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CONSUMER ENGAGEMENT

5 steps for proactive member engagement following Medicaid redeterminations

Since the termination of the continuous enrollment provision for Medicaid beneficiaries following the end of the COVID-19 Public Health Emergency (PHE), more than 21 million members have been disenrolled from their coverage. Missed renewal notices due to inaccurate contact information, confusing paperwork, and language barriers are some of the key contributors to high rates of disenrollment—and members often only discover that their coverage has been rescinded after seeking care. Overall, according to KFF, seven out of 10 members have been terminated for procedural reasons rather than actually being determined ineligible to renew their coverage.

Disenrollments have already significantly passed the Department of Health and Human Services’ (HHS) original estimate of 15 million enrollees following the end of the PHE—and they aren’t over yet. While 51% of members had coverage renewed, according to KFF, 26% of renewals still have not yet been processed, revealing an urgent need for an effective member communications strategy among health plans.

Here are five steps you can take to help ensure your population remains informed both during and beyond the ongoing renewal process.

National health plan deploys Eliza for secure digital engagement with members

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Maintain consistent, personalized member communication  

Use multiple channels of communication to offer coverage reminders through text, email, interactive voice response (IVR) calls, and live agents. Enrollments need action every year for plans to continue to retain members. Helping families understand their options with personalized, culturally appropriate messaging can motivate members to act.  

Perform regular address and contact updates

Continuous outreach can help build trust and remind members to update their information when prompted. Regular outreach can prevent future members from facing disenrollment due to procedural complications. While the PHE created a backlog of redeterminations for states to work through, eligibility will once again need to be evaluated every year moving forward

Conduct SDoH surveys and needs assessments

Social determinants of health (SDoH) screenings can enhance member health profiles and direct members to appropriate clinical programs and community-based services, ultimately improving health outcomes. Utilizing the redetermination process to gain valuable member data can allow plans to support the social and physical health of members. One large regional health plan deployed Cotiviti’s Eliza secure digital solution to reach more than 90% of its targeted members, enabling the plan to gather valuable SDoH data and connect members to care.

Prioritize clinical care

Preventive care reminders and education on benefit availability is an important piece of member education all year. Engaging both new and existing members to prioritize preventive check-ups, vaccines, and screenings can reduce reliance on emergency care services and help them better manage chronic conditions.

Connect to dual-eligible members and understand needs as a growing population

Because rule and eligibility requirements vary by state, navigating care for dual-eligible populations can be difficult. Dual-eligible members may also have access to benefits like meal plans and in-home support of which they are not aware due to inadequate network access to obtain these services. Understanding the socio-economic characteristics of this rapidly expanding population is essential to forming effective systems of communication and preventing further disenrollment.

Navigating member eligibility requires proactive and secure communication channels to help members understand how to maintain their coverage. Linking members to the proper resources is vital to securing critical data and serves as a welcome opportunity for member education. By determining factors like preferred language, method of delivery, and SDoH, plans can extend personalized support to reach members during yearly eligibility recertifications.

Health plans of all sizes worked with Cotiviti to conduct redetermination campaigns leveraging Eliza, Cotiviti’s multi-channel consumer engagement platform. Read our case studies and learn how three large payers, both regional and national, worked with Cotiviti to deliver more than 16.7 million outreach messages across all 50 states in 2023, as well as 9.4 million text messages and more than 500,000 IVR calls to 1.5 million members already through May 2024.

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WRITTEN BY

Leah Dewey
Leah Dewey is an experienced leader in population health, clinical strategy, product development, and value-based outcomes. As vice president of clinical and consumer engagement operations, she drives product value for Cotiviti’s Consumer Engagement and Population Health solutions. Leah is focused on improving healthcare outcomes by leveraging data and insights to drive closure in care gaps, improve consumer quality, and move population health across various cohorts and cultures.

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