nearly 30% of all covered lives. That’s 20 million individuals who likely have never completed a traditional or pre-pandemic redetermination and three years since the last time everyone else has. Lest we forget a lot has changed and occurred over the last three years in general.

Stats and surprises aside, we still have a long road ahead of us and a lot of work to do. Thankfully our regulatory friends like CMS and the FCC have stepped up to help keep individuals from slipping through the cracks. CMS has provided a strategic toolkit calling for states and plans to work together in timely sharing of enrollment data and contact information, for states to expedite content approvals or provide pre-approved language for member outreach, and for enhanced processes for moving individuals who no longer qualify for state-based programs to marketplace offerings. The FCC’s recent declaratory ruling that clearly states the provision of a phone number on an enrollment form constitutes as express consent allowing federal and state agencies and their partners to make Medicaid enrollment calls and send text messages without violating call or text prohibitions. Plans should take full advantage of the resources provided to them by incorporating each toolkit and clarified regulation into their overall member engagement strategy.

Learn more about outreach strategies for the end of continuous enrollment by viewing our redetermination webinar series featuring Kaiser Permanente and Mostly Medicaid »

Key Engagement Factors for the Return of Redetermination

Now let’s talk engagement strategy. Most plans will be using CMS or state-approved content and timelines are tight, so there may not be as much room for the creativity we see when dealing with other engagement topics like closing gaps in care or encouraging timely rx refills. That doesn’t mean, however, that you can’t still take a strategic approach in areas where you can still have an impact, such as channels, personalization, and branding. 

Channels: We know one single communication channel isn’t going to be enough, and it’s just not how people are consuming information or connecting to resources. Adult Medicaid beneficiary smartphone or tablet ownership rates are similar to the general US adult population, and 47.4% of dually eligible Medicare beneficiaries report using the internet to get information. An effective and successful engagement strategy is delivered through multiple channels by combining digital outreach like SMS and email with traditional modes of communication like mail and phone calls. mPulse is currently working with over 30 Managed Care Organizations across more than 20 states within different phases of their redetermination efforts to support engagement on all channels and channel combinations.

Personalization: After selecting your channels, be sure the messages you are sending are personalized and relevant to the member. Even if you are using pre-approved language for your redetermination outreach, make sure your salutation and any other merged fields are in the proper case and not all caps. Even an Excel novice can easily convert cells in all caps to proper case by applying a =PROPER formula to your selected cells. Proper case is easy, but what about language preferences? Reaching your Limited English Proficient (LEP) members can be difficult, especially when you don’t know who they are or what their preferred language is. For example, mPulse technology allows for you to go beyond typical language challenges or compliance required taglines by automatically transitioning between English and Spanish in our two-way SMS conversations.

Branding: Brand awareness and recognition leads to trust. You want your members to automatically know who all messages are coming from so they will not only trust it but also complete the desired request or action. Consider other communications that may be coming from your organization around the same time and coordinate your naming conventions to maximize brand awareness. Help get your brand on the right side of the inbox or in their known contacts by encouraging your members to store your phone number or SMS short code on their device or enhance those efforts by deploying mPulse Virtual Contact File (VCF) messages. 

The New Normal for Medicaid

The return to normal, or rather the return to the new normal is here, and there is no slowing it down. This is still uncharted territory with a lot of work yet to be done, but if we have learned one thing here today, it is that working together, maximizing resources, and leveraging technology to provide a personalized member experience will be the key to successful redetermination efforts.

For more insights into how to deliver this experience to your medicaid population, view our on-demand webinar series for Redetermination.

Activating Healthcare Consumer Behavior Change: Make it Personal

Key takeaways from our interview with Solome Tibebu

In the last decade, behavioral health has grown from an ancillary service offering to a critical component of health services and care delivery. According to an OPEN MINDS Market Intelligence Report, spending on mental health services totaled $225 billion in 2019, up 52% from 2009. Companies like Talkspace and BetterHelp, founded in 2012 and 2013, recognized this spike and made it their mission to increase the availability and accessibility of mental health services to those struggling to access and navigate care. Behavioral health has continued to evolve, and it is incumbent on all healthcare organizations to adopt new methods of providing care to vulnerable populations. Learning from innovative companies and forward-thinking leaders is vital to building an effective care strategy for the one in five U.S. adults living with a mental illness.  

mPulse sat down with Solome Tibebu, a pioneer in behavioral health technology and innovation, whose passion stems from the care gaps that have existed and still remain in mental healthcare. At the early age of 16 years old, Tibebu started a non-profit online resource, Anxiety in Teens, to offer education and support for teens and young adults who were struggling with anxiety and depression. After ten years, she began working in startups and consulting, continuing to advocate for the role of technology in advancing behavioral healthcare. 

This year in June, Tibebu will be putting on her third annual Going Digital: Behavioral Health Tech summit, a conference where health plans, providers, health systems, employers, investors and startups convene to discuss the evolving landscape of behavioral health. The virtual (for now) event is a great opportunity to share best practices for implementing digital resources and innovative technologies to improve access to mental health services. We are proud to be a sponsor for the second consecutive year, and we look forward to contributing to discussions around how healthcare organizations can implement solutions to tackle barriers and make mental healthcare more accessible for all.

Improving Access through Technology Innovation

COVID-19 created an array of challenges to advancing mental health access, but it also sparked a digital transformation that brought innovation to the center stage. With more consumers staying home, “tech has exploded as a response to the pandemic,” Tibebu prefaces. Technology plays an important role in understanding and addressing the social dynamics that affect each person living with mental illness. Some of the challenges that plague mental health accessibility require more than simple one-way consumer interactions, however. 

Talking about health plans, Tibebu emphasizes, “stigma is a huge barrier even after they’ve procured some kind of solution, so they need to have a strategy around how they’re gonna address stigma, and engagement of the member.” Stigma can produce feelings of worthlessness and lead to social isolation while social determinants of health (SDOH) like transportation access or income level can prevent consumers from seeking care. To tackle barriers like SDOH and stigma, it is necessary to utilize technology to understand consumer needs and preferences. 

Conversational AI and Natural Language Understanding power the capability to deploy behavioral science strategies at scale when communicating with vulnerable populations. For instance, incorporating a strategy like Affect ensures that messaging is based in empathy, increasing motivation to engage with sensitive healthcare outreach. Social Proof is an effective strategy that helps assure consumers that they are not alone and can help reduce social isolation caused by mental health stigma.  

Applying behavioral science and identifying SDOH in conversational outreach enables a deeper understanding of consumers. Once individual preferences are captured, healthcare organizations can efficiently tailor relevant content to each consumer and activate meaningful behavior change. 

Delivering Tailored Content at Scale

Incorporating clinically validated behavior change techniques helps with understanding the needs and preferences of consumers. Tibebu asks, “now all of these payers have implemented their telehealth solution but it’s the next level – how do we get something more customized, personalized to their respective populations?”  

Plans and providers can drive deeper engagement and self-efficacy by adopting tailored engagement strategies that lift utilization of the programs they’ve invested in. Conversational AI enables the orchestration of programs and resource delivery across preferred consumer channels. Natural Language Understanding helps capture important data from consumer responses to help route them to the appropriate digital resource. 

A one-size-fits-all care model fails to meet the needs of each consumer, while customization empowers healthcare organizations to intervene with meaningful content that drives behavior change. “How can you identify the consumer’s need and triage them to the right end solution?” Tibebu reiterates. Certain individuals who prefer a visual learning experience may benefit from a course like Living with Anxiety & Depression, while those who respond better to audio can be directed to a podcast like Mental Health Matters. 

Providing on-demand, curated content can motivate consumers to take control of their health and execute healthier behaviors, leading to improved outcomes and a better consumer experience.

Impacting Beyond Mental Health

We asked Tibebu why personalization in mental healthcare should be important to payers specifically. She responded, “because mental health is at the vortex of all health…for all of these other conditions, expensive conditions, that are impacted as a result of poor mental health.” Consumers who are negatively affected by mental health are more likely to develop chronic conditions, which piles up costs for both the consumer and the organization providing services. This creates an opportunity for plans and providers to adopt innovative solutions that promote well-being through tailored engagement. 

MagellanRx Management serves a complex population and recognized the need to incorporate well-being content for their members who were experiencing loneliness and anxiety from COVID-19. They partnered with mPulse to deploy digital fotonovelas, which use culturally sensitive stories in a comic-strip format to improve health education and activate diverse populations. The program drove impressive outcomes, yielding over a 38% engagement rate and a 90% member satisfaction score. 

We questioned how organizations outside of payers and providers can “step up” to make mental healthcare more accessible. Walmart Wellness is a nationally recognized brand whose goal is to “help customers raise their hand and more easily access their hubs,” Tibebu clarifies. Walmart partnered with mPulse to implement SMS solutions along with streaming health education to drive their customers to the right well-being resources. The program included custom learning plans across several wellness topics and produced significant improvements in customer engagement. 

After chatting with Tibebu, we are reassured that mental healthcare should be the focal point of an effective engagement strategy. Innovative companies can promote mental well-being and health literacy by leveraging technology that personalizes outreach. Educating consumers with tailored content through timely and convenient engagement builds self-efficacy and lasting behavior change.

Learn more about Conversational AI and streaming health education here. 


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.

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.

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.

5 Key Takeaways from Speaking at Rise National

mPulse Mobile’s CEO, Chris Nicholson, spoke alongside Rex Wallace at RISE national on the Engaging Hard-To-Reach Members to Drive Action Around Quality and Risk speaking session. Chris and Rex explored how to define hard to reach Medicare members, the importance of trust in engagement, some proven strategies and results, and how the new weight on Star Measures will impact how plans think about these populations.

Here are our 5 key takeaways:  


Members who do not engage or act after multiple outreach attempts tend to face several factors that make building a connection more difficult. Sometimes the issue is a matter of access to the content or channel. Language or cultural barriers can severely limit engagement with English-only outreach, and members who rely solely on smartphones for internet access can be much harder to reach via email and web portals. Our research shows that lower engagement tends to correlate with higher impact from Social Determinants of Health (SDOH). That impact can take many forms, from housing insecurity which causes mail to be delivered to old addresses, to lower overall health literacy that makes one-size-fits-all reminders to close care gaps less meaningfulBut the area that Chris and Rex explored the most was the members who simply did not trust their plan 


Data from Oliver Wyman suggests that trust is vital when members consider taking action on their health. A 2017 study that Chris and Rex discussed in the session shows that consumers are just as likely to consult with friends and family on whether to seek medical care as they are to ask a provider. And they were less than half as likely to check with their health plan. The difference is the level of trust and strength of relationship. Plans have an opportunity to build trust in their outreach by making it more conversational and tailored to the member.  


 Asking members questions – Why haven’t you visited the doctor? Why didn’t you refill your prescription last month? – and listening to their responses creates a twofold impact: You build trust by letting the member guide the conversation, while also uncovering barriers to action. Members who identify barriers feel heard and can be connected to plan resources to overcome them like ridesharing, appointment scheduling assistance, or health literacy-building content. And gathering barrier data can give vital insight to your quality improvement strategy.  


Rex and Chris dove in on how to define and measure trust in a member’s relationship to the plan. They used a four-part definition of trust from the American Psychological Association to explore how plans can measure something so qualitativeFirst, trust is based on past experiences and prior interactions, so plans should take steps to treat engagement as a long-term relationship rather than a series of campaigns and monitor engagement rates over time and across touchpoints. Second, trusted partners are seen as reliable, dependable, and concerned, which makes analyzing the sentiment of member responses to outreach a possible proxy for measuring how members view their plan. Third, trusting parties disclose information to each other and take on risk by relying on the other. This is where measuring and analyzing member responses to questions that ask for them to disclose things like barriers, SDOH impact, or other challenges can help plans understand the level of trust members place in them. Finally trust means confidence and security in the caring responses of a partner – which means members lose trust in plans that ask questions but don’t seem to listen or act on answers. Chris noted that when plans ask a member if transportation is a challenge but don’t correctly understand their answer (or don’t provide a remedy if they say yes), they damage the relationship they were trying to strengthen. 


Rex noted how the major changes from CMS to emphasize Member Experience and Complaints measures in formulating overall plan Star Ratings are a game changer for MA plans’ engagement strategies. These changes make the importance of each member’s relationship with their plan all the more critical to understand and improve. Previously, outreach focused on driving specific member actions to complete screenings, refill prescriptions or control a chronic condition. CAHPS measures making up over 50% of the 2023 Star Ratings measurement weights will mean that outreach should shift to measuring member experience and coordinating interventions based on their responses. Rex reminded the audience that one of the most important factors in member satisfaction and experience is what happens during provider encounters, which has traditionally been a blind spot for most plans. Chris and Rex said targeted and two-way outreach to gain insight about those blind spots is a great first step to incorporating the new CMS rule into engagement strategies.