Redetermination

Reduce Member Churn with Proactive Medicaid & Medicare Redetermination Conversations

Retain members. Increase continuity of care.

The importance of continuing plan coverage is abundantly clear: lower administrative and care costs, more predictable capitation payments and, most importantly, the feeling of security and wellbeing for your members.

Despite this, over 30% of members will churn over the course of an annual coverage period. Because contributing factors are complex, improving Medicaid and Medicare redetermination requires understanding each member’s unique situation and providing tailored support.

The mPulse Mobile Redetermination Solution provides important reminders and nudges for members, complementing each with tailored conversations that address knowledge gaps and administrative challenges.

Proven Results

20pp

Increase in redetermination rates

31%

Click-through rates for members to update mailing addresses on file with their State Medicaid agency

How It Works

UNDERSTAND Your Members

We build a dynamic profile of each member that includes key factors influencing redetermination.

  • Spoken language and cultural background
  • Health literacy
  • Choice or auto-assign
  • Health activation levels
  • Previous program engagement
  • Proprietary SDOH Index score
  • Demographic information
  • Engagement history

DELIVER Redetermination Conversations

The member receives conversational reminders to drive renewals.

  • Remind and nudge members to complete their renewals
  • Tailor conversations based on dynamic member profiles
  • Utilize conversations to gather key administrative information to complete renewals
  • Adapt conversations to align with electronic and paper-based re-enrollment

OPTIMIZE Your Solution

We work with you to capture key insights and optimize your solution to continuously improve renewal rates.

  • Analyze all aspects of solution performance using solution dashboards
  • Measure and understand conversational engagement across population segments
  • Optimize conversations and minimize friction for members to take action

Solution Content

Core Solution:

  • Redetermination Reminders

Additional Modules:

  • Bad Address
  • Choice vs. Auto-assign
  • Paper Renewal Form
  • IVR
  • Spanish Language
  • CAHPS Monitor

Advanced technology. Practical solutions.

The mPulse Mobile Medicaid and Medicare Redetermination Solution is delivered using our enterprise-grade communication platform and innovative technology that powers effective and scalable conversations.

 

  • Conversational AI – Forms the core of our Natural Language Understanding and allows us to automate tailored conversations
  • Engagement Console – Empowers your support staff to have 1:1 mobile conversations with members using a cloud-based desktop application
  • Reporting – Provides you with the data views and analysis to understand member engagement and optimization of solution outcomes
  • SDOH Index – Lets us understand populations at scale to tailor conversations, so you can provide support to all your members
  • Activation Intelligence – Builds individual activation profiles for each member, so we can adapt and tailor conversations to drive solution outcomes
  • Conversation Science – Enables us to measure and assess the quality of our automated conversations at scale, so we can be more meaningful and engaging

Start Conversations.
Build Relationships.
Drive Outcomes.

It all starts with conversation. Our omnichannel solutions empower you to have conversations with your consumers through their preferred channel and with relevant content. Our behavioral data science team and Conversational AI platform give you the smarts and automation to intelligently tailor your conversations to build stronger, tighter relationships with all your members. Relationships are the key to activation and behavior change that drives positive outcomes.

It’s all about relationships.
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