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Don’t Let the 2025 CMS Changes Get You Down: Get Ahead With These Member Engagement Best Practices

Posted on by Reva Sheehan

Now that the dust has settled and we have all had a chance to unpack the 1,300+ pages of the 2025 Final Rule, the real work begins.

Many aspects of this final rule were anticipated and some long overdue, this Final Rule represents a powerful shift in the continued pursuit to expand access, strengthen beneficiary protections, address (not just identify) social needs, improve the quality of care and member experience, and…gulp…shift dollars back into the Medicare Trust Funds. 

Stars, HEDIS, Risk Adjustment, and senior market supporting teams are all here because they are not afraid of a little work, and they are passionate about improving the lives of the beneficiaries they serve. So, we do what we do every year, roll our sleeves up and get to work.

That’s exactly what the mPulse teams have been doing since the release of the Final Notice. We started our strategic conversations around much of this work during the Proposed Rule and Advance Notice and have already implemented a number of changes and updates to our solutions and products so we can better support our health plan clients tackle the big stuff.

Whether they were new, codified, or just now at our ‘front door’ topics, we’ve summarized a handful of key items that we’re getting to work on and providing some best practices, tips, and strategies for plans to address them head on.

1. Medication Therapy Management (MTM) 

Expanding MTM program eligibility criteria by:

  • Adding HIV/AIDS to the core condition list
  • Including all Part D maintenance drugs
  • Revising the cost threshold calculations

 

mPulse’s Strategic Approach

Chapter 7 of the Prescription Drug Benefit Manual (as noted in 30.3 & 30.7) states CMS expects sponsors to have procedures in place to drive participation and follow-up with beneficiaries that do not respond to initial offers and to consider using more than one approach, when possible, to reach all eligible patients.

Offer an omni-channel approach to reach all eligible members, anticipate your members needs by reminding them the service is a covered benefit and helping them prepare for the CMR, and reinforcing the benefit of routine medication reviews. 

Remember, adding new channels or additional supports to help members complete their CMR can be added to your MTM program throughout the year.

2. Health Equity Index (HEI) and Reward 

Data collection beginning with calendar years 2024 and 2025 will shape the 2027 Star Ratings and impact the 2028 payment year. Ratings and reward will be determined by not only performance but enrollment thresholds within dual eligible, low-income, and disabled beneficiary populations.

mPulse’s Strategic Approach

With expanded LIS eligibility extended to individuals with incomes up to 150% federal poverty level (FPL) in 2024, some beneficiaries may not even know they qualify. Plans will want to make sure all of their eligible members have applied and qualified for subsidies. Not only should all beneficiaries have the protections available to them, plans can’t afford to miss those HEI enrollment thresholds whenever and wherever possible.

There are a few steps to a successful approach: 

  1. Use predictive models and analytics to identify members who may be eligible for but not currently receiving extra help. 
  2. Develop an omnichannel engagement strategy to inform members of the income thresholds, provide them with information and support on how to apply. 
  3. Be prepared to support members who may not qualify by offering additional plan, local, state, or federal resources. And help any new LIS members understand and utilize their new benefits fully. 

Want to learn more about addressing health inequities? Download the white paper »

3. Mid-Year Enrollee Notification of Available Benefits

In addition to the new requirement to submit utilization and costs data in EDS, CMS will require plans to provide beneficiaries with a mid-year notification of all unused supplemental benefits. Each notification must be personalized, include details about the unused benefit including applicable cost-sharing details, information on how to access, required network information, and a contract center number for additional assistance. 

mPulse’s Strategic Approach

Getting the right benefits, supplemental and otherwise into the right hands of the right members isn’t always easy. We often cast a wide net and hope standard means of communication (EOCs, SOBs, landing pages etc.) are sufficient. Actions taken by CMS in this area prove that it is not enough, and many benefits are being underutilized or not used at all.  

Start looking at your membership now, even without robust supplemental benefit utilization data, use claims and encounter data to create need-based populations who could most benefit from your supplemental offerings. Putting in efforts now will pay off in AEP and OEP when your members can be prompted to benefits that resonate with them both socially and clinically. And if done well, could not only cut down on the number of benefits you’ll need to notify them about come mid-year but support your broader retention and satisfaction efforts.

4. Member Experience and Access Measures, CAHPS & HOS  

  • Member Experience and Access Measure Weights Reducing from 4x to 2x for Stars Year 2026 
  • Improving or Maintaining Mental Health & Improving or Maintaining Physical Health Weight Increasing from 1x to 3x each for Measurement Year 2025

 

mPulse’s Strategic Approach

CMS realigning the weight of experience and access (aka administrative) measures while still providing beneficiaries with a ‘voice’ that will hold plans accountable and impact ratings, these measures will still account for nearly 20-30% of the overall Star Rating over the next few years (trending to less moving forward). 

After being moved to the display page due to data disruption during collection years during the pandemic, the two longitudinal HOS measures will be returning to their original weights.

Weight shifts and temporary retirement to the display page should never be an excuse to ease up on overall strategy for any measure category. There is no one-size-fits-all approach to CAHPS and HOS, rather a data driven and personalized approach to understand what is working, what is not, who is in need, who is not, who is aggrieved and at risk to respond negatively and so on. Leverage data collected through regulatory and off cycle surveys along with health plan data, both clinical and non-clinical to develop an informed strategy for outreach. Deliver live agent calls to those most at ‘risk’ and deploy high-touch digital communications to your other segments. This allows you to cover the largest volume of membership without sacrificing personalization and service recovery.

5. Inflation Reduction Act – Part D Redesign 

  • Medicare Prescription Payment Plan (M3P) 
  • Elimination of Coverage Gap 
  • Part D annual out-of-pocket maximum reduced to $2000 

 

mPulse’s Strategic Approach

CMS continues to strengthen protections for individuals who rely on Part D coverage. Between the 2022 IRA and 2025 Final Rate & Rules and beginning on January 1, 2025, beneficiaries will have a lower out of pocket maximum, no coverage gap phase, and the opportunity to spread the cost of their drugs out over the year with monthly average payments instead of all at once at the POS.

While all favorable financially to beneficiaries, some of these changes are bound to cause confusion. Even when a 2025 copay or coinsurance is less than it was in 2024, beneficiaries will still call and ask why. The M3P is likely to cause confusion for not only your members, but your call centers, and network pharmacies. Relying on traditional means of communication won’t be sufficient. Highly tailored and personalized communications to members who may need it the most (high spend and utilizers, early donut hole goers in 2024 etc.) will not only help them navigate this new Part D world, but it should also reduce the need for inbound calls, and ideally yield favorable satisfaction and retention for CAHPS and OEP.

6. Colorectal Cancer & Breast Cancer Screening 

  • Expand Screening Age for Colorectal Cancer Screenings  
  • Gender Neutral Terms for Breast Cancer Screening 

 

mPulse’s Strategic Approach

In alignment with NCQA, CMS will also expand eligible member populations to cover those aged 45-49 for the colorectal cancer screening measure and begin using gender neutral terminology for the breast cancer screening measure.

While changes to Stars often lag other measures stewards (NCQA, PQA, USPSTF) it shouldn’t necessarily stop plans from early adoption of some changes. The two listed above are a prime example. As soon as available and aligned with preventive coverage, new age bands should be included in educational outreach. And we don’t necessarily need a measure steward to tell us when to use gender neutral terminology. 

Best practice here is to incorporate these changes early on, educate your member facing teams, update your stock and custom printed materials, as well as digital communications and landing pages.  

 

If you’d like to learn more about how we are applying DecisionPoint by mPulse predictive analytics and mPulse digital engagement strategies to these and other changes across all lines of business, reach out to me directly or visit our solutions page at www.mpulse.com.

MTM – Rx Drug Manual: https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/downloads/dwnlds/chapter7pdf 

Supplemental Bene Reporting Requirements: https://www.cms.gov/files/document/cy2024-part-c-reporting-requirements.pdf 

3 Ways Health Information Technology Improves Health Outcomes

Posted on by Gabbie St Remy

It’s no secret that better provider-member relations can often lead to better health outcomes for the member and improved financial performance for the health plan.

Building trust, enhancing communication, and personalizing care through health information technology not only fosters better provider-member relationships but also improves health outcomes and the financial performance of health plans.

When trust is built, communication flows, and care is personalized, patients are willing to follow the care plans put in place more closely. With providers having shorter appointment times to spend with patients inside the exam room, most of this relationship-building needs to be focused outside of that small window of time. 

Health Technology Connects Providers and Patients

Providers can tap into digital health technology at their fingertips!

We are walking (okay, maybe running) into a time when healthcare will be no stranger to digital transformation nationwide.

The latest HIMSS State of Healthcare Report says, “Digital transformation is a top-level priority for health systems, with 99% of U.S.-based health system leaders agreeing that it’s important for their organizations to invest in digital transformation.”

Payers are also in alignment, with 74% of U.S.-based payers reporting that their organizations have a dedicated core team focused on digital transformation.

With so many invested in bringing health technology to the forefront of their patient care, the question is how? 

3 Ways Technology Improves Health Outcomes

1. Leverage Patient Data to Offer Personalized Care

In a time where personalization is becoming the norm in so many areas of our lives, it’s about time that healthcare gets into the game. The 2022 State of Healthcare Report found that “roughly 25% of patients or less completely agree that their provider personalizes care based on their current health, lifestyle and unique health goals.”

With so much room to grow, it’s time to tap into the data available on each patient to create a truly tailored healthcare experience. As a health plan, offer a single location where physicians, members, and the plan can see a comprehensive, action-oriented view of their patients/members.

The EHRs today are not integrated with the health plan, and to improve care, we need to ensure that all three are in the know. Knowing everything they can about a member, such as diagnosed conditions, known allergies, immunization records, and medication history, will help them develop a plan that makes the most sense for each person.

A disease or condition could affect one patient very differently from how it affects another. Because of this, treatment options and care plans cannot be treated as a one-size-fits-all approach if we want to see the healthiest outcomes for each patient. They need to consider a person’s unique health history, behaviors, and preferences.

When personalized care becomes the norm, everyone wins. Patient satisfaction increases, and the potential to improve health outcomes grows exponentially.

2. Provide the Right Tools to Help Members Manage Their Health

Patients often need ongoing support with health management between office appointments. As a health plan, your members will turn to you, and it is important to ensure that both providers and members have access to the resources they need to make this support a reality.

Using digital health technology, patients can improve their health in the comfort of their homes, leading to better clinical outcomes. Giving them access to tailored self-management tools and providing personalized health education materials are two great ways to help members stay the course.

When health plans, healthcare organizations, and providers can come together to implement patient-centric education strategies, members may become more inspired to make changes that better their overall health. A 2018 study published in the Journal of the American Osteopathic Association showed that just 45 minutes of patient education can improve chronic disease management

3. Strengthen Communication Through Secure Channels

Regular check-ins with physicians can keep members on track once they leave their appointments. With connected and HIPAA-compliant patient and provider portals, physicians can send secure messages to members about their progress regarding any current care plans or wellness programs. Sending these timely and encouraging messages demonstrates to members that providers are still within reach outside of the office and are dedicated to helping them along their health and wellness journey.

Are you ready to elevate provider-member relations and enhance health outcomes with digital health technology? Discover how mPulse’s provider and member portals can transform your health plan today!

 

This article was originally published on healthtrio.com.

Answering the Demand for Consumerism in Healthcare

Posted on by Gabbie St Remy

7 Ways to Meet Healthcare Consumers Online and Boost Your Member Experience

“Healthcare consumerism” – it’s a buzzword heard a lot over the past few years as the healthcare industry has evolved to be more consumer-centric, and all healthcare professionals should know and understand it. Patients are taking a more proactive role in their own health and wellness (long overdue), acting as purchasers and turning to digital solutions for quick and convenient access to healthcare information, products and care. As consumers, they now demand more control and responsibility for selecting the right health plan that best fits their needs and the needs of their families. Once a member, they want relevant and timely information regarding their plan and benefits at their fingertips.

It’s important to ensure health plans are providing the support and resources needed for healthcare consumers to make educated and informed decisions about their health and benefits. 

The first question to ask: what are the key resources to provide?

1. A Digital Front Door

In a recent article, Advisory Board identified four main goals of the digital front door:

  • improve satisfaction with a simplified member experience 
  • expand access to care 
  • optimize resource allocation (often through self-service tools) 
  • reduce unnecessary treatment through better care coordination 

For these reasons, investing in digital front doors should be the highest priority for health plans and other healthcare organizations. Consumers today expect a digital experience in many elements of their lives, and their health is no exception. 

To achieve these goals, health plans can focus on providing digital resources through their portals, such as care team messaging, helpful chatbots, pre- and post-visit or operation educational resources, disease management tools, and online premium payments. The more a member can do online and through their portal, the happier they are as a healthcare consumer.

2. Omnichannel Digital Engagement

Omnichannel engagement strategies are used by successful brands to lure customers, learn about their behaviors, and drive loyalty. They allow brands to create a series of touchpoints and to reach people through their preferred channels. Obsolete methods of communication, such as direct mail, lack personalization and the ability to collect data at scale. 

When healthcare organizations use omnichannel digital engagement, they are able to reach consumers in the way they prefer and provide a more enjoyable member or patient experience. Without an omnichannel communication strategy, it’s impossible to effectively deliver appropriate resources and education to a broad member database.

Want to learn more about omnichannel digital engagement? Download our white paper: From Members to Consumers » 

Below are just a few examples of digital ways to engage and activate more consumers and engage them about impactful topics that have significant impact on the member experience.

  • Interactive voice response (IVR) 
  • Email 
  • Mobile web 
  • Short message service (SMS) 
  • Multimedia message service (MMS) 
  • Rich communication services (RCS) channels

3. Tailored Plan Shopping

Each healthcare consumer has a unique set of needs to be met and features that are important to them when searching for a health plan. Desired monthly premiums, copay and deductible amounts, in-network doctors, hospitals, and other health care providers, chronic illness support, and so much more. Searching through and finding the right health plan based on all of these things can be an overwhelming and complicated process. 

According to the 2023 KFF Survey of Consumer Experience with Health Insurance, nearly one in three adults with Marketplace coverage (31%) found it very or somewhat difficult to compare copays and deductibles under their plan options, and one in four (25%) found it very or somewhat difficult to compare monthly premiums. 

Simplify the plan shopping process through an intuitive questionnaire that gathers information from the consumer that can then be used to present them with the health plan that makes the most sense. Taking the burden off the consumer to do the hard work boosts their confidence in making the right selection and will lead to higher member satisfaction down the road. 

4. Provider Search

Consumers spend a lot of time online researching practices, providers, and more. In fact, more than 3 in 4 patients (77%) look for doctors online often according to Tebra’s 4th annual Patient Perspectives survey. One of the top places patients start looking is their online insurance directories, with 53% of patients saying online insurance directories contribute to their doctor selection decision. 

Providing correct and updated information for all providers, as well relevant search filters such as location, type of provider, gender, language spoken, and whether they are accepting new patients, are helpful in a consumer’s search. The easier you can make it for a member or potential member to find the information they need, the happier they will be with their health plan experience. 

5. Price Transparency Tool

Health plan price transparency tools help consumers know the cost of care or service before seeing a provider. The State of Patient Access 2023, completed by Experian Health, found that: 

  • 65% of patients said they did not receive an estimate prior to care, with 41% of those respondents said final costs were more than expected 
  • 40% of all patient respondents said they were likely to cancel or postpone care without an accurate estimate 
  • 79% of all patient respondents say an accurate estimate helps them better prepare to pay care costs 
  • 88% said receiving a price estimate before care is important 

Not having the cost estimates they need is leading healthcare consumers to defer treatment and avoid the care they need, leading to increased hospitalization and complications from preventable diseases. 

By providing a price transparency tool and giving members the opportunity to access this information before a visit, procedure, or purchase, health plans are giving consumers the ability to make informed decisions that best meet their needs and financial situation and help improve health outcomes. 

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

6. Easy-to-Understand Member Statements and Benefits Overview

A recent KFF Survey of Consumer Experiences with Health Insurance asked insured adults about how well they understand key aspects of their health insurance. Half (51%) of insured adults say they find at least one aspect of how their insurance works at least somewhat difficult to understand.

 These items caused the most confusion: 

  • What insurance covers – More than one-third (36%) of all insured adults say it is at least somewhat difficult for them to understand what their insurance will and will not cover 
  • Out-of-pocket costs – Thirty percent of insured adults overall say it is difficult for them to understand what they will owe out-of-pocket when they get health care 
  • Explanation of Benefits (EOB) – Three in ten insured adults say they find it difficult to understand whether or how much insurance will pay for care from looking at their EOB 
  • Basic health insurance terminology – A quarter of all insured adults say they have difficulty understanding specific terms, such as “deductible,” “coinsurance,” “prior authorization,” or “allowed amount.” 

Health plans can alleviate this confusion by providing resources that help their members understand their coverage. Through the member portal, plans should show up-to-date information regarding what is available to members with their benefits or even plan discounts, explain and outline their deductible and out-of-pocket maximums in a member-friendly manner, and inform them of their benefit accumulators for both in-network and out-of-network services. Using a built-in glossary to define key terminology can also help members as they sort through the information being presented to them. 

7. Member and Patient Education 

One major factor impacting the member and patient experience is health literacy. With 35% of the adult US population having basic or below basic health literacy, education is vital to ensuring a positive member or patient experience.

To combat the health literacy challenge, the healthcare industry must reimagine what member and patient education looks like. Healthcare consumers are, at the end of the day, simply consumers, and consumers ingest content and information continuously every day from a multitude of sources: short, bite sized videos on social media, streaming services for shows and movies, a large volume of self-produced content, and more.

Taking inspiration from all around us and applying it to member and patient education means engaging with healthcare consumers in the ways they are showing us they like, enjoy, and want. When engaging with members, you can send short, bite sized videos on why getting vaccinated from the flu is important or a full course they can stream to learn about managing their diabetes.

And this type of streaming health content has proven to be an effective method of capturing the health consumer’s attention. One large national plan which partnered with mPulse on digital outreach saw a 274% increase in link clicks to schedule their annual eye exam when this video was utilized vs when no video was sent.

Getting Started

The second question to ask: why should a health plan make the commitment and investment to provide these resources? 

Health plans who implement these tools for their members can gain: 

  • Increased member acquisition and retention 
  • Higher member satisfaction 
  • Operational efficiency 
  • Competitive advantage   

How can health plans get started if they already aren’t doing these things? 

Reach out to mPulse to learn more about our product offering and how we can help you answer the demand for healthcare consumerism. Our products are built to provide your members with the resources they need to be educated, informed, and proactive about their health.

Article originally published on healthtrio.com.

mPulse Recognizes Innovative Healthcare Organizations in the Sixth Annual Activate 2023 Awards

Posted on by mPulse Team

mPulse Mobile recently wrapped up its fifth annual Activate conference with the Activate Awards, which provided yet another celebration of healthcare leadership, innovative program design, and improved health outcomes amidst various health engagement challenges.

The theme of Activate2022, The Power of Behavioral Science to Drive Health Action, was reflected throughout the conference with captivating speaker sessions and expert panel discussions. Networking inspired exciting conversation around innovative technology, behavior change design, and consumer experience, and the Activate Awards surely brought those conversations full circle.

The awards help illuminate health plans, health systems, health service providers, PBMs and other types of healthcare organizations that utilized new strategies or unique tools to activate their consumer populations. The companies highlighted each year typically face barriers with engaging a certain population or driving specific health actions, so they search for innovative solutions to tackle those challenges. 

For example, in 2019, CountyCare saw drastic rates of members losing Medicaid coverage, so the managed care organization (MCO) implemented automated text dialogues and saw their Redetermination rates improve by 3.3 percentage points in just one month, subsequently running away with the Most Improved Consumer Experience award. Last year, CareSource incorporated secure surveys, SMS, and streaming video to significantly impact their hard-to-reach members – they won 2021’s Best Use of Conversational A.I.  

The same story is true for this year’s winners.   

The remaining 3 award categories are Achieving Health Equity, Most Innovative Solution and Most Significant Outcome. Like the teamwork and critical thinking generated from breakout workshops and Q&A during the conference, the awards are a celebration of two companies that partnered together to overcome consumer barriers or gaps in care by building uniquely tailored engagement programs. 

Here are the winners of the 2022 Activate Awards: 

Achieving Health Equity

 
Program Goal
Increase Colorectal Cancer Screenings

AltaMed Health Services is one of the largest Federally Qualified Health Centers (FQHC) in the United States and provides a range of health services to Latino, multi-ethnic and underserved communities in Southern California. After seeing a steep drop in colorectal cancer screenings during the COVID-19 pandemic, the health center sought a solution that could help patients overcome barriers like language and lack of awareness of services. 

AltaMed partnered with mPulse to deliver multi-lingual, educational health content to patients using mobile fotonovelas tailored to both males and females who had not completed a screening. Patients received and digested vital communication about getting screened, where to find the nearest screening site, and more through culturally sensitive stories delivered in a familiar format.  

A randomized control study found that 63% of patients who responded to the fotonovelas either liked or loved it, and 39% reported it positively impacted their willingness to act. By educating patients with curated content, AltaMed closed a key screening gap, lifted health literacy and perhaps most importantly – made significant progress toward health equity.

Notable Outcome
Patients that viewed the fotonovelas (19%) were more likely to submit a sample for cancer screening than patients in a control group (11%)

Best Use of Conversational A.I.

 
A Technology-Enabled Health Services Company
 
 
Program Goal 
Promote smoking cessation among teen vapers 

This leading health services organization employs over 210,000 employees globally and utilizes technology-enabled solutions to promote consumer wellness and population health. A major public health problem facing young adults, particularly teens, across the U.S. is the use of e-cigarettes, or vaping. The company sought to promote smoking cessation among teen vapers, a cohort still widely understudied, by implementing intelligent conversational solutions and educational content.

They collaborated with mPulse to build a personalized SMS program, lasting 4-6 months, that leveraged Natural Language Understanding (NLU) to deliver automated, interactive text dialogues to a targeted teen population. Individuals were also provided custom-built streaming health videos that offered tips on quitting and even an option to connect with an SMS coach. 

The use of NLU enabled the delivery of automated messaging based on text responses, which helped the organization direct each individual to the appropriate resource. The program yielded an 85% engagement rate, and ultimately 69% of participating teens completed the program. The key result, that 73% of teens in the program set a date to quit vaping, demonstrates the value in utilizing automated text conversations and on-demand content to promote smoking cessation in vulnerable teens.

Notable Outcome 
73% of participating teens set a quit date
 
 

Check out a new streaming health course for smoking cessation. »

 

Most Improved Consumer Experience

 
CalOptima Health
 
 
Program Goal 
Increase Awareness of SNAP benefits (CalFresh)

CalOptima Health is a County Organized Health System that provides health insurance coverage for low-income children, adults, seniors and people with disabilities. As Orange County’s largest health plan, the organization includes a network of over 10,000 primary care doctors and serves over 900,000 Medi-Cal beneficiaries. The health system looked to address a gap they had identified with low-income families enrolling in the state’s food assistance program, CalFresh, federally known as SNAP.

CalOptima and mPulse partnered to launch a two-way texting campaign, which utilized interactive SMS powered by NLU and tailored to 7 different languages. The health plan addressed language barriers by delivering vital information about CalFresh’s food security benefits to underserved families and Medi-Cal members in their preferred language.  

Through automated text workflows, members could respond in their native language with answers like: “I already have CalFresh” or “I want to apply.” The program has continued to expand, having delivered over 5 million messages in 2022 already. Communicating with members according to their preferences about important CalFresh benefits helped CalOptima both improve consumer experience and reduce food insecurity for an at-risk population.  

 
Notable Outcome 
Over 5 million messages delivered to members in 2022 about CalFresh benefits

Like what you’re reading? Join us next year for Activate2023! Secure your spot now. »

Most Innovative Solution

 
 
Program Goal 
Drive members to schedule a diabetic eye exam

Humana is one of the five largest health plans in the country according to member enrollment and has been partnered with mPulse for over 10 years. With more than 20 million members, including over 5 million Medicare members, the plan looked to close a gap with their members scheduling the annual diabetic eye exam.

The plan worked with mPulse to launch an SMS texting campaign to increase awareness around the importance of the eye exam and to drive members to schedule an exam. The program featured A/B testing, in which one half of members was provided a 30-second streaming health video in the initial message while the other half received only text.  

The educational video enabled a learning experience that was easily accessible and familiar, concluding with a URL for members to learn more about scheduling the eye exam. Humana saw a remarkable 270% increase in clicks to schedule an exam when outreach included the streaming video. The test demonstrates that using streaming health content alongside two-way conversational solutions can significantly help activate hard-to-reach members with diabetes.

Notable Outcome 
270% increase in clicks to schedule a diabetic eye exam when outreach included 30-second streaming video

Most Significant Outcome (tie)

 
A Technology-Enabled Pharmacy Services Company
 
 
Program Goal 
Improve member experience and pharmacy engagement

The leading PBM and pharmacy services company is nationally recognized and fills over 1 billion prescriptions annually for millions of healthcare consumers across the country. With a rapidly growing population, the healthcare leader sought a solution to improve pharmacy patient engagement by utilizing a new communication channel for its home delivery pharmacy and prior authorization programs. 

The pharmacy leader partnered with mPulse to roll out more than 50 outbound-dialer Interactive Voice Response (IVR) campaigns. The IVR messages notified members about prior authorization approvals/denials, refill reminders, shipping details and doctor responses.  

Ultimately, over 5.8 million IVR records were exchanged and the outbound dialer launched over 5.1 million total calls. By offering a new avenue for members to complete a healthy action like ordering medications, the pharmacy enterprise initiated meaningful conversations to help enhance member experience, improve self-service capabilities, and close pharmacy engagement gaps.

Notable Outcome 
Reached over 2.2 million members with 55,000+ members giving SMS consent

Most Significant Outcome (tie)

 
 
Program Goal 
Improve refill adherence for HIV patients 

MetroPlus Health Plan is a subsidiary of NYC Health & Hospitals, the largest municipal health system in the country. The insurance organization serves a diverse group of over 600,000 New York residents across Medicaid Managed Care, Medicare, D-SNP, MLTC and more plan types. A big challenge for the plan was getting HIV patients to refill medications that are pivotal to managing their condition and avoiding complications.

MetroPlus partnered with mPulse to educate the vulnerable population through interactive text messaging about the importance of medication adherence and reducing their  unmedicated days. Texts were delivered one week apart and provided members with vital resources like phone numbers of a pharmacy or a member of the HIV care team.

The plan measured results based on whether or not a patient completed a refill within 7 days of initial outreach. The program yielded a 69% improvement in medication refills when SMS text reminders were deployed, indicating that text nudges inspire self-efficacy and action within this vulnerable population. Through targeted, mobile intervention, MetroPlus helped positively impact medication adherence for over 1,000 patients living with HIV.

Notable Outcome 
69% improvement in medication refills with mPulse text reminders

Health Challenges in 2023

The 6 winners of this year’s Activate Awards showed that even when a new barrier is identified with engaging a population, healthcare organizations must adapt to adhere to their consumers’ needs. Whether utilizing a new communication channel, adding streaming video or incorporating multiple languages, the awards demonstrate that providing healthcare consumers with tailored, learning experiences can significantly impact how they engage with a program. 

As the needs and preferences of healthcare consumers continue to evolve, so too should the capabilities of the healthcare organizations that serve them. Next year’s awards ceremony will surely exhibit a new string of engagement challenges with complex populations and niche use cases – let’s see what type of healthcare innovation surfaces in 2023! 

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

Posted on by Nicole Lopez

Why The Annual Wellness Visit is So Important

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

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

Annual Well Visit Statistics: Underutilized, Underestimated

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

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

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

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

Example Scenario

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

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

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

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

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

Using Technology to Unleash the Power of Annual Wellness Visits

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

Behavioral Science

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

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

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

AI Technology

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

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

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

Health Equity

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

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

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

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

Instructional Strategy

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

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

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

Putting it All Together

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

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

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

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

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

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

Celebrating Achievement in Health Equity and Technology Innovation at the Activate Awards

Posted on by Gabe Kratzer

mPulse Mobile recently wrapped up its fifth annual Activate conference with the Activate Awards, which provided yet another celebration of healthcare leadership, innovative program design, and improved health outcomes amidst various health engagement challenges.

The theme of Activate2022, The Power of Behavioral Science to Drive Health Action, was reflected throughout the conference with captivating speaker sessions and expert panel discussions. Networking inspired exciting conversation around innovative technology, behavior change design, and consumer experience, and the Activate Awards surely brought those conversations full circle.

The awards help illuminate health plans, health systems, health service providers, PBMs and other types of healthcare organizations that utilized new strategies or unique tools to activate their consumer populations. The companies highlighted each year typically face barriers with engaging a certain population or driving specific health actions, so they search for innovative solutions to tackle those challenges. 

For example, in 2019, CountyCare saw drastic rates of members losing Medicaid coverage, so the managed care organization (MCO) implemented automated text dialogues and saw their Redetermination rates improve by 3.3 percentage points in just one month, subsequently running away with the Most Improved Consumer Experience award. Last year, CareSource incorporated secure surveys, SMS, and streaming video to significantly impact their hard-to-reach members – they won 2021’s Best Use of Conversational A.I.  

The same story is true for this year’s winners.   

The remaining 3 award categories are Achieving Health Equity, Most Innovative Solution and Most Significant Outcome. Like the teamwork and critical thinking generated from breakout workshops and Q&A during the conference, the awards are a celebration of two companies that partnered together to overcome consumer barriers or gaps in care by building uniquely tailored engagement programs. 

Here are the winners of the 2022 Activate Awards: 

Achieving Health Equity

 
Program Goal
Increase Colorectal Cancer Screenings

AltaMed Health Services is one of the largest Federally Qualified Health Centers (FQHC) in the United States and provides a range of health services to Latino, multi-ethnic and underserved communities in Southern California. After seeing a steep drop in colorectal cancer screenings during the COVID-19 pandemic, the health center sought a solution that could help patients overcome barriers like language and lack of awareness of services. 

AltaMed partnered with mPulse to deliver multi-lingual, educational health content to patients using mobile fotonovelas tailored to both males and females who had not completed a screening. Patients received and digested vital communication about getting screened, where to find the nearest screening site, and more through culturally sensitive stories delivered in a familiar format.  

A randomized control study found that 63% of patients who responded to the fotonovelas either liked or loved it, and 39% reported it positively impacted their willingness to act. By educating patients with curated content, AltaMed closed a key screening gap, lifted health literacy and perhaps most importantly – made significant progress toward health equity.

Notable Outcome
Patients that viewed the fotonovelas (19%) were more likely to submit a sample for cancer screening than patients in a control group (11%)

Best Use of Conversational A.I.

 
A Technology-Enabled Health Services Company
 
 
Program Goal 
Promote smoking cessation among teen vapers 

This leading health services organization employs over 210,000 employees globally and utilizes technology-enabled solutions to promote consumer wellness and population health. A major public health problem facing young adults, particularly teens, across the U.S. is the use of e-cigarettes, or vaping. The company sought to promote smoking cessation among teen vapers, a cohort still widely understudied, by implementing intelligent conversational solutions and educational content.

They collaborated with mPulse to build a personalized SMS program, lasting 4-6 months, that leveraged Natural Language Understanding (NLU) to deliver automated, interactive text dialogues to a targeted teen population. Individuals were also provided custom-built streaming health videos that offered tips on quitting and even an option to connect with an SMS coach. 

The use of NLU enabled the delivery of automated messaging based on text responses, which helped the organization direct each individual to the appropriate resource. The program yielded an 85% engagement rate, and ultimately 69% of participating teens completed the program. The key result, that 73% of teens in the program set a date to quit vaping, demonstrates the value in utilizing automated text conversations and on-demand content to promote smoking cessation in vulnerable teens.

Notable Outcome 
73% of participating teens set a quit date
 
 

Check out a new streaming health course for smoking cessation. »

 

Most Improved Consumer Experience

 
CalOptima Health
 
 
Program Goal 
Increase Awareness of SNAP benefits (CalFresh)

CalOptima Health is a County Organized Health System that provides health insurance coverage for low-income children, adults, seniors and people with disabilities. As Orange County’s largest health plan, the organization includes a network of over 10,000 primary care doctors and serves over 900,000 Medi-Cal beneficiaries. The health system looked to address a gap they had identified with low-income families enrolling in the state’s food assistance program, CalFresh, federally known as SNAP.

CalOptima and mPulse partnered to launch a two-way texting campaign, which utilized interactive SMS powered by NLU and tailored to 7 different languages. The health plan addressed language barriers by delivering vital information about CalFresh’s food security benefits to underserved families and Medi-Cal members in their preferred language.  

Through automated text workflows, members could respond in their native language with answers like: “I already have CalFresh” or “I want to apply.” The program has continued to expand, having delivered over 5 million messages in 2022 already. Communicating with members according to their preferences about important CalFresh benefits helped CalOptima both improve consumer experience and reduce food insecurity for an at-risk population.  

 
Notable Outcome 
Over 5 million messages delivered to members in 2022 about CalFresh benefits

Like what you’re reading? Join us next year for Activate2023! Secure your spot now. »

Most Innovative Solution

 
 
Program Goal 
Drive members to schedule a diabetic eye exam

Humana is one of the five largest health plans in the country according to member enrollment and has been partnered with mPulse for over 10 years. With more than 20 million members, including over 5 million Medicare members, the plan looked to close a gap with their members scheduling the annual diabetic eye exam.

The plan worked with mPulse to launch an SMS texting campaign to increase awareness around the importance of the eye exam and to drive members to schedule an exam. The program featured A/B testing, in which one half of members was provided a 30-second streaming health video in the initial message while the other half received only text.  

The educational video enabled a learning experience that was easily accessible and familiar, concluding with a URL for members to learn more about scheduling the eye exam. Humana saw a remarkable 270% increase in clicks to schedule an exam when outreach included the streaming video. The test demonstrates that using streaming health content alongside two-way conversational solutions can significantly help activate hard-to-reach members with diabetes.

Notable Outcome 
270% increase in clicks to schedule a diabetic eye exam when outreach included 30-second streaming video

Most Significant Outcome (tie)

 
A Technology-Enabled Pharmacy Services Company
 
 
Program Goal 
Improve member experience and pharmacy engagement

The leading PBM and pharmacy services company is nationally recognized and fills over 1 billion prescriptions annually for millions of healthcare consumers across the country. With a rapidly growing population, the healthcare leader sought a solution to improve pharmacy patient engagement by utilizing a new communication channel for its home delivery pharmacy and prior authorization programs. 

The pharmacy leader partnered with mPulse to roll out more than 50 outbound-dialer Interactive Voice Response (IVR) campaigns. The IVR messages notified members about prior authorization approvals/denials, refill reminders, shipping details and doctor responses.  

Ultimately, over 5.8 million IVR records were exchanged and the outbound dialer launched over 5.1 million total calls. By offering a new avenue for members to complete a healthy action like ordering medications, the pharmacy enterprise initiated meaningful conversations to help enhance member experience, improve self-service capabilities, and close pharmacy engagement gaps.

Notable Outcome 
Reached over 2.2 million members with 55,000+ members giving SMS consent

Most Significant Outcome (tie)

 
 
Program Goal 
Improve refill adherence for HIV patients 

MetroPlus Health Plan is a subsidiary of NYC Health & Hospitals, the largest municipal health system in the country. The insurance organization serves a diverse group of over 600,000 New York residents across Medicaid Managed Care, Medicare, D-SNP, MLTC and more plan types. A big challenge for the plan was getting HIV patients to refill medications that are pivotal to managing their condition and avoiding complications.

MetroPlus partnered with mPulse to educate the vulnerable population through interactive text messaging about the importance of medication adherence and reducing their  unmedicated days. Texts were delivered one week apart and provided members with vital resources like phone numbers of a pharmacy or a member of the HIV care team.

The plan measured results based on whether or not a patient completed a refill within 7 days of initial outreach. The program yielded a 69% improvement in medication refills when SMS text reminders were deployed, indicating that text nudges inspire self-efficacy and action within this vulnerable population. Through targeted, mobile intervention, MetroPlus helped positively impact medication adherence for over 1,000 patients living with HIV.

Notable Outcome 
69% improvement in medication refills with mPulse text reminders

Health Challenges in 2023

The 6 winners of this year’s Activate Awards showed that even when a new barrier is identified with engaging a population, healthcare organizations must adapt to adhere to their consumers’ needs. Whether utilizing a new communication channel, adding streaming video or incorporating multiple languages, the awards demonstrate that providing healthcare consumers with tailored, learning experiences can significantly impact how they engage with a program. 

As the needs and preferences of healthcare consumers continue to evolve, so too should the capabilities of the healthcare organizations that serve them. Next year’s awards ceremony will surely exhibit a new string of engagement challenges with complex populations and niche use cases – let’s see what type of healthcare innovation surfaces in 2023! 

The State of Health Disengagement

Posted on by mPulse Team

How do we unlock digital to get more people enrolled, lower costs to serve, and improve health outcomes at scale?

That question sums up a major challenge and business imperative to lift programs and people. To frame up that challenge, three key gaps must be considered for meaningful innovation:

The Health Programs Gap

There’s no shortage of solutions or investment focused on the problem. By 2027, the global corporate health and wellness market is expected to exceed $100 billion.

From health coaches to wellness programs, EAPs to DPPs, 401k to HSA, there’s a lot of shorthand around programs that are too often short on utilization.

By the Numbers

At a time when nearly half of U.S. adults report struggles with mental health or substance abuse, only 5% of employees reach out to their EAP. Plus, 6 in 10 are unaware of wellness programs that offer incentives just to engage.

Meanwhile, better convenience and reduced risk of illness are driving more health consumers to telemedicine for mental health and routine care than ever before.

Bottom Line

You likely have many programs in place to support the rising need for total-person care. The opportunity is now to connect your offerings and streamline the digital path to serving the right ones based on need.

By aligning your human services alongside your digital experience journey, you can start shifting from push-based efforts across disconnected programs to a pull-based model that assesses and adapts to the individual’s needs.

The Health Literacy Gap

Patty Starr at Health Action Council sums it up: “Health literacy is the key to lowering healthcare costs and better education is the key to health literacy.”

By the Numbers

As just a sample of an increasingly global problem, 88% of U.S. adults lack health literacy skills needed to manage their health and prevent disease or other illness. 70% of healthcare costs come from lifestyle choices, and people with lower health literacy report worse outcomes.

Bottom Line

Back up. Nearly 9 in 10 adults lack health literacy? That’s a huge number. And part of the problem is that people don’t know their numbers, from reading nutrition labels and measuring medications to understanding lifestyle factors and personal health history.

So if education drives lifestyle choices and choices drive costs, shouldn’t we invest in better education? Yes. But that’s not the problem. From Dr. Google to a WebMD article (designed to sell ads) to a pamphlet to take home, most health “education” is built to inform not to teach.

We know from adult learning theory that simply telling someone to read, watch or listen is not enough. These are inherently passive ways to impart information. If we want real learning and change to occur, we need to design learning experiences that give us ways to reflect, process and apply what we’re learning.

Across need state or wellbeing dimension, a properly designed digital learning experience can personalize to the individual’s needs and guide them to the right programs. In doing so, it can help us solve the health program gap and the health literacy gap at the same time.

The Latent Health Gap

When we look at health programs and services offered today, we see a spectrum from prevention to intervention.

On one side, wellness and benefits offerings are trying to expand beyond hand raisers to help more people quit smoking, move more, or talk to a health expert to start us down a healthier path.

On the intervention side, disease management, care coordination and a host of point solutions are trying to reach people before major issues occur.

That movement to the middle is by no mistake. The vast majority of people show up in the middle. Except, they don’t show up. That’s the problem.

So now that we’ve covered key gaps behind health disengagement, how can we align with evolving consumer behaviors to lift engagement at scale?

Keep Reading: The Future of Health Literacy

D-SNP Spotlight, Part 2: Engagement Opportunities within the 2023 Ruling

Posted on by Andrea Amelse

The CY 2023 Medicare Advantage and Part D Final Rule places a magnifying glass on vulnerable D-SNP members with additional regulations that will require plans to integrate services, adopt new products designed to deepen engagement, drive growth and retention, and inspire meaningful behavior change. Plans must consider these new guidelines when designing their D-SNP engagement programs. Visit Part 1, D-SNP Spotlight: Engagement Opportunities within the 2023 Ruling, to read a summary of the ruling and related changes to D-SNP regulations.

Why D-SNP? 

D-SNP members offer plans a unique engagement challenge, particularly due to their hard-to-reach reputation and growth potential. There are roughly 4 million D-SNP members nationwide, with 7 million additional individuals remaining eligible. This rapidly expanding population saw a growth increase of 52% since 2018, with an increase of 16.4% in 2021 alone. 

This fast-growing member population qualifies for both Medicaid and Medicare due to their complex needs and requirements. D-SNP members often have a disabling condition, suffer from mental health disorders, receive care from multiple doctors for a variety of health conditions, and/or receive in-home care or other specialized health and social service care. D-SNP members also have access to additional benefits which often include dental care, discounted over-the-counter pharmaceuticals, hearing exams, annual eye exams, and no-cost transportation to health care visits.  

Despite their complex needs, D-SNP members open the door to several opportunities due to the requirements in place that enforce plan coordination and whole person care engagement models. Here are a few opportunities to consider.

Opportunities to Engage and Drive Outcomes  

Cut Through the Competition 

Creating meaningful relationships is the key to retaining members, and the stakes are high when it comes to D-SNP. To retain members, each individual needs to feel seen and addressed. Scaling communications across an entire population is no small feat, particularly when each member has their own unique needs and challenges. 

Personalized omnichannel messaging is essential to creating a valuable experience and allows for resources and services to be delivered on a case-by-case basis through each member’s preferred channel of communication. Conversational AI allows messaging to remain dynamic, while Natural Language Understanding (NLU) analyzes each response. mPulse Mobile uses a combination of industry, public and private data sets combined with plan data to create highly accurate predictions, and continually optimizes dialogs using conversational insights. By sending the right message at key moments, and providing resources and information each member needs most, we can begin building meaningful relationships that reduce churn. 

Break Down the Barriers 

Reaching and getting D-SNP members to engage is a great start, but instilling behavior change and self-efficacy to create action? Definitely a challenge – particularly when we consider the unique needs D-SNP members face. Members face a combination of mental health and physical health challenges, which can include ailments such as substance abuse and comorbidities. They often receive in-home care, reside in long-term care facilities, or have designated caregivers. These situations can create even more barriers to engaging and activating D-SNP members. Despite obstacles, providing relevant and critical care information and resources, particularly benefits they may not be aware they have access to, through their preferred communication channel is a great first step. But how do we create meaningful behavior change? 

We can begin building health literacy by providing powerful media experiences that include interactive and educational modalities. mPulse Mobile offers streaming health education across a variety of health topics. All content is designed by our team of production designers and learning strategists, with the goal to build skills that empower members to own their health and adopt healthier behaviors over time. Not only do we design for health literacy, we design for entertainment and boast a 71% member self-reported likelihood to take action after engaging with our streaming content.  

Drive Value Again and Again 

D-SNP members offer plans tons of flexibility. Because Medicare and Medicaid benefits are tied into a single member, premium dollars increase and open the door to curating much-needed exceptional member experiences. Allowing plan resources and benefits to reach, engage and educate this rapidly growing and vulnerable population is crucial. To attain and retain the market share, developing partnerships with organizations designed to drive repeated value is key. Understanding your member’s needs, using behavioral and learning science to engage and educate them, and driving action at key moments increases member retention, and delivers better health outcomes. 

How mPulse drove a 58% D-SNP Engagement Rate 

mPulse partnered with a national payer who serves over 17 million members nationwide, with D-SNP member eligibility available in 28 states.  

Goals 

The program focuses on welcoming new D-SNP members to the plan, with an emphasis on increasing awareness and utilization of available benefits and services. By providing a white glove experience, the plan aimed to increase retention of D-SNP members and create meaningful relationships with these members at scale. Additional goals included HRA completion. 

Execution 

Over the course of three weeks, more than 45,000 D-SNP members were enrolled into a 3-week SMS program. Each week promoted a different service offering, including healthy food card and over-the-counter pharmaceutical discounts, as well as assistance in finding a provider and ensuring members received their ID cards.  

Results 

SMS text messages saw a 99% delivery rate with 58% engagement. More than 30% of engagement included link clicks to related plan benefit offerings, which included over-the-counter pharmaceutical discount cards, healthy food cards, and provide finder links.

What’s next?  

By understanding how to reach members with complex needs, plans can cut through the competition and provide unrivaled experiences for D-SNP members. mPulse Mobile is the leader in Conversational AI solutions for the healthcare industry and operates to continually drive outcomes using tailored and engaging digital experiences. Our rich understanding of diverse populations enables our team of behavioral and learning scientists to curate highly tailored programs designed to impact the lives served by our 180+ client roster.