When a premier health insurer needed to improve Medicare Advantage star ratings and drive better outcomes across nearly 20 million members, coordinated health plan member outreach became the answer — and a defining test of what partnership can do.
01
Engagement at enterprise scale
Coordinated engagement across programs enables smarter execution and a consistent member experience.
02
From pilot to partnership
A focused pilot evolved into a long-term engagement partnership across programs.
03
Trust drives performance
Transparency and shared accountability delivered measurable impact.
One of the nation’s largest customer-owned health insurers wanted to improve Medicare Advantage star ratings and reap the benefits of expanded, personalized member engagement — which could impact everything from quality scores to risk adjustment to member loyalty.
Yet with nearly 20 million members in commercial, Medicaid, and Medicare Advantage plans across multiple states and growing demands for internal resources, the organization needed an external partner to scale health plan member outreach without sacrificing quality.
“As engagement coordination increases, so does the power to apply learnings for enterprise-level optimization.”
Carenet Health — Engagement Partnership Framework
across Commercial, Medicaid & Medicare Advantage plans, managed through one strategically integrated engagement program — not separate vendors or platforms.
The health plan had already established an initial relationship with Carenet Health, contracting for fitness program enrollment outreach. The two organizations immediately decided to partner on a new pilot — a Medicare HEDIS program to help members close gaps in care.
After just a few weeks of successful HEDIS outreach, the plan asked Carenet to take on its Medicare Advantage welcome calls. From there, the relationship quickly expanded, and as the partnership grew, so did synergies among the insurer’s plans and programs.
Soon, Carenet teams were working within the plan’s care management and member services ecosystem — including the rewards-partner platform — leveraging flexible technology solutions that allow for seamless integration, real-time comprehensive data views, immediate updating, and the capacity to address a wider range of member needs with each interaction.
02
The trust that developed between the partners was significant and rooted in a dedication to transparency. A shared reporting dashboard was developed providing the insurer with ongoing confidence at the member, program, and management level. Performance-based contracts were created as a collective effort; if goals were met, it was a win-win for all.
03
Effective training and coaching programs — customized to the plan’s culture, population, technology, and programs — were a must-have for every new engagement initiative. Programs and interactions were continuously monitored for quality and effectiveness across phone, email, SMS, click-to-call, and AI-supported interactions.
04
Enterprise-Wide Programs = Enterprise-Wide Learning
1
3
8
13
Two-year performance gains through coordinated member outreach across Medicare Advantage, Medicaid, and Commercial lines of business.
Breaking Down Engagement Siloes at Scale — Full case study PDF, free to download
Get the PDF to share with your team — including the complete portrait of partnership, program-level performance data, and the four components that drove Medicare Advantage star ratings improvement and enterprise-wide member engagement success.
