PERSONALIZED ENGAGEMENT FOR IMPROVED MEDICAID OUTCOMES How to Successfully Reach and Motivate Medicaid Members to Take Action and Improve Population Health
TABLE OF CONTENTS Engagement to Achieve the Triple Aim
Challenges Engaging Medicaid Populations
Designing Medicaid Solutions for Results
Eliza Medicaid Solution Suite
CASE STUDY: One year, 1 million members, 2.3 million outreaches
Preventive Care: Improving Well-Child Visits
Onboarding and Retention: Reducing Churn and Ensuring Member Retention
Chronic Disease Management: Diabetes Testing Improvements Among Hispanic Population
The Eliza Impact
The Power Behind the Eliza Engagement Engine
Health Engagement Management
The health of Medicaid members depends on their willingness and ability to take action to manage their care. This eBook examines the issues that complicate Medicaid member engagement and proven strategies to improve health outcomes and lower costs.
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ENGAGEMENT TO ACHIEVE THE TRIPLE AIM
Patient engagement is one strategy to achieve the Triple Aim of improved health outcomes, better patient care, and lower costs.1 Strategies that effectively address the Triple Aim have been the elusive goal of healthcare reform ever since the Institute for Healthcare Improvement introduced the concept in 2007. However, according to research cited in Health Affairs, there is one strategy that works: patient engagement. Engagement is most effective when intervention strategies build skills and confidence and provide support tailored to each patient’s level of activation. By understanding how to motivate Medicaid members to engage in their health, pinpointing any barriers to care, and connecting IMPROVED HEALTH them to the proper resources, engagement has proven OUTCOMES effective in achieving all three goals of the Triple Aim—improved health outcomes, better patient care, and lower costs.
TRIPLE AIM BETTER CARE
Patients with the lowest activation scores, having the least skills and confidence to actively engage in their own healthcare—incurred costs up to 21 percent higher than patients with the highest activation levels.1
1 “Health Policy Brief: Patient Engagement,” Health Affairs, February 14, 2013.
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CHALLENGES ENGAGING MEDICAID POPULATIONS
Medicaid managed care has grown steadily over the past 25 years, now covering an estimated 70% of all Medicaid members—more than 50 million people in 39 states. Increasingly, Medicaid agencies are utilizing pay-for-performance incentives as a way to improve the quality, efficiency, and overall value of Medicaid managed care. This puts added pressure on managed care organizations (MCOs) to improve outcomes and meet quality goals—all while keeping costs in line. The Medicaid population presents a variety of challenges to enhancing engagement:
Socioeconomic status (SES): SES is traditionally defined as a combination of education, income, and occupation. Socioeconomic disparities are the most fundamental contributors to health disparities, with low SES correlating with higher instances of morbidity and mortality.2 In addition, Medicaid members experience higher rates of homelessness, unemployment, and food insecurity, and may not have access to transportation—all of which can thwart engagement efforts and activation levels.
Transience: Medicaid members move more frequently, making it harder to manage their care and maintain updated contact information via phone or mail. This contributes to unnecessary disruptions in Medicaid coverage, or ‘churn’.
Comorbidities: The majority of Medicaid beneficiaries have more than one chronic condition, and between 38% and 52% of non-elderly Medicaid members with physical chronic conditions such as diabetes, cardiovascular disease and respiratory disease also have a comorbid mental illness.3
Cultural barriers: Language differences and the lack of local support systems can hinder outreach and response for some Medicaid members.
The result of these factors is a conundrum: a population that requires more engagement to ensure compliance, but is much more challenging and resource-intensive to engage. Enter Eliza.
ARTICLE: Looking beyond medical claims data to understand the social determinants of health READ IT NOW>
2 Adler, N.E. & Newman, K. (2002), “Socioeconomic Disparities in Health: Pathways and Policies,” Health Affairs, 21, No. 2: 60-76. 3 Kaiser Family Foundation Fact Sheet: “The Role of Medicaid for Adults with Chronic Illnesses,” November 2012.
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DESIGNING MEDICAID SOLUTIONS FOR RESULTS
Eliza works with Medicaid MCOs to identify the pressing business imperatives (i.e., HEDIS improvement) requiring member engagement. Our Medicaid Solution Suite supports your business goals by engaging Medicaid enrollees throughout their membership—from onboarding, to closing gaps in care, to retention efforts. Every client has specific business goals requiring a blend of programs, and every member has unique needs to motivate them to act. This is where Eliza delivers the most value. Each of our programs identifies best practice approaches to drive results in the Medicaid population. However, we recognize that you may have unique business goals, so we can also tailor our programs to meet your desired results.
ELIZA MEDICAID SOLUTION SUITE SOLVES YOUR BUSINESS CHALLENGES
Quality and Cost Management
Revenue Management/ Membership Growth
• Improve HEDIS ratings
• Meet pay-for-performance goals
• Market expansion • Utilization management
• Support medical cost management initiatives
• Preventive screenings
• Chronic condition management
• Benefit reminders
• Episodic management
• Payment reminders
Consumer Experience • Unifying experience across multiple vendors • Streamlining and coordinating internal department goals for member engagement
• Member playbooks: - Channel opt-ins and preferences - Identification of barriers • Experience enhancers: - Welcome/onboarding - Medication reminders
• Medication adherence • Care management
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ELIZA MEDICAID SOLUTION SUITE
Eliza offers a comprehensive, data-driven health engagement management solution that effectively engages Medicaid populations during key events of their healthcare journey. Below are the programs in our Eliza Medicaid Solution Suite: • Welcome and Onboarding: First impressions are lasting. Timely and relevant conversations are designed to get to know your members, capture critical information to make the member’s healthcare journey successful while building loyalty and enhancing satisfaction. • Preventive Care: Education and awareness to promote regular checkups, health screenings, and the use of a primary care physician as a medical home. • Prenatal and Postpartum: Outreaches to pregnant members to educate them on the importance of timely care, assess risk and transfer to plan resources, as necessary. • Chronic Disease Management: Programs including diabetes and heart health interventions that address key HEDIS measures and focus on increasing care coordination and closing gaps in care. • Medication Adherence: Align medication programs with condition management needs to engage a targeted population to improve adherence. • Post-Hospital Discharge and ER Avoidance: Outreaches triggered by member events, engaging members in key health decisions to reduce readmissions and unnecessary ER use. • Satisfaction and Outcome Surveys: Population-wide surveys addressing risk assessment, satisfaction and CAHPS measures, as well as barriers to care such as social determinants of health, provide valuable member-level actionable data for intervention strategies. • Year-End Gap Closure: Timely engagements triggered by claims data and past behavior to educate members on the importance of health screenings, assess intent to comply and support real-time appointment scheduling.
BLOG: MEDICAID RETENTION: When it comes to Medicaid renewal, the value of a proactive touch is easily quantified. READ IT NOW>
• Member Retention: Renewal reminders and assistance solidify the member experience while building brand recognition and loyalty.
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ELIZA OFFERS PROVEN MEDICAID SOLUTIONS THAT SUPPORT THE FULL RANGE OF MEMBER NEEDS A Representation of Client Programs with Supporting Results
ONBOARDING & RETENTION Redetermination/Renewals • Improved retention of children: 9% • Retained revenue: $15.6M
ER AVOIDANCE/ POST-HOSPITAL DISCHARGE ER Utilization Avoidance • 1.9% reduction in ER visits • Cost avoidance: $800K Post-hospital Discharge • 2.2% reduction in 30-day, all-cause readmissions • Cost avoidance: $3.8M
PREVENTIVE CARE Well-Child Visits • 1,722 well-child visits scheduled in one year • 12.4% increase in well-child visit rate, using HEDIS methodology
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PRENATAL/POSTPARTUM Postpartum • 12.5% year-over-year improvement in postpartum care rates, using HEDIS methodology
CHRONIC DISEASE MANAGEMENT Diabetes Management • 8.5% higher HbA1c testing rate for those who chose to receive communications in Spanish • 4.5% lift in HbA1c testing rates within four months
MEDICATION ADHERENCE Antidepressant Medication Adherence • 10-13% increase in adherence
LIFECYCLE OF A MEMBER’S NEEDS
SURVEYS Social Determinants of Health • 40% report having some difficulty getting to the doctor’s office • 35% were concerned about the cost of the tests • People reporting concern for life necessities were 8x more likely to report high emotional stress and 5x more likely to report poor physical health
YEAR-END GAP CLOSURE Achieved in Two Months • 162 PCPs assigned • Over 1,700 appointments scheduled
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CASE STUDY Medicaid Client: One year, 1M members, 2.3M outreaches This case study highlights three of the 20 integrated multi-channel programs that Eliza implemented over the course of a year for one client. These programs addressed specific business challenges, including the successful execution of a quality improvement strategy to meet pay-for-performance goals.
The Challenge A large regional Medicaid MCO needed to quickly launch a comprehensive multi-channel member engagement strategy that would: • Close gaps in care, improve HEDIS rates and meet quality pay-forperformance goals • Improve brand loyalty and member retention • Prioritize the competing and diverse outreach needs of its members • Collect contact information and consents
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Enter Eliza Over the course of a single year, Eliza launched over 20 programs and initiated 2.3 million outreaches to a million members, resulting in the client achieving pay-for-performance goals. Other results included:
30-42% OVERALL ENGAGEMENT RATE
utilizing automated phone, email, text, and live agents
GAPS IN CARE CLOSED
in child redetermination rates
HEDIS MEASURES IMPROVED
13% IMPROVEMENT in cervical cancer screening rates from the previous year, using HEDIS methodology
4% IMPROVEMENT 100% INCREASE
in acute phase antidepressant medication adherence rates from the previous year, using HEDIS methodology
in number of members with governmentsponsored mobile phones, enabling a direct connection with their health plan
IN REVENUE RETAINED through member retention efforts
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PROGRAM SUCCESS: PREVENTIVE CARE
IMPROVING WELL-CHILD VISITS Population: Medicaid and CHIP pediatric members Channels: Automated phone, email, text
Business Problem Our client struggled with getting children to their annual well-child visits. Many parents needed education on preventive care, others needed reminders to make appointments for their child, and some required help finding and getting to a doctor. Since the majority of Medicaid enrollees are children, several states are leveraging quality measures related to well-child visits in pay-forperformance programs, making HEDIS improvement in this area critical. WELL-CHILD RATES USING HEDIS METHODOLOGY
Program Overview Eliza partnered with the client to educate parents about the importance of preventive care, remind them that their children may be due for a wellchild visit, and even help them find a doctor and set up an appointment. A multi-channel, multi-touch approach was used, including an automated call, followed up by an email to reinforce the information that was discussed and to promote plan resources. Thirty days later, another email or a text message was sent, reminding parents to schedule an appointment for their child.
0% Not Reached
Reached via Automated Call and Email
Members reached by Eliza had a 14.1% higher rate of well-child visits than those who werenâ€™t reached (Fig. 1.0). Across clients, we consistently see an incremental lift in rates for each additional touchpoint. In this particular program, members who received a phone call and an email had a 6.2% greater rate of well-child visits than those who received only a phone call.
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Thank you for the call and the advice and also for the recommendation for my son’s check-up. It’s a little hard now that he’s a teenager... It’s good to receive recommendations to be able to help him, so [he] can avoid doing something that can harm [his] health or life. Thank you. —Parent
A lighter touch was used for members who, according to claims data, received their well-child visits the year before, and were therefore considered to be compliant. This group received a brief phone call and follow-up text message reminding parents and guardians that their child was due for a well-child visit. Those who were reached over the phone and received a text reminder had an 8.5% higher rate of well-child visits than those who weren’t reached (Fig. 1.1).
WELL-CHILD VISIT RATES FOR ‘REMIND’ GROUP 80%
77.1% 68.6% 60%
0% Not Reached
Reached via Automated Call and SMS (Fig. 1.1)
Multi-channel, multi-touch outreaches yield results. Not only did Eliza increase the number of children who received important preventive and ongoing care, we also connected families to medical and community resources, an essential component of supporting traditionally underserved populations.
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PROGRAM SUCCESS: ONBOARDING AND RETENTION
REDUCING CHURN AND ENSURING MEMBER RETENTION Population: Children in Medicaid and CHIP Channels: Automated phone, email, text
Business Problem Like so many Medicaid MCOs, our client struggled with retaining members year-over-year and the significant costs associated with churn. ‘Churn’ is the unnecessary disruption in health coverage, due to eligibility changes and/or administrative problems. About half of all members who lose eligibility end up coming back on the plan within six months. In the meantime, they may have gone without important medications, preventive care, or treatment for chronic conditions, resulting in a sicker population and higher medical costs for the plan to manage. In this case, 60% of the people we reached hadn’t even received their redetermination paperwork from the state. Had they not heard from Eliza, they too would have contributed to Medicaid churn.
Program Overview Eliza implemented a proactive, personalized, and easy-to-understand outreach to members ahead of their renewal dates. We reached nearly 74,000 parents and guardians of children up for redetermination to inform them about their coverage and the renewal process, confirm receipt of the state Medicaid renewal letter, and direct them to update their information online.
Results Eliza drove compelling results, including retaining over 6,600 members that otherwise would have lost coverage, retaining $15.6M in revenue. Those reached by Eliza were nearly 12% more likely to complete their redetermination paperwork than those who were not reached (Fig. 1.2). Adding more channels, only improves results. We saw almost a 2% lift “Reducing Churn”: Strategies to in renewal rates when members were sent a improve member retention and follow-up email after receiving an automated call. loyalty for Medicaid MCOs and QHPs WATCH IT NOW>
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MEDICAID RETENTION AFTER AUTOMATED CALL AND EMAIL 80%
0% Not Reached
Reached via Automated Call and Email (Fig. 1.2)
Additionally, those not reached via automated phone call, but who opted in to receive text message reminders, experienced a 10% increase in redetermination rates, compared with members who werenâ€™t reached at all (Fig. 1.3).
MEDICAID RETENTION AFTER SMS REMINDER 80%
0% No SMS
SMS Reminder Sent (Fig. 1.3)
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PROGRAM SUCCESS: CHRONIC DISEASE MANAGEMENT
DIABETES TESTING IMPROVEMENTS AMONG HISPANIC POPULATION
Population: Medicaid Channels: Automated phone, email, text
Business Problem Our client needed to increase compliance around recommended diabetes screening particularly in their Hispanic member population. They have a large Hispanic population, and wanted outreaches to be both effective and culturally-appropriate.
Program Overview Eliza reached out to Medicaid members, ages 18 and over, who according to claims data, had been diagnosed with diabetes. Members were given a choice of receiving outreaches in English or Spanish. The outreach program included educational calls, emails or text messages encouraging them to get the recommended diabetes screenings. A culturally-adapted approach, rather than a straight one-for-one translation, was used to drive the desired activities and build relationships with Hispanic members.
Results Eliza’s culturally-adapted approach enabled greater engagement and improved outcomes among those who chose to speak Spanish (Fig. 1.4). • 8.5% higher HbA1c testing rate for those who chose to receive communications in Spanish, versus those who were not reached. • Those who chose to interact in Spanish had a 3.6% higher HbA1c testing rate (based on HEDIS methodology) than those who spoke English.
HBA1C TESTING RATE BASED ON LANGUAGE SELECTED BY MEMBER ON CALL 100%
0% Not Reached
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THE ELIZA IMPACT
Over the past two years, these programs have continued to deliver measurable results. In fact, 72% of the programs continue to show improvement in year-over-year analysis. We started off by launching selected programs key to driving member engagement and providing an immediate impact to HEDIS outcomes. Our continued partnership and focus on aligning our client’s business imperatives with member engagement programs have strengthened the overall outcomes for our client. Member satisfaction rates are as high as 92% and our client continues to see improvement in member engagement and health outcomes, resulting in higher quality ratings, less member churn, and cost savings. In fact, the client was so pleased with these Medicaid outcomes that they chose to expand the program to other populations. Because Eliza has proven experience and data insights, we have a deeper understanding of consumer behavior. This gives Eliza the ability to design more effective conversations and ultimately the best outcomes for our clients.
MOST EFFECTIVE CONVERSATIONS
MEMBER ENGAGEMENT IS KEY TO ACHIEVING POSITIVE HEALTH OUTCOMES, BETTER PATIENT CARE, AND LOWER COSTS. Engaged members are more likely to: (1) allow the plan to complete needs assessments and care plans; (2) participate in person-centered care planning; and (3) actively work with the plan to meet goals (i.e., keeping medical appointments, filling and taking prescriptions as directed, and following other clinical and service provider advice).4 —The Center for Health Care Strategies
4 Sarah Barth and Brianna Ensslin, “Building a Culture of Engagement for Medicare-Medicaid Enrollees: Health Plan Approaches,” Technical Assistance Brief, Center for Health Care Strategies, Inc., August 2015.
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THE POWER BEHIND THE ELIZA ENGAGEMENT ENGINE
Eliza has engaged with 85 million healthcare consumers in 1.8 billion multi-channel interactions, resulting in the collection of over 15 billion member data points that grows on average 10% per month to fuel insights from the Eliza Engagement Engine.
Multi-Channel Interactions, Resulting in...
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Our engagement engine enables us to create personalized conversations with today’s healthcare consumers on an enterprise scale. We have over 15 years of experience driving robust programs that generate member activation.
Healthcare Consumers Engaged
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HEALTH ENGAGEMENT MANAGEMENT
Eliza works with Medicaid MCOs to align business goals with engagement structures, identifying a tight set of objectives and metrics: • Greater administrative efficiency • Improved member satisfaction resulting in member retention • Improved health outcomes • Culturally-tailored outreaches • Expansion to new communication channels for traditionally hard-to-reach populations Our industry-leading science and analytics team profile and segment member populations by propensity to act, and by receptivity to various communications channels, informing intelligent engagement design and increasing our ability to drive action. Eliza’s pioneering creative and communication strategists then design campaigns that are personalized and brand-aligned using our truly unique multi-channel communications capabilities. We then meet consumers where they are, and have conversations—listening for clues about the issues each consumer faces, and incorporating that information into future tactics. Then finally, true integration with your systems allows us to monitor and report on improved outcomes and ROI in real-time.
DATA INTEGRATION It starts with managing medical/Rx & consumer data & infusing with Eliza’s proprietary database
RESULTS Continuously measure success to enhance future outreach
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SEGMENTATION Predictive models and propensity analysis
ENGAGEMENT DESIGN Highly tailored and targeted outreach strategy
OUTREACH DELIVERY Personalized conversations driving engagement
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DATA MANAGEMENT AND ANALYTICS
The ability to expertly ingest, clean, load, and analyze data from a variety of sources allows us to develop effective outreaches and refine best practices from program results. Eliza’s analytics capabilities delve deeper into a population’s data and glean vital insights that enable us to: • Separate people into logical cohorts • Recommend whom to engage • Identify receptivity to build engagement strategies that will be the most effective • Determine how engagement programs should be executed to achieve desired goals
ENGAGEMENT DESIGN SERVICES
Eliza design experts ensure that all interactions—from phone scripts to email content, to print, mobile, and web-based campaigns—are relevant, measurable, data-driven, and unified at an enterprise scale. Our work builds on over 15 years of experience-based understanding of how consumers relate to healthcare, what techniques drive engagement, and how to motivate action. We understand how to enable real interactive conversations by engaging with consumers across the most appropriate channels—mail, web, text, or phone—to motivate them to change their behavior.
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Channel expertise matters. The selection of channels—and the conversation cadence—can mean the difference between success and failure. Eliza understands the strengths and limitations of each channel and how best to leverage them for each cohort. The Eliza Engagement Engine is purpose-built for healthcare and tailors the most effective outreach strategies and channels to engage members. This enables us to successfully create a conversation with consumers while listening for clues about the issues they face, and incorporating that information into future tactics. We continue to innovate and evolve the Eliza Engagement Engine to support more targeted, robust, efficient—and cost-effective—health engagement programs that deliver results. As outreaches are conducted, the outcomes are tracked and the resulting data is fed back into the system to inform the next generation of interventions, enabling continuous improvement. In addition, outcomes data is compiled, analyzed, and reported to clients in real-time to ensure strategic alignment and program success.
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ENGAGE WITH ELIZA: Contact us today for more information about how Eliza Corporation can help you better engage your Medicaid members. elizacorp.com Eliza Corporation on LinkedIn Eliza Corporation on YouTube Eliza Blog 1.844.343.1441 email@example.com