3 Things to do Ahead of Q4

Too many health plans over-rely on fourth quarter interventions, which often creates more challenges than results. Q4 efforts to close last minute care gaps and capture Hierarchical Condition Category (HCC) codes are:

• Expensive  
• Rushed  
• Inefficient  
• Reactive, not built upon best practices or a data-driven strategy

Essentially, Q4 initiatives borrow a “hope for the best” approach, when a more proactive strategy is within reach.

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Q4 prep should begin in Q2

All health plans aim to close as many care gaps and resolve as many member sentiment issues as they can in the fourth quarter, but optimal success depends on starting in Q2, building momentum in Q3 and then deploying ultra-targeted efforts to specific members in Q4.

With earlier preparation, health plans will see:

• More care gaps closed, earlier in the year  
• More accurate risk coding and maximized revenue  
• Higher member retention and satisfaction

Where to start

More than likely, your plan has the right information already to achieve higher end-of-year gap closure. Here’s how to get started:

1. Identify open care gaps. This can — and should — start now. Segment your members based on those who typically close care gaps, those who never do and those who need extra nudging. Focus engagement on members with health risks that require re-coding for 2025. These segmentations will inform which members receive which outreach method and help gauge how many members will require higher-touch engagement, like live agent calls.  
2. Capture demographics. Motivating members to close care gaps is significantly more challenging when you don’t know how to communicate with them. Identify preferred languages and social risk factors that inhibit access to care. Tailor outreach accordingly, so members not only understand their care gaps, but also their options for overcoming barriers like transportation, scheduling difficulties or even finding a new provider.  
3. Start engaging. By starting early in the year, you can use low-cost, lower-effort forms of digital engagement as your first line of defense. This filters out proactive and highly engaged members and helps chip away at your segmented audiences based on what you know about what they are likely to do — and not do. Some members will always require a personal phone call. Engage those members now to capture accurate HCCs sooner and drive follow-up care. For members who have some history of gap closure, use early digital outreach to determine which members will require follow-up engagement before initiating phone calls in Q3.

The most important piece of the puzzle is to make sure you have a plan ahead of the third and fourth quarters when it’s too late to course-correct and forge a strategic approach to end-of-year gap closure.

At Healthmine, we can implement live agent outbound calls in as little as four weeks. Our calls are delivered using local area codes and timed appropriately to members’ time zones. Our teams can assist with:

• Appointment scheduling: We’ll connect members to a provider in real time and help them schedule an appointment on the spot.  
• Benefit support: We’ll identify members with barriers to care and help them understand which supplemental benefits are available to help them overcome obstacles.  
• Problem resolution: Timely follow-up after member complaint is often more important than the resolution itself. We proactively engage low-sentiment members to improve CAHPS scores and support member re-enrollment.

We will help you build a stronger outreach strategy and start engaging the members who need it most. Our live agents have a 4.7 out of 5 satisfaction score among members they interact with, and we have a 4.9x higher conversion rate than industry averages — meaning we’re getting more members to complete actions during phone calls.

Don’t let Q4 define your year

Fourth quarter interventions will always have a place — but they shouldn’t be your only strategy. By starting earlier, segmenting smarter and engaging members with the right, tailored level of support, your plan can drive stronger results all year long. Whether you need help optimizing your outreach strategy or activating high-touch love agent calls, Healthmine is here to help. Let’s close more gaps, earlier.