4 Strategies for Closing Care Gaps in Q4

As we head to the end of the year, many Medicare Advantage (MA) plans are busy reviewing and analyzing plan performance data so they can properly reconcile the data and identify opportunities for improvement in Q4. However, while the final results may be top of mind, your main priority should be maximizing compliance rates before December 31.

Addressing pivotal quality measures is key to securing a 4+ Star Rating and collecting valuable bonus payments. It’s not too late to engage members to complete health actions and close care gaps during Q3 and Q4.

Use the remaining months in the year to initiate a data-driven member engagement strategy that has a powerful impact on plan performance. Here are four steps to initiating a targeted outreach campaign that closes time-sensitive care gaps.

1. Identify Non-Compliant Members with Outstanding Care Gaps

Your Q3 and Q4 push to improve Star Ratings will need to focus on identifying the right members and quality measures that will have the most influence on your scores. Non-compliant members with outstanding care gaps can have a negative impact on your Star Ratings if not properly addressed, but directly connecting them with the care they need can boost performance across multiple measures.

What measures you choose to target will play an important role in your campaign. While you should continue efforts to increase compliance for long-term measures like medication adherence, this campaign must focus on the quality measures you can immediately impact in a short period of time. Narrowing down your list of targeted measures to screenings that do not require multiple appointments will allow you to control the scope and spend of your campaign while improving performance.

Do not worry about cracking open data silos and building out comprehensive member records on the fly. Healthmine can stand up an outreach campaign with certain basic information. The most impactful member engagement campaigns can be initiated with targeted outreach lists that include non-compliant members’:

  • ID number
  • First and last name
  • Language
  • Phone number
  • State
  • Care gap

2. Develop a Targeted Outreach Campaign

Once you have compiled your list of non-compliant members, you will need to develop a high-touch outreach campaign that directly addresses barriers to care and connects members to providers.

Outbound call campaigns provide personalized experiences that will motivate hard-to-reach members to engage with their health. By leveraging live agents who can three-way call members and provider, you can directly reach out to specific segments of your population to ensure appointments and screenings are scheduled. Your campaign should focus on maximizing these appointments while also delivering a positive member experience.

While working with a regional MA plan, Healthmine targeted time-sensitive care gaps for members with outstanding care gaps. An estimated one-third of all targeted members ended the campaign with an appointment, successfully closing time-sensitive care gaps that impacted the 2024 Star Ratings.

3. Provide Tailored Member Support

Your call campaign should be supported with the appropriate resources and strategies to ensure members are experiencing meaningful interactions with their plans.

Studies show that people are more likely to accept calls from local area codes, and having the option to choose between an automated support system or speak to a live agent in a preferred language can improve member satisfaction. Depending on the size of your target list, you will also want to scale up staff to provide the appropriate volume of calls and work closely with providers to ensure appointments are scheduled seamlessly—which can be handled by the right member engagement vendor. Healthmine has the immediate resources and staffing capabilities in place to jump-start your outbound call campaign in four weeks.

A comprehensive and successful call campaign includes:

  • Live agents who can help members schedule appointments and screenings
  • Direct transfers to provider offices to confirm appointments
  • Formalizing a health education script to explain the benefits of getting an appointment
  • Customize dialing hours to maximize response rates
  • Utilizing local areas codes
  • The ability to leave voice mails and take inbound calls
  • Controlling the number of outreach attempts per members

Any additional resources, such as member rewards programs, comprehensive member records and travel benefits, can also support your efforts to increase appointment rates and ensure members have the appropriate access to care. Providing positive experiences during these calls can circle around and benefit your Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores down the line, further improving Star Ratings.

4. Find the Right Member Engagement Partner

Given the limited amount of time left in the year to boost plan performance, scaling up a call campaign on your own can cost you precious time, resources and operational efficiency. Working with the right member engagement partner who has experience leading call campaigns can empower you to initiate outreach in a short period of time and have the strongest impact on plan performance.

Our team can implement an outbound call campaign in four weeks, enabling you to influence member engagement and close important care gaps by December 31. We tailor each campaign to our clients and their members’ unique needs to ensure maximum engagement and improved compliance rates. When combined with Healthmine’s rewards and incentives programs, members are encouraged to take a proactive role in completing health actions, now and into the future, further maximizing engagement.

Partner with Healthmine to start closing care gaps and improving Star Ratings with a targeted outbound call campaign. Fill out the form to learn more about our outbound call campaign solution.