Struggling with HOS and CAHPS Measures? You are not alone.

Did you miss the Eliza Webinar on HOS/CAHPS on August 11th?  Listen to Ellen Harrison, SVP Market Strategy and Consulting at Eliza Corporation in the on-demand webinar as she discusses:

  • Opportunities to address the challenges all Medicare Advantage plans face and how some health plans have leveraged Eliza’s multi-channel solutions to efficiently and effectively engage their population with HOS and CAHPS proxy assessments — delivering the population and member level insights they need to address potential issues before they impact Star scores.

Access the recording here or read the webinar excerpt below.


We don’t have to tell you that HOS and CAHPS scores are important. They count for 25% of a Medicare Advantage (MA) plan’s overall Star rating, meaning that members’ perceptions about their care experiences directly affects the bottom line. These are difficult measures for all plans to improve. Over the last 3 years, HOS and CAHPS scores for MA plans have remained stagnant, with CAHPS scores hovering around 3.4 Stars and HOS scores at 3.0 Stars. And it’s no wonder. The HOS and CAHPS are based on a sample population’s perceptions about service, access and coordination of care and outcomes.  Plans receive aggregated output highlighting the broad opportunities but only limited actionable insights at a detailed member level.

Health plans need member-level data so limited resources can be used to create a focused and realistic action plan that will yield an effective return. Eliza’s approach provides early and deep insights into the drivers of perceptions that can help boost Star scores. We believe micro-targeted assessments that approximate the HOS and CAHPS key questions and issues applied across the health plan population, can provide you with early direction on results, specific information on member perceptions, and allow for laser-focused interventions.

Eliza’s HOS and CAHPS outreach impacts member perceptions and results in three ways:

  1. Recency and relevance play a role – We have found that the action of completing a survey of similar questions provides some lift in completion of the formal CAHPs and HOS surveys.
  2. Drive to act – We expand on standard HOS and CAHPS question sets by including tips and recommendations for immediate action to influence the member to act on care and outcomes issues. For example, if a member confirms some issues with balance or a recent fall, we include persuasive messaging to encourage the member to speak with their provider and seek out support and treatment. This messaging helps to not only captures member details for targeted intervention, but can result in enhanced member activation and early intervention.
  3. Actionable outputs – Our population based surveys give health plans member level details that cannot be gleaned through formal HOS and CAHPS results, which are reported in aggregate. The data collected is invaluable in connecting individual members with plan resources to address areas of concern that impact outcomes and satisfaction.

Our programs can be tailored to a plan’s specific objectives, we offer the flexibility to target key areas for improvement that matter most in your market.  And, with our integration experience gained from over 440,000 programs we can be market ready in as little as weeks.

Year_over_year_Star_Improvment

Recently, a regional Medicare Advantage plan turned to Eliza because they had a 1-Star rating in 2014 for many of their CAHPS measures. Eliza was able to provide targeted support, survey branching logic utilizing personalized questions based on individual responses and key problem areas, and survey tailoring based on past CAHPS and HOS opportunity areas for this particular plan. The results were at least a 1-Star improvement in the target CAHPS measures, and in some instances, improvement by two or three Stars.

Access the webinar recording here.

For more information on Eliza’s HOS and CAHPS solutions, email us at info@elizacorp.com.

 

Women’s Health – Could we be doing more?

An estimated 40,000 women die each year from breast cancer and another 4,000 from cervical cancer according to the CDC.[i] One in eight women will be diagnosed with breast cancer in her lifetime and it is the 5th leading cause of death for women over 50 years of age. Breast and cervical cancer screening offer early detection and treatment for better outcomes and fewer deaths. Information about breast and cervical cancer screening is widespread. Guidelines, headlines, and subject lines are put in front of women daily to remind them to make appointments and get tested. So why do screening rates continue to lag all our goals?

Why are only 70% of targeted women seeking mammography every two years, and less than 65% of eligible women are receiving recommended cervical cancer screening (PAP and HPV testing)? Many times, messages aren’t getting through the clutter of busy lives. Some are numb to the messages as they relate to ourselves and our families. For others, the messaging isn’t culturally appropriate, and doesn’t resonate with some of our most at-risk populations in a personal and engaging way. Race, income and education play a significant role. Black and Asian women are less likely to have recommended screenings. Lower income populations have low screening rates as well. Not surprisingly, women with a high school or higher education are much more likely to obtain recommended screening. While the Affordable Care Act has attempted to reduce barriers to care, a recent Kaiser Family Foundation survey of Marketplace enrollees, showed that nearly 33% think that copays and deductibles still apply to preventive services.

At Eliza, we understand engagement and messaging. We have demonstrated the ability to move populations when other types of communications haven’t had the desired impact. In one program, we were able to help a large regional health plan increase mammogram rates by 27.7% and increase Pap test rates by 22.5% over a control group that received no intervention.

chart1

Breast Cancer and Cervical Cancer Screening Outcomes

We believe that messages need to be tailored to the populations and personalized to have the greatest impact. Eliza’s women’s health solution utilizes targeted outreaches including phone calls, email and text messages to uncover barriers to care and encourage women to have appropriate screenings. For example, 37% of women stated that they hadn’t had their mammogram because they were unable to find a convenient time or location. Eliza outreach offers direct appointment scheduling to speed up gap closure and ensure a higher rate of cancer screening.

Mammogram direct appointment outreach

Listen to one patient as she shares how an outreach by her healthcare plan through Eliza motivated her to get a mammogram and ultimately saved her life:


Early detection and treatment of breast and cervical cancer saves lives. The best way to cheat these cancers is through simple proven screenings. Let’s not be satisfied with 70% compliance when 80+% percent is well within our reach.

Eliza gets modern healthcare consumers to act by engaging them in personalized conversations – at enterprise scale. Unlike disjointed point products requiring extensive integration, Eliza’s unified solution is more adaptable to change and easier to deploy, so it drives better healthcare outcomes, faster.

Check out Eliza today.

About the Author: 

Ellen Harrison – SVP, Market Strategy & Consulting Ellen joined Eliza February 2016 as the Market Strategy and Consulting leader responsible for market strategy and planning, lead generation and direct to market consulting engagement for Eliza’s Medicaid, Medicare, Commercial, DM, PBM and other ancillary products.  She brings over 20 years of experience in strategic planning and managed care operations with demonstrated results leading teams to build and redesign health care products, provider incentive systems and developing successful quality, cost and utilization improvement programs for commercial and senior populations.

Ellen most recently came from a consulting engagement as COO of Portland-based, Network for Healthcare Improvement, a grant funded member organization which facilitates regional quality improvement programs across the country through private and government funding.   Prior to this she was the Vice President of Medical Management for Martin’s Point Health Care.  She directed care management, quality improvement and provider network strategy and contracting for Tricare and Medicare Advantage products and coordinated integrated population health management resources for the MPHC medical practices.  During her tenure, Martin’s Point achieved NCQA accreditation and a Medicare Advantage 5 Star rating for 2 consecutive years.   Previous senior roles included VP of Shared Decision Making Products at a national disease management firm, Sr. Vice President of HMOs for Trigon Blue Cross and Blue Shield, Virginia and Vice President and General Manager for CIGNA Healthcare of Connecticut.  In 2016, Ellen will serve on a CMS Technical Expert Panel for MA program care coordination measure development.

Ellen is a registered nurse with a BS in Nursing from Syracuse University and an MBA with a concentration in healthcare from the University of Connecticut.

[i] U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2013 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2016. Available at: http://www.cdc.gov/uscs

 

 

Post-hospital discharge engagement reduces adverse events and improves patient safety

The transition from hospital to home is a particularly vulnerable juncture in patient care that requires significant oversight and checkpoints. In addition to the largely avoidable costs of readmissions, there is a significant patient safety issue associated with post-hospital care transitions.

CMS issued a proposed rule late last year in an effort to modernize and improve discharge planning and follow-up. CMS notes that, “post-discharge telephone call programs can improve patient safety and patient satisfaction, and may decrease the likelihood of post-discharge adverse events and hospital readmission. Post-discharge follow-up can help ensure that patients comprehend and adhere to their discharge instructions and medication regimens. Furthermore, post-discharge follow-up may identify problems in initiating follow-up care and detect complications of recovery early, resulting in early intervention, improved outcomes, and reduced re-hospitalization.”

We’re glad to see that CMS acknowledges the benefits of telephonic post-discharge follow-up, but it needs to be executed effectively in order to truly impact patient safety and improve health outcomes. That’s where Eliza comes in. Our post-hospital discharge solution is proven to reduce readmissions and improve patient outcomes, and here’s why:

  1. Our message is effective. We get results. Eliza conducted an outreach to patients who were recently discharged for a behavioral health event. Those reached by Eliza were 72% less likely to be readmitted than those who weren’t reached.
  2. Outreaches are timely and relevant. We follow-up with patients 24-48 hours post-discharge in order to quickly assess and address the most common drivers of readmission – whether they fully understand the discharge instructions, whether they’re following the prescribed medications, and whether they’ve scheduled an appointment with a clinician. Patients are also offered resources ranging from nurse advice lines, to health coaches and care managers, to emails with further information on post-discharge care. In the behavioral health post-discharge outreach discussed above, 57% of those asked, requested a follow-up email.
  3. We find people who need extra help. We are able to identify those who need a little support or a lot, and connect patients to appropriate resources quickly. Over 30% of those asked accepted a transfer to a health coach for additional support, and 40% of those who did not take the transfer, requested that a health coach call them back later.
  4. We’re efficient. Time is of-the-essence when contacting patients who have been recently discharged from inpatient care. Our automated multi-touch, multi-channel outreaches reach more people, faster and more efficiently than live callers or direct mail.
  5. We build patient trust and satisfaction. People appreciate that their provider or health plan care enough to check-in on them during a difficult time with some extra help if they need it.

Engage Eliza to connect your recently discharged patients to resources that can keep them moving forward on the road to recovery.

 

Themes from Webinar, Reducing Churn: Strategies to Improve Member Retention and Loyalty for Medicaid MCOs and QHPs

Eliza recently hosted a webinar, “Reducing Churn: Strategies to Improve Member Retention and Loyalty for Medicaid MCOs and QHPs,” with Gary Polonski from Neighborhood Health Plan (NHP). For those of you who missed it, you can replay the webinar here.

Key themes:

1. The impacts of churn are multifaceted and costly

“Churning” is unnecessary disruption in healthcare coverage, due to eligibility changes and/or administrative problems. Churn can be the result of fluctuations in income, incorrect mailing addresses, unpaid premium payments, disconnected phone numbers, confusion navigating the application process and missed deadlines due to busy lives.

Churn causes gaps in care and can have detrimental effects on the health and well-being of members. Reduced access to preventive and specialty care, important medications, and valuable provider and health plan resources often lead to worsening health status, and increased ED use and inpatient hospitalizations.

Churn also causes inefficiencies and increased costs for health plans. Studies show that the longer a member is enrolled with a health plan, the lower their monthly medical expense is, and so it pays to ensure enrollment continuity. The average tenure of a Medicaid beneficiary is actually less than 10 months, which isn’t enough time for plans to track quality improvement or to make meaningful differences in the health status of a member. In addition to increased medical expense due to gaps in care, the administrative effort and cost to re-enroll members can be upwards of $100 per member.                                                          NHPWebinar Map

There are significant savings available to Medicaid and Marketplace plans that successfully reduce churn. Eliza was able to help a large Medicaid plan save a million dollars by retaining over 6,000 members that otherwise would have lost coverage.

2. Member retention is an ongoing effort

Retention is more than one outreach at the end of the year. –It’s the continuous engagement of members, starting upon enrollment with welcome and onboarding, and continues throughout the year so that members feel supported by their health plan. NHP and Eliza have had great success with this approach, resulting in a 70% Medicaid retention rate and 90% retention of the Marketplace population.

NHP always strives to meet and exceed member expectations and has consistently seen high satisfaction with Eliza-driven outreaches. On average, 80% of respondents state that the information in the call was valuable, and those who take the call in Spanish have a 98% satisfaction rate.

3. Smart, multi-channel communications are key to member engagement and activation
NHPOutreachChart
We consistently see that members who received multiple outreaches, via different channels, are more likely to achieve desired outcomes. For example, Eliza studied the retention rates for a Medicaid plan and found that 50.6% of those who received only a redetermination letter from the state, renewed their benefits with the plan. The retention rate went up by 4% for those who received a state letter and additional reminders from the plan either by automated phone, direct mail or email. Retention went up to 57% when members received three touches – a state letter, plan letter, and an email or automated call.

Email is particularly effective in retention campaigns when links to plan and state websites are included, prompting members to take action right away. NHP was able to reach over half its membership via email, allowing them to successfully guide members through the renewal process. Email addresses and consents were collected by Eliza during an initial phone outreach, and once Eliza was able to detect a preference for email communication, follow-up email reminders were used, rather than a phone call.

Special thanks to Gary for sharing his experience and insights with other plans struggling with these issues. Replay the webinar, ‘Reducing Churn: Strategies to Improve Member Retention and Loyalty for Medicaid MCOs and QHPs’  here.

For more information on Eliza’s retention solutions, email us at info@elizacorp.com, or call us at 1.800.701.7864.

About the Author

Jennifer Forster joined Eliza in the summer of 2014 as the Director of Medicaid Strategy. Before Eliza, Jennifer was at Network Health, a Medicaid Managed Care Organization and division of Tufts Health Plan. She served as the key operational and product contact with state and federal agencies and managed staff to support contract management activities such as compliance, reporting, communications, and negotiations.

Jennifer attended Syracuse University where she earned a B.S. in Marketing from the Whitman School of Management and a Masters in Public Administration from the Maxwell School of Citizenship and Public Affairs.

 

 

Imagen de una enfermera afroamericana hablando con una madre hispana y su hija. La niña tiene un yeso  en la muñeca izquierda y está sentada sobre una camilla - Toda comunidad merece ser sana. En abril celebramos el Mes Nacional de la Salud de las Minorías. Logotipo del Mes Nacional de las Minorías – Acelerando la Equidad en la Salud en el País.

Understanding and Addressing Social Determinants of Health to Achieve Health Equity and Improve Outcomes

According to the Centers for Medicare and Medicaid services, as a share of the nation’s Gross Domestic Product (GDP), health spending accounted for 17.5%. While this represents a significant portion of our GDP, as a whole, our nation’s health outcomes are not representative of that investment and in many ways lag behind many other industrialized nations. Even more concerning is when you start to peel back the reasons behind these outcomes, and an alarming number of disparities become apparent:

  • African-American women are 10% less likely to be diagnosed with breast cancer, and over 40% more likely to die from the disease, compared to non-Hispanic white women
  • Hispanic adults are 7 times more likely to have been diagnosed with diabetes than non-Hispanic white adults
  • Asian/Pacific Islander adults are more than 2 times more likely to have liver and bile duct cancer than non-Hispanic white adults

These are just a few of the health disparities that disproportionately affect racial and ethnic groups in the United States. Social determinants, including barriers to care – such as language and culture, lack of access to preventive and urgent care, lack of health insurance, and fear of deportation – often mean that these population groups are also less likely to receive the quality preventive care they need.

To begin to impact health outcomes, we need to ensure that the communications and services we provide are culturally and linguistically tailored to specific population groups. Understanding the unique socio-demographic characteristics of the individual patients and individuals we are engaging, as well as the best ways to reach them, are critical success factors.

In order to yield greater results, Eliza works with our clients to create tailored, culturally appropriate approaches to member engagement. For some ideas on how you can engage your Hispanic member populations in their health and healthcare, take a look at the recent blog post written by Mara Jimenez, Eliza’s Bilingual Health Engagement Designer. –Or, if you prefer, read it in Spanish!

To learn more about Eliza’s tailored approach to member engagement, please contact us at: info@elizacorp.com.

 About the Author:

Sarah McLaughlin, MPH brings 15 years of experience working in health and human services on program planning, strategic and organizational planning, and population analysis. Sarah joined Eliza in 2014 as a Consultant on the Consulting Services team. In her role, Sarah is primarily responsible for leading comprehensive, health engagement projects and working with clients on strategic business solutions across the healthcare space – payers, providers and PBMs – to design, develop, and implement integrated, technology-enabled solutions that more effectively engage consumers and improve outcomes.

Prior to joining Eliza, Sarah was a consultant working with local, state, and federal health and human services agencies on projects utilizing behavioral economics and population analysis to drive outreach and engagement strategies through targeted behavior-change interventions. Areas of expertise include chronic disease, preventive health, as well as maternal and child health. Sarah has a Master of Public Health degree from Boston University and a BA from
Bryn Mawr College.

 

3 consejos para atraer a la población Hispana:

De acuerdo con la oficina del censo (Census Bureau) la población hispana viviendo en los Estados Unidos asciende a 55 millones de personas en la actualidad, lo cual representa el 17% de la población total de la nación. Además, en términos de poder adquisitivo representan alrededor de un 1.5 trillones de dólares. Con la reforma de salud impulsada por la Ley de Asistencia Asequible (ACA), cada vez más hispanos tienen acceso a seguro médico y algunos otros se han visto beneficiados al recibir una mejor cobertura médica. Sin duda alguna, estas cifras han captado la atención de las compañías de seguros médicos a tal punto, que ya han comenzado a reconocer y aceptar la importancia de desarrollar estrategias para conectar con los consumidores hispanos. Ahora bien, para mejorar la comunicación con la población hispana es importante tener en cuenta las diferencias culturales y de lenguaje, ambos puntos son factores predominantes si buscamos obtener una comunicación eficaz. No obstante, las grandes empresas están conscientes que para comunicarse con el mercado hispano deben hacerlo en español, pero muchas veces no realizan que el idioma no es el único factor que caracteriza a esta población, y que una simple traducción no funciona si no se toman en cuenta  otros aspectos.

Tres estrategias para que los hispanos estén comprometidos con su Salud:

1. Evitar las traducciones literales, traducir no es personalizar – A pesar de que el idioma es un factor importante, no es decisivo en la toma de decisiones. Traducir los anuncios, no hace que la gente compre o utilice más un servicio. La simple traducción de un mensaje general del mercado suele ser ineficaz e incluso contraproducente si un consumidor siente que “esta marca no se preocupa por mí”.  Además, no todos los hispanos tienen el mismo origen, asumir que esto es un hecho, es un gran error, es un sector muy variado con cambios ampliamente marcados entre edades y estratos económicos. Otro punto para tener en cuenta, es que muchos no son bilingües y no se están aplicando estrategias culturalmente relevantes para ellos. Por ejemplo, la traducción literal de la campaña publicitaria “Got Milk?”,  sería el equivalente a preguntar “¿Tienes leche materna?” En este caso es muy claro identificar el por qué una traducción literal no funciona, como vemos el efecto de comunicación no se consiguió, ya que no se integraron todos los elementos bajo un conjunto unificado, carece de sinergia y arruina por completo el esfuerzo del mensaje.

GotmilkTranslation

 

 

 

 

2. Crear mensajes culturalmente relevantes – El idioma no es suficiente. Para captar la atención de los hispanos y para lograr que el mensaje tenga eco en la población objetivo se deben considerar entre otros los aspectos culturales de este segmento. Por ejemplo, cuando el estado de California lanzó una campaña publicitaria para persuadir a hispanos de comprar cobertura de seguro médico, cometieron algunos errores de mercadotecnia. La Ley de Asistencia Asequible (ACA), ha logrado grandes avances y uno de los puntos más atractivos de la ley era que no se le podría negar cobertura a todo aquel que tuviera condiciones médicas existentes. Este mensaje fue difundido en casi todos los anuncios en California:

No se te puede negar cobertura médica (You cannot be denied medical coverage)

Desafortunadamente, el mensaje no logro su cometido, ya que no era relevante para el sector hispano. Cerca del 60% de la población sin seguro médico en California es hispana. Muchos de ellos nunca habían tenido seguro médico y por consecuente ignoraban si padecían de alguna condición médica que necesitará de cuidados. California desestimó la importancia de crear mensajes culturalmente relevantes. Con miras a revertir esa situación, el estado incurrió en una nueva inversión de 8 millones de dólares para una siguiente campaña.

3. Tenga en cuenta la preferencia de los medios de comunicación entre los hispanos – Es un hecho – la comunidad hispana está a la vanguardia en el mundo digital, es por esto que representan un interesante nicho de mercado. En general son quienes utilizan dispositivos móviles con mayor frecuencia. El punto clave para el individuo hispano es la movilidad. El uso de la tecnología representa otra oportunidad para todas las empresas que buscan comunicar, captar la atención y satisfacer las necesidades de este segmento utilizando una estrategia de comunicación integrada dirigida al público hispano que reside en los Estados Unidos.

Para obtener más información acerca de los programas/servicios que ofrece Eliza dirigidos/ confeccionados específicamente para el mercado hispano, por favor contacte, info@elizacorp.com.

Sobre el Autor:

Massiel Ayala pertenece al departamento de diseño de contenido (Health Engagement Design) de Eliza Corporation. Nació y vivió en la ciudad de Panamá, lugar en donde comenzó su carrera en marketing y publicidad. En el año 2010 obtiene una maestría en Publicidad en La Universitat de Barcelona, España. En el 2013, Massiel decide mudarse a Boston y explorar nuevos caminos. Actualmente, concentra mayormente su trabajo en la creación del contenido que va dirigido al público hispano. Es mamá de Luna y en su tiempo libre le gusta cocinar y seguir blogs de decoración e ideas creativas. Fanática del Real Madrid.

Share our blog in support of National Infant Immunization Week and tag @elizacorp.

Healthiest Nation 2030 – Focusing now will help ensure we make it

National Public Health week kicked off on Monday, April 4. The theme – Healthiest Nation 2030 – directly correlates with the primary goals at the heart of public health initiatives – creating the healthiest nation within one generation.

The United States health care system has been undergoing material change in recent years with the intention to support a more consistent focus on health and wellness across our diverse population, yet a  report from the Institute of Medicine brought light to the fact that the current generation of children and young adults in the U.S., could experience shorter life spans than their parents. We spend more on health care than any other industrialized nation, but have some of the worst health outcomes. Over 75% of our health care costs are spent on preventable conditions, while less than 3% is spent on prevention.

We know that prevention not only saves lives, but saves money too. Vaccination, one of the most pivotal achievements in public health, has prevented approximately 322 million illnesses and 21 million hospitalizations in just the last 20 years, saving the U.S. over $1.38 trillion in related health care costs. Ensuring that children go for their well-child visits and receive all recommended immunizations is one of the easiest ways to protect them, and those around them, from serious diseases. National immunization rates remain quite high, but disparities do exist within sub-groups on the population. In 2013, a group of researchers analyzed the Medicaid administrative claims data of more than 650,000 babies and found that two out of five infants were not fully vaccinated against rotavirus.

To become the healthiest nation by 2030 and raise a healthy generation of children, we need to focus on prevention. As health care industry clinical and engagement professionals, our job is to support and educate families on the importance of preventive care and help connect them to necessary resources to remind parents and caregivers of upcoming well-child visits, help them find a primary care doctor, and assist them in scheduling appointments.

Individuals that make up families are not one-size-fits-all, and neither should the approach to engaging them. Understanding the unique sociodemographic characteristics of the individual patients and members we are engaging, as well as the best ways to reach them, are critical success factors to drive consequential outcomes.

At Eliza, we have found that utilizing predictive analytics and leveraging multi-channel approaches to outreach yields significantly greater results. Jennifer Forster, Director of Medicaid Strategy, recently wrote a blog post outlining the success we’ve had utilizing a multi-channel outreach strategy to increase compliance with preventive visits in the Medicaid population.

To learn more about how Eliza works with health plans to help increase compliance to annual preventive screenings, email us at info@elizacorp.com, or call us at 1.800.701.7864.

 

About the Author:

Sarah McLaughlin, MPH brings 15 years of experience working in health and human services on program planning, strategic and organizational planning, and population analysis. Sarah joined Eliza in 2014 as a Consultant on the Consulting Services team. In her role, Sarah is primarily responsible for leading comprehensive, health engagement projects and working with clients on strategic business solutions across the healthcare space – payers, providers and PBMs – to design, develop, and implement integrated, technology-enabled solutions that more effectively engage consumers and improve outcomes.

Prior to joining Eliza, Sarah was a consultant working with local, state, and federal health and human services agencies on projects utilizing behavioral economics and population analysis to drive outreach and engagement strategies through targeted behavior-change interventions. Areas of expertise include chronic disease, preventive health, as well as maternal and child health. Sarah has a Master of Public Health degree from Boston University and a BA from
Bryn Mawr College.

Heart of the Matter: Heart disease kills over 600,000 people every year, and is preventable

About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Several factors that put people at a higher risk for heart disease are preventable lifestyle choices and manageable medical conditions, including: high blood pressure, high cholesterol, diabetes, obesity, poor diet, physical inactivity, and excessive alcohol use. [i] But these preventable conditions can be positively influenced through effective engagement with preventive and screening reminders and other consumer health education outreach.

At Eliza, we have been communicating with consumers about their health since 1999, using a multi-channel approach that fosters member engagement and closes gaps in care to improve clinical outcomes. Using our experience of millions of consumer interactions, Eliza engages individuals where they are, in ways that work best for them, so they can modify their own health-related behaviors for the better.

Our results help close gaps in care and enable individuals to understand and receive the proper medical treatment or information to improve their overall heart health.  The following are findings from Eliza’s work with health plans across the US:

1. Improved Cholesterol and Related Clinical Screening 6.9% among Medicare Beneficiaries to Improve Star Rating 4.5 to 5

Eliza worked with Independent Health, a 50,000 member Medicare Advantage health plan to develop a comprehensive program to improve population health. The year-long award winning multichannel engagement program included key Medicare Star measures such as medication adherence for high blood pressure and cholesterol, diabetes care, heart health, immunizations, and HOS/CAHPS improvements.  The program received recognition by URAC for Best Practices in Health Care Consumer Engagement and Protection for Quality Measurement and Data Analytics for Improving Medicare Advantage Star Metrics through Automated, Interactive Outreach.

After 1 year, Cholesterol screening was 6.9 percentage points higher in the Eliza intervention group vs. a control group. The rate of other gaps in care closures increased by as much as 32%, and the Medicare Advantage plan Star rating increased from a 4.5-Star to 5-Star status across clinical and satisfaction metrics.

ElizaInterventionVsControl

“Eliza was instrumental in helping Independent Health achieve our highly ranked quality outcomes with our Medicare Advantage members,” said Thomas J. Foels, M.D., Independent Health’s chief medical officer.  “These types of initiatives are effective at encouraging members to see their doctor and get important screenings, tests and treatments.  Eliza enables us to keep our members well informed about ways they can be engaged in their own health.”[ii]

2. Increased Medication Adherence with Statin Treatment by 24.8%

Working with a regional Medicare Advantage plan, Eliza developed an adherence program for patients who had recently started statin therapy or lapsed their statin prescription. The 3 month program focused on improving patients’ understanding of their condition and provided support, motivation, and confidence so that patients were better equipped to actively manage their health.

The Eliza intervention involved sequential and cadenced calls to patients with a tailored direct mail piece delivered after the initial contact. Those who experienced the outreach intervention increased statin medication adherence by 24.8% over those in a control group.

 In a randomized clinical trial lead by Humana Inc. and Astra Zeneca in a managed care setting, an Eliza adherence communication outreach and intervention program resulted in a 16% increase in medication adherence over a 6 month period. [iii] Additionally, from the health plan members involved, Eliza uncovered surprising beliefs among members about taking their statin medication. These included:

  • More than 50% of members reached didn’t believe that taking a statin will lower their cholesterol
  • More than 58% of members reached thought they could stop taking their statin once their cholesterol was reduced

The Eliza team provided educational intervention recommendations to mitigate these barriers to appropriate care.

3. Drive to Resources increased over 116% for Health and Wellness Programs

Eliza collaborated with Kaiser Permanente in the ‘Thrive Healthy Living’ program to proactively engage 69,000 members who were identified as having either an elevated body mass index and/or as smokers.  Eliza seized the opportunity to improve health literacy by driving members to health and wellness resources and programs. The solution intensified utilization of online health and wellness content beyond expectation:

  • 292% increase in Weight Management questionnaire completion
  • 477% increase in Smoking Cessation questionnaire completion
  • 226% increase in Stress Management questionnaire completion
  • 116% increase in Health Risk Assessment questionnaire completion
  • 161% increase in Healthy Eating questionnaire completion

Over 30% of members reached were inspired to schedule an appointment with their physician and participation in the online weight and stress management programs more than doubled and participation in the smoking cessation program increased four-fold. The program was awarded Gold recognition in the Consumer Health Improvement category in the URAC Best Practices in Health Care Consumer Empowerment and Protection Awards. The award recognizes innovative leadership and successful programs in consumer-focused health care management.

A preventable death from heart disease is one death too many. Engage Eliza to improve population health and realize more positive heart health outcomes. For more information on Eliza solutions to close gaps in care and support health literacy with engaging communication strategies, email info@elizacorp.com

About the Author:

Carolyn Peterson, Marketing Manager at Eliza Corporation shares a passion for science and technology that puts people at the center of their health and ultimately improves quality of life. Prior to Eliza she worked at PHT Corporation, the leading provider of mobile technology that collected patient reported outcomes in clinical research.  She holds a bachelors of business administration from the University of Massachusetts at Amherst.

[i] CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed Feb. 3, 2015.
[ii] Eliza Corporation and Independent Health Receive Award for Best Practices in Health Care Consumer Engagement and Protection from URAC. Fiercehealthpayer.com. FierceHealthPayer, 10 Oct. 2013. Web. <http://www.fiercehealthpayer.com/press-releases/eliza-corporation-and-independent-health-receive-award-best-practices-healt>.
[iii] Stacy, J. N., Schwartz, S. M., Ph.D, Ershoff, D., Dr.P.H, & Shreve, M. (2009). Incorporating Tailored Interactive Patient Solutions using Interactive Voice Response Technology to Improve Statin Adherence: Results of a Randomized Clinical Trial in a Managed Care Setting. Population Health Management, 12(5), 1-14. Retrieved March 31, 2016, from http://online.liebertpub.com/doi/abs/10.1089/pop.2008.0046

 

Eliza Supports American Diabetes Association Alert Day®

March 22, 2016 is American Diabetes Association Alert Day® – The day that the American Diabetes Association encourages people to take the Type 2 Diabetes Risk Test. The Association has put a good deal of emphasis on Alert Day, and we at Eliza encourage everyone to get their screening test. Knowing one’s risk level means one can take appropriate action to mitigate the risk, such as working with a health care provider to make healthy lifestyle choices.[1]

Diabetes affects more than 29 million Americans, or nearly one out of every ten people in the United States. One in every four persons with diabetes is unaware that they have the disease. All forms of diabetes, including elevated glucose levels (undiagnosed), carry an economic burden. The cost per case of undiagnosed diabetes was $4,030 in 2012.[2] This could mean that the total cost for undiagnosed diabetes may be in excess of $29B. Getting tested is the first step.

Eliza member engagement leads to increasing adherence to blood glucose (HbA1c) screenings among commercial, Medicaid, and Medicare populations.  Examples of our client success are noted below:

Case Study 1: Eliza was tasked with increasing adherence to several screenings, including HbA1c testing, among adult Medicaid members with a diabetes or heart condition diagnosis based on claims data.

Eliza created a multi-channel program, including automated phone call, email or text, tailored to members’ pattern of screening adherence. Members who were reached by Eliza (vs. not reached) exhibited a .5% lift in HbA1C testing rates within four months.

Case Study 2:  Eliza was tasked with increasing diabetes screening rates and associated HEDIS rates among commercial health plan members.

Eliza’s program was designed to engage with members and help them manage their diabetes. This program offered education and support on the importance of being up-to-date with recommended screenings and tests. Members were connected with health coaches as appropriate.

The plan’s Comprehensive Diabetes Care HEDIS rate related to HbA1C control was increased by more than 7 percentage points, and the LDL-cholesterol control rate, by more than 4 percentage points. According to the client, the Eliza engagement program contributed to $2.3 million per year cost savings.

The plan’s Comprehensive Diabetes Care HEDIS rate related to HbA1C control was increased by more than 7 percentage points, and the LDL-cholesterol control rate, by more than 4 percentage points.

The plan’s Comprehensive Diabetes Care HEDIS rate related to HbA1C control was increased by more than 7 percentage points, and the LDL-cholesterol control rate, by more than 4 percentage points.

Case Study 3:  Eliza was tasked with increasing the percentage of Medicare members who have their recommended diabetes screenings.

Eliza’s engagement program targeted members with medical claims with a diabetes diagnosis, or prescription for diabetic medication, and severity score.

According to claims analysis by the client, the percentage of members who had their HbA1c test was nearly doubled (vs. control), and the percentage of members who saw their physician 90 days post-intervention was more than doubled vs. control.  Both outcomes contributed to a long-term savings of $16 per member per year.Diabetes blog chart 2

Eliza uses communication expertise and data-driven strategies to reach and empower populations to improve their health literacy as well as their health.

Engage Eliza to realize more positive outcomes and lower economic burden when it comes to diabetes and elevated blood sugar. For more information on Eliza solutions to close gaps in care and support health literacy with engaging communication strategies, email info@elizacorp.com.

About the Author:

Suzanne Carter, Manager of Business Intelligence and Marketing Analytics at Eliza Corporation, firmly believes in the power of data and story to nudge us toward better choices and, ultimately, improve health outcomes.  She holds an MBA from Simmons School of Management and a Ph.D. in social/personality psychology from the University of Wisconsin-Madison.

[1] See more at: http://www.diabetes.org/in-my-community/wellness-lives-here/mission-engagement-days/#sthash.FepWdzTo.dpuf

[2] National Institute of Diabetes and Digestive and Kidney Diseases Retrieved from http://www.niddk.nih.gov/health-information/health-communication-programs/ndep/partnership-community-outreach/diabetes-alert-day/Pages/index.aspx

[3] The economic burden of elevated blood glucose levels in 2012: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Dall TM, Yang W, Halder P, Pang B, Massoudi M, Wintfeld N, Semilla AP, Franz J, Hogan PF. Diabetes Care. 2014 Dec;37(12):3172-9. doi: 10.2337/dc14-1036.

Retention Webinar with Neighborhood Health Plan (NHP)

The next World Congress sponsored webinar, “Reducing Churn: Strategies to improve member retention and loyalty for Medicaid MCOs and QHPs” highlights how NHP builds loyalty and retains members with targeted outreach to Medicaid and Qualified Health Plan members. NHP nurtures members year round with a multi-channel, behavior-driven engagement strategy. This focus, including best practices, will be presented during the webinar.

Register here for the Tuesday, March 29 webinar, scheduled for 1pm EST, 10am PST.

NHP currently serves businesses and individuals throughout Massachusetts and is becoming the plan of choice for a number of small to mid-size organizations that are attracted to its value, network and customer service. For more than 25 years, employers, individuals, and families across Massachusetts have turned to NHP, an NCQA-accredited, not-for-profit plan, for health care coverage that is both high-quality and affordable.

NHP works with Eliza to employ a variety of solutions in order to make member interventions more efficient and effective. NHP’s reach rates are close to 50%, exceeding Medicaid engagement benchmarks by more than 10%, and over 80% of members surveyed find the information valuable. These results demonstrate effectiveness in an area that has proven to be challenging for organizations serving low income populations.

Join the conversation as Gary Polonski, Senior Business Consultant at NHP, and Eliza’s Medicaid Strategy Director, Jennifer Forster, share their experiences engaging hard-to-reach populations with compelling and comprehensive retention programs that streamline and improve member loyalty and reduce churn.

Learn more about the webinar and register:

http://elizacorporation.mediaroom.com/2016-03-14-Eliza-and-Neighborhood-Health-Plan-Present-a-Webinar-Reducing-Churn-Strategies-to-Improve-Member-Retention-and-Loyalty-for-Medicaid-Managed-Care-Organizations-and-Qualified-Health-Plans

Medicaid Retention: When it comes to Medicaid renewal, the value of a proactive touch is easily quantified  

 

One of the biggest sources of angst for a Medicaid Managed Care Organization (MCO) is ensuring member retention. Easier said than done considering the majority of members don’t even know they are up for renewal, and if they are aware, many miss deadlines because they don’t know how to navigate the process or life circumstances get in the way. About half of all members who fall off of Medicaid, end up coming back on within 6 months. In the meantime, they may have gone without their medications, preventive care, or important treatment for chronic conditions. This translates into lost revenue for health plans, and higher administrative and medical costs as well.

Eliza’s Retention Solution is proven to keep members on your roster, reducing the headaches and costs of Medicaid churn. We recently worked with a large Medicaid plan to implement a proactive, personalized, and easy-to-understand outreach to members ahead of their redetermination date. Eliza drove compelling results, including over 6,000 members retained that otherwise would have lost coverage and $1 million in savings. We reached out to parents and guardians of over 194,000 children up for redetermination to inform members about their coverage and the renewal process, confirm receipt of the state Medicaid renewal letter, and direct them to update their information online. Those reached by Eliza completed the redetermination process 9.4% more than those who were not reached. Additionally, we saw a 10% increase in redetermination rates for those not reached via automated phone call, but opted in to receive text message reminders.

Whether deployed as a standalone product or as part of our multi-touch, multi-channel Medicaid solution, our best practices in program design yield strong completion rates for this notoriously hard to engage population. By sharing the important information they need to keep their coverage, you can help ensure they remain a loyal part of your membership year over year.

Eliza’s multi-channel redetermination outreach proactively engages members at critical points in their relationship with the plan to:

  • Remind the member that their redetermination date is coming up and confirm contact information to ensure the necessary paperwork gets to them
  • Highlight the steps the member needs to take to maintain their healthcare coverage
  • Determine barriers to completion, offer assistance as appropriate, and encourage the member not to let their benefits lapse
  • Connect members with helpful resources such as state websites, plan materials or health plan support

Join Eliza Tuesday, March 29th for the next World Congress sponsored webinar, “Reducing Churn: Strategies to improve member retention and loyalty for Medicaid MCOs and QHP.”  Eliza and Neighborhood Health Plan (NHP) will discuss how to effectively and efficiently improve member retention with strategies and results that overcome engagement obstacles while reducing Medicaid churn and build brand recognition and loyalty.

Attend the webinar by registering here.

Top 3 Takeaways from Secretary Burwell’s Keynote Address at AHIP Policy Conference

Earlier this week, the US Department of Health and Human Services (HHS) reported on the third Marketplace open enrollment period under the Affordable Care Act (ACA). It was a successful year, with 12.7 million people signing up for coverage. This is a significant increase over previous years’ enrollment – 8 million in 2014 and 11.7 million in 2015 – and evidence that we are achieving the ACA’s goal of reducing the number of uninsured Americans.

Last week, HHS Secretary Sylvia Mathews Burwell spoke at the AHIP National Health Policy Conference about the ways in which health plans can support the continued success of the Marketplace:

1. Help retain members. Plans have real-time data about members as well as knowledge of the ways to reach them. Support HHS by reaching out to members to help them avoid losing coverage, make a payment, provide additional documentation, or send re-enrollment reminders.

Member retention starts well before open enrollment. There are two main steps to obtain Marketplace coverage once determined eligible: Step 1 is choose a plan; and Step 2 is pay the first month’s premium. On average, there is a 15% attrition rate between plan selection and effectuation of coverage, which translates to a whole lot of potential lost revenue for Marketplace plans.

Marketplace CEO Kevin Counihan noted in a blog post earlier this week that some Marketplace consumers may have trouble navigating the payment process, aren’t clear on when their payment is due, or simply forget to pay before it’s too late. With over 85% of Marketplace enrollees collecting premium subsidies, the risk of triggering the 90-day grace period is a real one, since carriers must continue to pay claims during the first 30-days of the grace period.

Eliza helps Qualified Health Plans (QHPs) welcome and onboard new members prior to their start date, and at the same time, provide valuable information on how to make premium payments, thereby reducing the risk of attrition at the start of the plan year. We continue to help our QHP clients mitigate risk throughout the year by reminding individuals about upcoming monthly premium payments as well as instructions on how to make payments. Eliza’s Payment Reminder solution hasdelivered a 70% increase in performance compared to traditional direct mail outreach, and delivered in excess of a 20:1 return on investment.

2. Support transparency. Secretary Burwell notes, “In a market where 70 percent of returning consumers actively shopped for coverage; consumers need a way to know whether their doctor or drug is covered.” Last year, about half of returning consumers actively selected a plan, so shoppers are savvier and more likely to vote with their feet than in years past.

The Marketplace is evidence of the rise of consumerism in healthcare. The shopping experience allows users to compare plans based on benefits, price, network and starting next year, quality ratings, making it even more important for Marketplace plans to engage members throughout the year, building brand loyalty and satisfaction.

AHIP Quote

 

 

 

 

 

 

 

3. Engage members in their care. We want to keep members healthy, so encourage them to take action and complete their preventive screenings. Be innovative, and through apps, appointment reminders, and other tools, make it easier for members to be at the center of their health and well being.

Each and every day, Eliza engages with individuals and closes gaps in care with behavior driven analytics and multichannel communications that make interventions more efficient and effective.  The resulting conversations about their health and healthcare lead to demonstrably higher activation, more sustained engagement, healthier members and consequential better clinical quality scores and lower costs.

For more information about how Eliza can help you create a multi-channel, holistic communication approach for your QHP members, request a solution overview, or email info@elizacorp.com.

 

About the Authors

Sarah McLaughlin, MPH brings 15 years of experience working in health and human services on program planning, strategic and organizational planning, and population analysis. Sarah joined Eliza in 2014 as a Consultant on the Consulting Services team. In her role, Sarah is primarily responsible for leading comprehensive, health engagement projects and working with clients on strategic business solutions across the healthcare space – payers, providers and PBMs – to design, develop, and implement integrated, technology-enabled solutions that more effectively engage consumers and improve outcomes.

Prior to joining Eliza, Sarah was a consultant working with local, state, and federal health and human services agencies on projects utilizing behavioral economics and population analysis to drive outreach and engagement strategies through targeted behavior-change interventions. Areas of expertise include chronic disease, preventive health, as well as maternal and child health. Sarah has a Master of Public Health degree from Boston University and a BA from
Bryn Mawr College.

Jennifer Forster joined Eliza in the summer of 2014 as the Director of Medicaid Strategy. Before Eliza, Jennifer was at Network Health, a Medicaid Managed Care Organization and division of Tufts Health Plan. She served as the key operational and product contact with state and federal agencies and managed staff to support contract management activities such as compliance, reporting, communications, and negotiations.

Jennifer attended Syracuse University where she earned a B.S. in Marketing from the Whitman School of Management and a Masters in Public Administration from the Maxwell School of Citizenship and Public Affairs.

Well Child HEDIS Rates for 'Remind' Group

Multi-Channel Outreaches Increase EPSDT Compliance

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services are required for Medicaid enrollees under 21 years old. They are a vital component of a comprehensive set of benefits designed to assess a child’s health at regular intervals and identify potential problems early on. EPSDT, or well-child, visits provide an opportunity for families to ask questions, become educated on healthy behaviors, and develop a relationship with their child’s doctor. This is also a time when immunizations are administered, physical and behavioral development are assessed, and important health screenings, such as the lead toxicity screening, are done.

Eliza knows that healthy children are more likely to grow into healthy adults, and that preventive care is the key to raising a healthy generation. We work with Medicaid plans across the U.S. to educate members about the importance of preventive care, remind parents that their child, or children, are due for a well-child visit, and even help them find a primary care provider and set up appointments, should they need a little extra help navigating the system.

When conducting a multi-channel outreach for a large Medicaid plan, those reached by Eliza had a 7.9% greater rate of well-child visits than those that weren’t reached. We also consistently see an incremental lift in rates for each additional touch point. 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 only received a phone call.Well Child HEDIS RATES

Eliza conducted similar outreaches for members who, according to claims data, received their well-child visits the year before, and were therefore, considered to be compliant. We ran a lighter-touch campaign for this group consisting of a brief phone call and follow-up text message reminding parents and guardians that their child was due for their well-child visit. Those that were reached over the phone had a 6.5% greater rate of well-child visits than those that weren’t reached. There was an additional 2% lift in rates for those who received a text reminder following the call. Multi-channel outreach yields results.Well Child HEDIS Rates for 'Remind' Group
Not only did Eliza increase the number of children who received important preventive and ongoing care, Eliza also connected families to medical and community resources, an essential component of supporting traditionally underserved populations.

For more information on how Eliza can help you increase EPSDT compliance among your Medicaid members, email us at info@elizacorp.com, or call us at 1.800.701.7864.

About the Author

Jennifer Forster joined Eliza in the summer of 2014 as the Director of Medicaid Strategy. Before Eliza, Jennifer was at Network Health, a Medicaid Managed Care Organization and division of Tufts Health Plan. She served as the key operational and product contact with state and federal agencies and managed staff to support contract management activities such as compliance, reporting, communications, and negotiations.

Jennifer attended Syracuse University where she earned a B.S. in Marketing from the Whitman School of Management and a Masters in Public Administration from the Maxwell School of Citizenship and Public Affairs.

CMS and AHIP agree on new quality measures for physicians – ‘HOW DO WE IMPLEMENT?’

The Core Quality Measures Collaborative made up of the Centers for Medicare & Medicaid Services (CMS) and major commercial health plans, in conjunction with medical associations and employer and consumer groups, released on Tuesday, February 16 the first set of “core measures” that the government and private payers plan to use for value-based payments. Participating health insurers include members of America’s Health Insurance Plans (AHIP), as well as Aetna and UnitedHealth Group.

Following 18 months of consensus work, the group produced seven sets of clinical quality measures, a total of 37 measures, believed to support multi-payer alignment for physician, group practice and health system quality program in the following seven sets:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

The majority of the 37 quality measures are consistent with or drawn from NCQA, HEDIS and PCMH measures already in use, including readmission rates, diabetic measures, etc.

The goal of this work was to focus on broadly agreed upon quality improvement actions, simplify quality reporting for healthcare providers, make actionable information available to consumers to inform care choices and most importantly, to create a consistent platform to support the necessary shift from fee-for-service to value-based payments and alternative payment models. Achieving consensus is a tremendous step in the right direction for meaningful healthcare transformation.

ACOs under the Medicare Shared Savings Programs have been accountable to report against a similar set of quality measures. These new proposed measures would replace the measures for the current period, which started in 2015. Quality measure reporting requirements have only applied to Medicare ACO-engaged providers, and ACO organizations have invested significant time and resources to meet the reporting requirements. Absent the ACO requirements and incentives, the transition will be slow and challenging for smaller, independent physician groups.

Today, commercial payers independently contract with physicians and health systems, absent any standards, and have established custom and varied quality measure sets that have created a significant burden for management, measurement and reporting. The application of the newly defined core measure set by commercial payers will be voluntary, using these measures as the quality gate in alternative payment models or ACO-like risk contracting. This cannot happen overnight. Commercial payers will have to phase in these measures as providers contract renewals and new program negotiations roll out.

Whether payers choose to adopt a set standard or a custom measure set, in the end, the goal is the same – to help engage individuals and close gaps in care in order to improve measurements and results. Eliza Corporation has been working with the HEDIS, STARS and NCQA quality standards for over 15 years and realized positive member outcomes, raised HEDIS scores and STAR ratings, enhanced medication adherence and refill rates, and increased member retention. The first step is using behavior-driven healthcare analytics to identify actionable data and then applying a multi-channel communications plan that make interventions more efficient and effective.

Healthcare is complicated, but Eliza is here to help. For more information on Eliza’s provider and payer solutions, contact us at info@elizacorp.com or 800.701.7864.

About the Author:

Ellen Harrison
SVP, Market Strategy & Consulting

Ellen joined Eliza February 2016 as the Market Strategy and Consulting leader responsible for market strategy and planning, lead generation and direct to market consulting engagement for Eliza’s Medicaid, Medicare, Commercial, DM, PBM and other ancillary products.  She brings over 20 years of experience in strategic planning and managed care operations with demonstrated results leading teams to build and redesign health care products, provider incentive systems and developing successful quality, cost and utilization improvement programs for commercial and senior populations.

 

 

Webinar Recap: How Gateway Health is Influencing Medicaid and Dual Eligible Health Outcomes through Member Engagement

On February 2, 2016 Gateway Health’s, VP of Clinical Quality, Kara House joined Eliza for a WHCC webinar, “How Gateway Health is Influencing Medicaid Health Outcomes through Member Engagement.”

House discussed the challenges associated with engaging underserved populations, including incorrect phone numbers and bad addresses (often due to frequent moves), cultural barriers to care, comorbidities, and socioeconomic barriers to care such as food insecurity, unemployment, low health literacy and limited access to transportation. Gateway partnered with Eliza to better engage its membership and improve health outcomes. In addition to improving HEDIS rates and key administrative processes such as new member onboarding and retention, Eliza has helped Gateway improve member satisfaction and loyalty and open new communication channels.

Kara spoke about the positive preliminary HEDIS results they’ve seen for the Annual Dental Visit (ADV) and Plan All Cause Readmission (PCR) measures. Those reached by Eliza had an 8.3% increase in ADV rates and were 3.9% less likely to be readmitted within 30 days of discharge, than those not reached. Gateway also closed care gaps at the end of the year by utilizing Eliza’s live agents to schedule over 1,400 appointments for more than a thousand members with primary care, vision and dental providers.

Moving into 2016, Gateway will leverage Eliza’s behavior-driven analytics in a multi-year, multi-channel coordinated member engagement strategy. Historical claims data are layered upon consumer and engagement data to segment, target, and outreach the appropriate members at the right time, via their preferred channel, with communications that drive outcomes.

In 2015, we worked with a large Medicaid MCO to positively impact HEDIS rates, streamline the onboarding and retention processes, and assist in achievement of pay-for-performance goals. Over the course of one year, Eliza launched 21 multi-channel programs and 2.3 million outreaches to over one million members, resulting in:

  • 30-48% overall engagement rate, utilizing IVR, email, SMS and live agents
  • 10% increase in redetermination rates
  • 5% improvement in Continuous and Acute Phase anti-depressant medication adherence rates from the previous year
  • 5% improvement in diabetes Hba1c testing rates from the previous year
  • Over 1,700 well child visits scheduled to close gaps in care during the last three months of the year
  • Double the number of members with access to government-sponsored mobile phones

Special thanks to Kara House and Gateway Health for sharing your story. For those of you who missed it, a recording is available here. For more information about how Eliza can help better engage your Medicaid population, email us at info@elizacorp.com, or call us at 1.800.701.7864.