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Month: April 2021

Analysis of April 1, 2021 Supreme Court Ruling on the TCPA

Posted on by Brendan McClure
Big news for healthcare organizations that have been hesitant to fully leverage text messaging due to conservative interpretation of the Telephone Consumer Protection Act (TCPA). On April 1, 2021 the Supreme Court ruled that automated messaging did not fall under the TCPA if the system sending the messages was not an automatic telephone dialing system (ATDS). The court’s definition of an ATDS was very narrow. Whether storing or producing numbers to be called, the equipment in question must use a random or sequential number generator to be considered an ATDS. Therefore, if organizations, healthcare or not, are not using an ATDS to send messages, then those messages do not fall under the TCPA. The ruling provides additional protections that should persuade more conservative organizations to adopt prior express consent strategies. The TCPA was established in 1991 to protect consumers from the growing number of telephone marketing calls. In 2013 and 2015 a series of carve-outs added provisions for healthcare related calls and messages where consumers who have knowingly released their phone numbers to a HIPAA compliant entity (or its Business Associate) have effectively given their invitation or permission to be called at the number which they have provided, absent instructions to the contrary. The call or message must fall within the scope of the consent that it was provided. Most commonly, this means if an individual provides their mobile phone number e.g. filling out an application form (paper or online) for health coverage or signing up to a medical practice, then they have provided consent for that company or another operating under a BAA to use that number to contact that individual. If you applied to a state Medicaid agency for health coverage and provided your mobile number on that enrollment form, then after coverage was granted you received a message from the managed care organization you had been assigned to, it would not a be a surprise. More likely it would be a good experience. Maybe even expected. But some healthcare organizations have taken a more conservative interpretation of the law and require the strictest consent requirements: prior express written consent. Applying prior express written consent to the above example, in addition to providing their number when enrolling at the state level, the member would have to specifically provide written consent (typically, by providing their number again, checking a box to confirm consent, or texting in a keyword) in order to receive automated communications from that health plan managing their benefits. This approach significantly reduces the percentage of members who can benefit from valuable informational messages to help them manage their health. Unless healthcare organizations are using a system that has the capacity to generate and store random or sequentially generated phone numbers, which is extremely unlikely, this Supreme Court ruling means messages they send to patients and members do not fall under the TCPA. There is no law regulating their messaging, minimizing any risk of class action litigation. However, member consent is part of providing a positive experience. That’s best practice. So, what the ruling effectively means is that in addition to the protections afforded by consent, healthcare organizations have another layer of protection by falling outside of the ATDS definition. Depending on how organizations have previously interpreted TCPA, here is some guidance to help align on a new approach: Organizations that have historically obtained prior express consent
  • These organizations do not need to adjust their approach. Using prior express consent means they can engage the majority of the members and drive optimal value out of the SMS channel.
Organizations that have historically required prior express written consent
  • Business leads should work with their legal teams to transition to a prior express consent strategy. Any concerns about the prior express consent approach are mitigated by the additional protections afforded by the Supreme Court ruling.
Organizations that have historically received phone numbers from a 3rd party
  • Business leads should assess the context of how individual numbers were originally provided. If the number will be used to engage individuals on topics related to the scope of how it was provided, then the business leads should work with their legal teams to transition to a prior express consent strategy.
The definitions of ATDS apply to both pre-recoded voice calls and text messages. However, following the Supreme Court ruling, adapting consent strategies for text messaging is clean compared to pre-recorded voice calls or IVRs. Within the TCPA, pre-recorded voice calls have additional areas of regulation pertaining to how the mobile number was gathered and these areas must be taken into account when conducting automated calls. There are more protections for sending automated text messages than there are for pre-recorded voice calls. The ruling is favorable for organizations across industries, but it is unlikely to lead to dramatic changes to how organizations use the SMS channel. Firstly, considerable industry self-regulation exists, such as carriers’ ability to block automated spam calls. The CTIA (industry body for the wireless communications industry) provides strict guidance on how messaging programs should be managed and has the power to shut down non-compliant messaging programs. Secondly, it is in the interests of brands to follow best practices and deliver excellent consumer experiences. The Federal Communication Commission (FCC) that oversees the TCPA may react to the Supreme Court ruling by updating the law, but the manner and urgency of its response will in part be driven by whether brands put consumer interests at the fore and self-regulate best practices for consumer messaging engagement. If the FCC does act, and it has no obligation to do so, any new consent rules would have prospective effect only. For healthcare organizations that have been slow to adopt text messaging engagement due to TCPA regulations, the ball is firmly in their court. The TCPA is vague in parts and while many organizations see the opportunity the prior express consent approach, they hold-back because of uncertainty of the language. Now that the risk of class-action litigation has been largely ruled-out, these organizations have a significant opportunity to leverage the SMS channel more.

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

Posted on by Nora Cristobal

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

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

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

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

2022 Star Ratings: What We Know and What We Think We Know

Posted on by Reva Sheehan

To say the events of the last year had an unprecedented and unconventional impact on health plans would be an understatement. From early January 2020 when Health and Human Services (HHS) declared a Public Health Emergency (PHE) to aid the nation’s healthcare systems in responding to COVID-19 through the cancellation of the 2020 HEDIS and CAHPS collection and now with vaccines becoming vaccinations, the Centers for Medicare and Medicaid Services (CMS) has worked tirelessly to continue its pledge to put patients first in all programs.

To put patients first in all programs, you have to address their needs and provide support to the plans, practitioners, and communities who care for our most vulnerable populations. With the earlier than anticipated release of the 2022 Medicare Advantage and Part D Advance Notice Part II, CMS provided plan sponsors more time to prepare their bids during unprecedented times. While the better part of this Advance Notice focused on rate and payment policy, it provided plans with important updates and changes related to the Star Rating program which can have a tremendous impact on Quality Bonus Payments (QBP).

Following the earlier-than-anticipated Advance Notice in October 2020 came the equally early Final Rule in January 2021. Here are a few noteworthy changes that we discussed in the fall that are here to stay for 2022. For a deeper discussion, watch the 2021 Star Ratings panel with Rex Wallace, Jim Burke, and myself below.

  • CAHPS and the Member Experience. CMS is making good on its promise to lend a bigger voice to the beneficiary and will proceed with the increased weight of its member experience measures, including the Consumer Assessment of Health Plans and Systems aka CAHPS survey. While the 2021 CAHPS survey will still have a weight of 2x each (not including the flu measure) for the 2022 Star Ratings, the importance of member experience and perception is greater than ever as these measures will contribute to over 50% of the overall weight in 2023 Stars. Even the best and most robust regulatory and off-cycle surveys will only represent a small percentage of members at one moment in time. Plans need more experiential and real time data around common and frequently used benefits that scales not only the entire member population, but the entire member year. mPulse Mobile has developed an event-based check-in program that not only gathers valuable member experience and sentiment data, but also has the ability to address dissatisfaction and solve common pain points in real time using its patented natural language understanding and conversational messaging. Learn more about our CAHPS Solution.
  • Extreme and Uncontrollable Circumstances Policy was amended to note any additional COVID-19 relief under this policy for 2021 measurement year will have to come through future rule making. CMS adjusted its disaster policy and plans will be allowed to use the ‘better of’ between some of its 2021 and 2022 measure ratings. This ‘better of’ method may produce inflated performance numbers that will be difficult to sustain in future years. Plans should proactively identify their at risk areas and deploy a strategy at scale to offset a potential loss in QBP for future years.
  • With no new measures for 2022 and some remaining on the display for another year, plans will have the opportunity to continue efforts to close gaps, connect members to appropriate care, and review their data for one more year. Controlling Blood Pressure and Plan All Cause Readmissions will remain on display and likely return to the active page with a 1x weight for their first respective years. The potential introduction of a COVID-19 measure did not receive positive feedback during the open comment period and only time will tell if it was related to the reluctancy of accepting COVID-19 isn’t really going away anytime soon or the proposed collection and impact another vaccine measure may have on Stars.
  • HEDIS and Telehealth is here to stay and work together. According to the American Journal of Managed Care, telehealth claim lines increased 3.060 percent nationally from October 2019 to October 2020. As members seek care outside of the traditional office setting, providers and payers still have a need and obligation to capture the full burden of illness and these updates include additional code sets to be allowed for measure inclusion or exclusion when captured via telehealth visits alone. This is just another example of how members, plans, and providers are embracing digital technologies.
  • Part D measures, above all other measures for 2021 Star Ratings, got harder. Sure, some may think this could be attributed to CMS not having any CAHPS or HEDIS measures to use in their methodology calculations, but the increase in cut points should be attributed to an increase in performance across all of the eligible plans. Barriers to proper medication use and adherence are much greater than cost and access, especially as plans increased mail order access during the height of COVID-19. We often see poorer adherence and participation from members with the lowest cost share which tells us that what they really need is increased education and engagement. Simple one-way refill reminders for your adherence measures or offers to complete a Comprehensive Medication Review (CMR) for your Medication Therapy Management (MTM) program are no longer enough to compete with those top performing plans who are driving those cut-points higher every year. Learn more about our Medication Adherence Solution.

As shots go into arms and some semblance of normalcy begins to return, it’s still too soon to know the full impact the pandemic will have on members, plans, providers, technologies and so much more. CMS has equipped plans with a sneak peek of what’s to come and extra time to prepare for it in an effort to take better care of its members. It’s never too late to develop or enhance your member engagement strategy. How will you continue to wrap your arms around your members throughout the year and beyond COVID-19?

Leveraging Technology to Meaningfully Impact the Member Journey: Key Takeaways

Posted on by Nora Cristobal

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.

The Evolution of Member Engagement

Posted on by Andrea Amelse

Healthcare member engagement plays a crucial role in the success of health plans. With over 80% of healthpayers investing in member engagement, it’s clear that leveraging innovative technology, integrated care models, and frictionless communication is vital. 

This article explores how health plans can enhance member engagement, focusing on:

  1. Member retention
  2. Improved health outcomes, and
  3. Cost reduction.

Member engagement in healthcare involves creating meaningful interactions between health plans and their members. It’s about delivering personalized experiences ensuring members are informed, involved, and motivated to manage their health.

The importance of healthcare member engagement

Effective member engagement increases member satisfaction, better health outcomes, and reduced healthcare costs. It also contributes to positive survey results and protects the financial viability of health plans.

Challenges in healthcare member engagement

Many health plans face challenges in engaging their members due to fragmented communication, lack of personalized experiences, and evolving consumer expectations.

4 Strategies for improving healthcare member engagement

1. What consumers expect from their favorite brands, they’ll expect from healthcare.

The average US adult spends an average of 12 hours a day on media. This number continues to increase annually and highlights a clear message: if we want to engage members, we need to communicate with them through their preferred channels.

With consumer brands continually evolving their UX and products to get ahead of the competition, health plans will be expected to follow suit. Members associate quality and credibility with content and communication models that exceed their expectations. Preferred channels will help you reach your members; quality health content will keep them engaged in their care. To engage today’s health consumer, you need to begin looking at modern trends to inform your strategy.

2. Simplified and unified care models will be mandatory to increase satisfaction

Your favorite social channels and online shopping experiences likely have one thing in common: They are designed to bring you back to a single destination. You only log in once, and the experience feels effortless and caters to your preferences. When you’re frustrated with a product’s website interface, you probably won’t purchase now or in the future – this same principle applies to health care. A seamless member experience drives higher HEDIS ratings, HOS scores, and satisfaction surveys. Fractured and misaligned experiences will yield poor outcomes, stunted new member growth, increased complaints and appeals, and higher customer service line utilization.

This begins with the onboarding process. Straight out of the gate, establishing clear communication with new members will help them feel welcomed, inform them about their plan information, provide the opportunity to confirm data, and encourage members to submit an HRA. Setting high engagement expectations early on increases the likelihood of engagement throughout the membership. Ensuring all of your programs and services are accessible, easy to navigate, and play together nicely will save both you and your members time and money.

3. Focus on education, specifically for latent unhealthy populations

Empowering members throughout their health journey with tailored learning experiences will impact health outcomes and satisfaction

. Patients forget over 80% of what they’re told during POC and often will visit doctor Google to learn more about their health, which doesn’t always yield accurate results. The days of print-outs are coming to an end: streaming content accounts for over 50% of global time spent online, and viewers are over 9 times more likely to retain information from video vs text. Cinematic, tailored education delivered to members through their preferred channels will absolutely win your org brownie points while empowering members to own their health journey and sustaining member engagement time. This is particularly important when reaching latent unhealthy populations and providing them with the knowledge to prevent chronic conditions, determine the right care level, and navigate their benefits.

Through rich media, we can educate members on key topics such as medication adherence, nutrition, exercise, mental well-being, and more. For those living with chronic conditions such as heart disease and diabetes, health literacy increases quality measures and lowers costs for plans and members.

4. Sustained engagement = rich data

Gathering rich data across member services from specific populations will increase engagement and scale your efforts into the future. Sharing this data across your organization will strengthen internal efforts and improve alignment, ensuring better outcomes and higher quality of care.

The ecosystem of how members interact with their plans is evolving to meet the growing demand of what consumers expect today. Promoting and adopting innovative, streamlined, accessible resources and technology is the key to a lasting and impactful member engagement strategy.

Role of technology in member engagement

Advancements in technology, like conversational AI and streaming content, are transforming member engagement. These tools allow health plans to create personalized, engaging experiences at scale.

Measuring and evaluating member engagement

Monitoring key metrics and KPIs is essential to evaluate the effectiveness of member engagement strategies. This data helps in making informed decisions and refining engagement approaches.

Best practices to follow

  • Implementing a patient-centric approach from the onset, particularly during onboarding.
  • Utilizing digital platforms for effective communication and education.
  • Integrating behavioral science to understand and influence member behavior.

Health plans must adopt innovative strategies for healthcare member engagement to stay competitive and effective. Health plans can significantly enhance member satisfaction and health outcomes by focusing on personalized, technology-driven solutions.

For health plans looking to revolutionize their member engagement strategies and achieve sustainable success, Contact us to discover how we can transform your approach to healthcare member engagement.