Regional Health Plan Transforms Medicare Member Experience Resulting in Improved CAHPS Scores and Stars Ratings

At a Glance:

• Optimized client’s Medicare member experience strategy and delivery through updated communications, behavioral science techniques, personas & segmentation, and standardized measurement
• Improved member experience, CAHPS scores, and Stars ratings

Business Opportunity:

A regional health plan sought to transform their Medicare member experience. They needed a solution to enhance communications, upgrade member experience, and improve CAHPS scores and Stars ratings.

Client Type:

Regional health plan offering health insurance and similar services to commercial, Medicare, and Medicaid populations to meet the needs of individuals, families, and employers.

Engagys Solution:

Engagys deployed a full-spectrum member experience solution including:

• Conducted current state assessment and gap analysis
• Created a centralized communications map
• Transformed their outreach strategy from utilization-based personas to needs-based personas
• Revised outbound CAHPS call scripts to include empathy, behavioral science, and personalized messaging
• Created a customized communications best practices playbook
• Trained call center agents at employing the latest in behavioral science reducing the cognitive burden for both the member and the call center rep
• Revised hundreds of member communications across the organization to include behavioral science techniques including messaging around:
  • CAHPS communications
  • Urgent COVID communications regarding benefits
  • HEDIS
  • HOS
  • Acquisition/Retention
  • Pharmacy/PDP
  • AEP/Enrollment
  • Regional Health Plan Graphic

Deliverables:

Engagys designs engagement programs with deliverables and results in mind. For this health plan, Engagys:

• Completed work in multiple 90-120 day phases
• Identified quick wins within first 60 days
• Optimized effectiveness of communications across all channels including print, live agent talk tracks, and SMS text using behavioral science best practices for senior audiences
• Suggested appropriate communication channels and messaging cadence for optimum member experience and action
• Developed over 10 behavior-based personas and tailored messaging strategy per persona
• Customized communications best practices playbook for ongoing initiatives focused on behavioral science strategies specifically aimed at increasing satisfaction and CAHPS scores

Results:

This comprehensive member-centric communications strategy resulted in:

• Increased member satisfaction
• Increased member engagement
• Improved CAHPS scores
• Improved Stars Rating

About Engagys

Engagys is the leading healthcare consumer engagement consulting and research firm. With decades of experience in healthcare and having deployed hundreds of marketing and engagement projects, Engagys has driven significant value in revenue generation, consumer behavior change and more. Learn more about Engagys.