Essential Insights
- 67% member activation- Streamlined, high-impact welcome calls improved early engagement and activation across the member population.
- 97% satisfaction rate- Personalized, empathy-driven outreach significantly improved member experience and satisfaction scores.
- Integrated engagement model- Unified outreach replaced fragmented touchpoints, improving HEDIS performance and driving Star rating gains.
The Big Picture
Gaps in care, low satisfaction scores, and disconnected member touchpoints prompted a leading Medicare Advantage plan to rethink its outreach strategy.
Multiple internal teams and external vendors were involved in critical member interactions, creating friction, inefficiencies, and an inconsistent experience for members.
To address these challenges, the plan partnered with Carenet Health to implement a holistic, data-driven engagement strategy focused on integrated processes, streamlined member experiences, and targeted outreach to high-risk populations. The goal was to improve HEDIS performance, Star ratings, and associated bonus revenue while delivering a more seamless member journey.
Challenge
The health plan’s outreach model was fragmented across multiple teams and vendors, leading to inconsistent engagement and missed opportunities to connect with members in meaningful ways.
Welcome calls were underutilized, serving as administrative touch points rather than opportunities to drive early engagement and activation. Additionally, ongoing outreach efforts lacked coordination, making it difficult to effectively close gaps in care and ensure member follow-through on preventive services.
The organization needed a more unified and strategic approach to engagement—one that could simplify interactions, improve efficiency, and drive measurable outcomes across the member lifecycle.
Key Challenges
- Challenge 1: Fragmented member outreach model
- Challenge 2: Inconsistent member experience
- Challenge 3: Low activation and engagement rates
- Challenge 4: Gaps in care not effectively addressed
- Challenge 5: Limited coordination across teams
Solution
Carenet partnered with the health plan to design and implement a unified engagement strategy focused on simplifying interactions and maximizing the impact of every member touchpoint.
Transform the welcome call into a high-value activation moment
Carenet redesigned the welcome call to consolidate multiple actions into a single, high-impact interaction.
During one conversation, members could:
- Receive benefit education
- Select or confirm a primary care physician
- Schedule a wellness exam
- Complete a health risk assessment (HRA)
- Enroll in rewards programs
- Update contact information
- Indicate communication preferences
By reducing handoffs and combining multiple needs into one coordinated touchpoint, the plan created a simpler, more convenient experience while improving operational efficiency and early member engagement.
Sustain engagement and drive follow-through
To reduce gaps in care throughout the year, Carenet’s engagement specialists conducted proactive outreach grounded in empathy and behavioral engagement techniques.
Each interaction was designed to:
- Address multiple HEDIS measures per call
- Educate members on preventive care
- Identify and resolve compliance barriers
- Support appointment scheduling
- Complete follow-up confirmations
This approach ensured continuous engagement beyond the initial welcome call, driving stronger adherence to care plans and improving overall outcomes.
Results
The unified engagement strategy delivered strong, measurable outcomes:
- 67% member activation rate
- 97% member satisfaction rate
- Improved HEDIS performance
- Strengthened positioning for higher Star ratings
- Enhanced member experience and engagement
