Health plans today face a dual challenge—connecting with hard-to-reach members who are disengaged or overwhelmed, while also navigating fragmented operations between risk and quality teams. Unfortunately, these two issues often fuel one another.
When risk and quality teams operate in silos, members experience multiple, overlapping messages from various vendors or departments. One outreach campaign reminds them to schedule a primary care visit. Another urges them to book an in-home assessment or complete a preventive screening. Others follow with vaccine reminders, health surveys, or benefit education. These communications often arrive via different channels, with inconsistent messaging, from multiple sources.
The result? Communication fatigue. Confusion. Frustration. And worst of all, disengagement.
But there is a better way through strategic alignment and unified outreach—streamlining the member journey, reducing duplication, closing care gaps and ensuring more accurate risk coding. By partnering with Healthmine, plans can engage their hardest-to-reach members more effectively, reduce care costs and improve both health outcomes and member experience. That’s how our plan partners are achieving:
- 46% increase in provider visits and clinical gap closure.
- $336 pmpy in medical cost savings.
- $248 pmpy incremental risk adjustment revenue.
- 10% improvement in member retention.
- $128 pmpy in acquisition cost savings.
The cost of fragmentation
Across many health plans, risk and quality teams still operate with independent priorities, budgets and vendors. While both functions ultimately aim to improve care and financial sustainability, they engage members separately using different language, even for similar actions. Provider visit, PCP appointment, Annual Wellness Visit, Annual Preventive Visit — they’re all different names for the same need, getting the member to their doctor.
Without coordination, these efforts can inadvertently bombard the member with redundant, confusing or conflicting requests.
Aligning risk and quality: A shared challenge with a shared solution
Solving this problem requires more than better messaging—it demands a fundamental shift in how health plans coordinate their internal teams and outreach strategies.
We believe that risk and quality programs are stronger together. That’s why we work with health plans create integrated, omnichannel engagement experiences that consider both care needs and member preferences in a unified communication journey.
Instead of separate, disjointed campaigns, our approach allows both teams to operate from the same platform. The result is more effectively guiding each member through a personalized, prioritized sequence of actions—based on their open care gaps, risk factors and communication preferences.
How we do it
Our suite of tools enables plans to coordinate across risk and quality through a combination of digital-first engagement, strategic scheduling, and real-time insights.
1. Omnichannel outreach, personalized for each member
Smart segmentation and behavioral science drives engagement across preferred channels, whether email, text, direct mail, live calls or app-based notifications. Outreach adjusts based on prior activity—once a member completes a health action, we'll move them to the next needed action, like follow-up care.
2. PCP health action + dynamic checklist + IHA health action
At the heart of the Healthmine model is a streamlined pathway that leads with the right care at the right time:
- PCP visit health action: The starting point for members, driving holistic care and capturing both quality and risk data.
- Dynamic checklist: A digital, personalized pre-visit tool populated with Health Risk Assessment (HRA) data that informs the member and the provider about relevant quality gaps and chronic conditions to discuss.
- IHA follow-up: Reserved only for members who have not completed a provider visit, ensuring that in-home assessments are strategic—not default—and conducted with clinical integrity.
3. Provider matching and easy scheduling
We’re removing barriers by helping members identify and schedule appointments with preferred providers. Filters include provider language, gender, hours and availability. A voice-based AI agent initiates calls to the provider on behalf of the member, waits on hold and speaks directly with front desk staff while maintaining HIPPA compliance and enterprise-level security. See how it works with our self-navigated mini demo.
4. Engagement incentives and follow-through
Rewards, surveys and post-visit communications keep members engaged and encourage continuity of care. Incentives are trackable and customizable, with budgets segmented by department if needed, and most rewards fulfilled within 48 hours.
5. Integrated data and budget optimization
Healthmine provides a single-source dashboard for tracking engagement, appointment completions, campaign effectiveness and reward expenditures. Rewards programs can be administered together but allocated to multiple team budgets. This allows both risk and quality teams to operate from a shared playbook—streamlining costs, maximizing ROI and identifying new opportunities for member engagement—while managing independent budgets.
A digital-first path to better outcomes
In an era of rising regulatory scrutiny and performance pressure, health plans can no longer afford to operate in silos. Uncoordinated outreach leads to unnecessary abrasion, missed opportunities for care, and declining trust among members.
We’re helping break down those silos by giving plans the tools for collaboration between risk and quality teams and delivering a seamless, guided experience for every member. From initial outreach to provider scheduling, appointment support, and follow-up, Healthmine closes the loop with precision and compassion.
When members are guided—not overwhelmed—they take action. When plans coordinate—not duplicate—they save money. And when health plans partner with Healthmine, they achieve both.
Engaging hard-to-reach members is not impossible—but it does require a different approach. It means meeting people where they are—with the right message, at the right time, in the right format. It means working smarter internally—by breaking down silos, aligning budgets, and consolidating vendors. And it means building trust—with members who are increasingly skeptical, fatigued or left behind by fragmented healthcare systems.
We’re empowering plans to take this next step—transforming noisy outreach into clear, actionable journeys that close care gaps, capture accurate risk, and build healthier communities.
Ready to learn more about how we help risk and quality teams work better together? Let’s get started with a demo.
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