Q&A: Insights into End-of-Year Gap Closure

September 15, 2023


With the fourth quarter right around the corner, Medicare Advantage plans have one last chance this year to accelerate Star Ratings performance and secure quality incentives. To help health plans strengthen their end-of-year initiatives, Healthmine Chief of Staff, Kimberly Swanson, shared her insights into the best practices for member outreach during the final stretch of the year.

How Important are End-of-Year Campaigns?

All health plans know that a Q4 push isn’t ideal or best practice, but does every plan do it? Yes, to some degree. I ran a 5-Star plan and the end-of-year push was always part of our strategy, although, we relied on it less and less over time. Ideally, the push starts in Q3 and ends early December to have the strongest impact on quality measures before the Star Ratings are finalized.

Historically, these campaigns serve to close clinical, calendar year gaps in care. But as quality programs have evolved, it’s also turned into a great opportunity to pulse your members to gauge how satisfied they are with the plan services and offerings and if there is any risk of members leaving your plan. Forward-thinking plans balance the outreach as one part check-in and one part call to action while keeping it highly personalized to make the member feel at ease.

What are Health Plan’s Biggest Challenges?

There are many competing priorities at the plan-level near the end of the year: sales, reenrollment, gap closure and finalizing next year’s budgets and strategies. In most cases, the member is trapped in the middle of these priorities and receives many, uncoordinated outreaches by the plans, their providers, and brokers, as well as other health plans trying to get them to switch. It’s a confusing time, and often the member doesn’t know who is asking them to do what.

What Should Plans Prioritize in Their EOY Pushes?

Plans need to orchestrate all of this outreach very closely to avoid confusion and use multiple channels so the member isn’t getting phone call after phone call. Whether outreach is conducted by the plan or outsourced to a vendor, it needs to be on brand, personalized and address all the member needs to prevent abrasion.

If done well, end-of-year pushes to close care gaps are also a chance keep members satisfied so they want to re-enroll in the plan for the following year. Plans can achieve this through warm outreach that ties in “thank you for being a member” messaging and focuses on how the plan can help, instead of what the member needs to do for the plan.

How do EOY Pushes Impact Member Retention?

It’s imperative that outreach is member-centric, well-coordinated and doesn’t upset the member. End-of-year pushes overlap with the Annual Enrollment Period and, with the Open Enrollment Period looming, it’s important to deliver a 5-Star service to retain members.

This is the last chance to show members how plans care for them, how plans listen to their feedback by enhancing benefits and how plans make it easier to use benefits through technology and apps. Plans are already preparing for the next CAHPS® survey and can use the feedback collected from current members to fix anything causing member dissatisfaction.

What Can Plans do to Prepare for Next Year?

Q3 and Q4 can prepare plans for their beginning of the year initiatives. Plans should continue to provide coordinated, member-centric outreach that includes “Welcome” and “Welcome back” campaigns, health risk assessment (HRA) outreach and health action completion.

Surveys and HRAs conducted at the beginning of the year can help plans better understand their members, what channels they prefer and what languages they prefer. Plans can also identify patterns in behavior, such as how likely members are to schedule an Annual Wellness Visit in the first few months of the year. This can inform how plans communicate with members throughout the year.

Lastly, plans should help members learn how to best use their benefits. Plans should create simple guides with members that outline how to sign up for online health portals, find in-network primary care providers, schedule Annual Wellness Visits and update contact information with their plan. These guides can also incorporate clinical needs, such as explaining the top five to ten things members should do to improve their health or how to manage known chronic conditions.

Healthmine’s member engagement solutions and Professional Services team enable health plans to rapidly implement member-centric outreach in limited time periods. With the guidance of our Professional Services team, health plans can identify high-priority care gaps and determine the appropriate tools for engaging members in end-of-year care. We can rapidly implement call campaigns to close the most important care gaps before the year ends and launch pulse surveys to gage member sentiments going the Open Enrollment Period to guide 2024 CAHPS improvements. If you need assistance initiating an effective and member-centric end-of-year campaign, reach out to Healthmine for a demo.

Healthmine is the leading member engagement and rewards solution focused on empowering people to take the right actions to improve their health.

More Resources from Healthmine

More Like This