Essential Insights 

• Closed-loop engagement- Proactive, omnichannel outreach improved follow-through, insight capture, and year-round member trust.
• Performance lift at scale- A governed engagement model helped improve HRA completion, survey response, and post-discharge support.
• Better outcomes, higher quality- Personalized outreach helped close care gaps, reduce readmissions, and improve Star rating performance.

The Big Picture 

• Improve member engagement to measurably lift experiences, efficiency, and quality outcomes
• ·Proactive, omnichannel interactions – informed by member context, data insights, and next-best actions to create a closed-loop engagement model that improves experiences and drives completion.
• Improve member engagement to measurably lift experience, efficiency, and quality outcomes — powered by Intelligent Engagement™ that uses data, automation, and human connection to drive action

Using a five-touch outreach journey, this Medicare Advantage plan built year-round trust and achieved measurable performance lift.

Challenge 

Providing the Medicare population with the right care in the right setting at the right time is increasingly a challenge. Failure to do so can have a significant impact on outcomes, Star ratings, and incentive revenue. Engagement is also harder when interactions are fragmented across channels and teams, and when outreach does not translate into completed actions (e.g., assessments, screenings, appointments, or follow-ups).

One Medicare Advantage plan recognized that prioritizing member engagement would improve outcomes and compliance but needed an operating model that could orchestrate consistent outreach, capture insights, and drive closed-loop completion at scale. The plan partnered with Carenet Health to stand up a governed, performance-focused engagement model designed to elevate outreach, education, and overall member engagement.

Key Challenges 

Fragmented outreach across channels

Low completion of key actions

Limited closed-loop visibility 

Solution 

A smart and holistic approach

Carenet Health partnered with the plan to create a comprehensive strategy grounded in Intelligent Engagement, Carenet’s proprietary approach to healthcare consumer engagement. This approach combines leading technology and an AI-powered engagement platform with insight-led orchestration and operational excellence, enabling context-rich interactions, guided next steps, and consistent delivery across channels. 

Five personalized outreach touchpoints A five-point contact approach was designed to inspire action and empower Medicare members through personalized, data-driven outreach.

1. Health risk assessments delivered across multiple channels, including one-on-one engagement
2. Preventive screening outreach + education (benefits-aware and action-oriented)
3. Appointment scheduling + reminders + completion reinforcement
4. Post-discharge follow-up and transition-of-care support with escalation routing when needed
5. Member experience surveying (e.g. pre-survey, outreach/VOC capture) to inform improvements

 These proactive interactions created a closed-loop cycle: outreach → insight capture → next-best action → completion → feedback — strengthening trust and improving follow-through year-round.

Results 

Personalized, empathetic interactions add up Carenet’s data-driven, technology-supported, and multi-faceted strategy helped the plan improve overall performance across several key areas by combining intelligent automation with human connected and guided actions.

Actionable insights captured:

• 46% increase in HRA completions 
• 83% increase in annual plan survey completion

Follow-up care and compliance improved:

• 80% increase in post-discharge support
• 38% decrease in readmissions

Positive behavior changes took place:

• Gaps in care were closed for 17% of the targeted population
• 62% of nurse advice line callers were diverted from the ER when clinically appropriate
• 59% of nurse advice line callers were diverted from urgent care centers when clinically appropriate