Proactive Outreach: Ensuring Low-Income Subsidy (LIS) Access & Driving Better Member Health
Maintaining continuous prescription drug coverage is a critical concern for millions, especially those with limited incomes. Losing access to vital medications can have serious health consequences. Fortunately, Medicare Advantage (MA) plans are increasingly recognizing the power of proactive, personalized outreach to help members navigate complex programs like the low-Income subsidy (LIS). This article explores how strategic engagement not only improves member health outcomes but also contributes to better plan performance.
The Challenge: LIS Reapplication & potential Coverage Gaps
The LIS program, also known as ”Extra Help,” significantly reduces prescription drug costs for eligible Medicare beneficiaries. However, eligibility must be renewed annually. This reapplication process can be daunting, leading to potential lapses in coverage if members don’t complete the necessary steps. These gaps in coverage can negatively impact health, increase costs down the line, and ultimately affect a planS quality ratings.
A Leading Payer’s Success Story: Personalized Support in Action
One forward-thinking health plan is tackling this challenge head-on. They’ve partnered with Cotiviti, leveraging the power of Eliza to deliver a multi-channel outreach campaign specifically designed to support members through the LIS reapplication process.
This isn’t a one-size-fits-all approach. Instead, the plan utilizes a carefully timed sequence of communications:
90 Days Before Deadline: Initial awareness and encouragement to begin the process. 60 Days Before Deadline: More detailed facts and resources.
30 Days Before Deadline: A gentle reminder and offer of assistance.
15 days Before Deadline: Urgent reminder and direct support options.The outreach utilizes a blend of channels to reach members where they are:
Interactive Voice Response (IVR): Automated phone calls providing information and options.
text Messaging: Convenient reminders and links to resources.
Direct Mail: Detailed information for those who prefer physical materials.
Live Agents: Personalized assistance for complex cases.Crucially,the program offers a “warm transfer” directly to the Social Security Administration.This seamless connection allows members to complete their applications with immediate support, minimizing confusion and maximizing completion rates.
Notable Results: Impacting Lives & Improving Performance
The results of this targeted outreach in 2023 were remarkable:
Reachability: 81% of 27,000 targeted members were reached via IVR,and an impressive 93% through text messaging.
Application Completion: Live agents connected with 25% of members, and successfully guided 56% of those individuals to complete their applications.
Increased Access to Benefits: This proactive approach led to a significant increase in the number of members receiving no-cost prescription drug benefits.
This success directly addresses health disparities within low-income populations, ensuring access to essential medications. Furthermore, it demonstrates a commitment to member well-being that positively impacts plan performance.
Looking Ahead: The Growing Importance of Proactive Engagement
The introduction of the Health Equity Index (HEI) further underscores the importance of programs like this. Addressing the needs of vulnerable populations and ensuring access to critical benefits isn’t just the right thing to do – it’s essential for achieving higher Star Ratings.
here’s how MA plans can build on this success:
Data-Driven personalization: Leverage member data to tailor outreach messages and support options. Multi-Channel Integration: Offer a seamless experience across all dialog channels.
Proactive Support: Don’t wait for members to reach out – anticipate their needs and offer assistance.
* Focus on Simplification: Make the reapplication process as easy and straightforward as possible.
By prioritizing proactive engagement and personalized support, MA plans can improve member health outcomes, drive better performance metrics, and position themselves for long-term success in a rapidly evolving healthcare landscape.
Want to learn more about maximizing member engagement?
Health plans are in the final push to close member care gaps for 2024. Now is the time to revisit your member engagement strategies to help ensure retention during the open enrollment
