The Client Challenge
A $2.5 billion regional health plan identified its dual Medicare-Medicaid plan as a critical growth area, given limitations across other lines of business (LOBs) and the long-term impact dual eligible membership would have on its business.
The payer lagged behind competitors in the duals market, with limited year-over-year growth. Despite significant attention on the duals market, the payer lacked a proactive strategy for dual member recruitment, relying solely on external factors for growth.
WITHOUT A PROACTIVE DUALS GROWTH STRATEGY, THE HEALTH PLAN EXPERIENCED:
- Large population centers throughout the state ceded to competition
- Higher-than-expected member costs
- Poor care coordination and quality outcomes
- Low overall membership growth
- High member attrition, especially among new members
Navigating to Next: The Solution
HealthScape analysis across current membership and statewide trends identified opportunities with current members (including up to 8,000 duals look-alike transitioning members) and a net-new opportunity of 11,000 dual-eligible beneficiaries each year. A competitive member-network analysis confirmed the health plan’s capacity to compete in key geographic areas it hadn’t prioritized previously. The analysis also clearly laid out the payer’s strengths and weaknesses compared to its peers’ strategies. Counties were identified where the plan could compete immediately, was at risk of membership attrition due to emerging network deficiencies, or could drive competitive membership acquisition through targeted network strategies.
The payer partnered with HealthScape to deploy a member growth and retention framework focused on cultivating relationships with members. Together, we developed a roadmap of interventions to build more proactive capabilities in member engagement, network, and care management. The roadmap concentrated on current and newly enrolled members and included phased action plans for proactive member messaging, stronger care coordination relationships, and a more complete network based on member preferences and utilization.
