Engaging Hard-To-Reach

Members to Drive Action

Around Quality and Risk
Chris Nicholson Rex Wallace
mPulse Mobile Rex Wallace Consulting
About mPulse Mobile
mPulse Mobile, the leader in Conversational
AI solutions for the healthcare industry, drives
improved health outcomes and business
efficiencies by engaging individuals with
tailored and meaningful dialogue.

10+
YEARS OF
100+
HEALTHCARE
>250M
CONVERSATIONS DELIVERED
EXPERIENCE CUSTOMERS ANNUALLY
About Rex Wallace

Founder and principal of Rex Wallace Consulting,

LLC, a firm that specializes in improving Star Ratings
for Medicare Advantage health plans.

Prior to launching RWC:

- Spent twenty-three years in strategic healthcare
roles, with a strong focus on Medicare Advantage
- Most recently, led Stars for a large, multi-state
plan that consistently achieved 4 and 4.5 Stars
across its multiple contracts
Engaging Hard To Reach Members
Who is a Hard-to-Reach Member?
• Higher SDOH Impact
• Language/Cultural Barriers
• Channel Preferences Not Met
• Bad Contact Information
• Disconnected from Care –
“I feel fine”
• Lower Health Literacy
• Low Trust in Plan
Poll Question:
Does your organization have a specific strategy around
identifying hard-to-reach member and improving engagement
with them?
A. No – We don’t segment members based on engagement
B. No – But we have outreach cadences that make repeated
efforts and switch channels if members don’t engage at first
C. Yes – We run specific campaigns for unengaged or hard-to-
reach members after primary outreach
D. Yes – We have specific campaigns and we gather data from
members on barriers to action or engagement to optimize
Where Do Members Go for Help
Taking Action?
Web, Friends and Family are Top Sources in Deciding Whether to Seek Care
Under $50k household income Over $50k household income

Search online 38%

49%
Specific website 38%
46%
Friend or family member (not a healthcare professional) 36%
43%
Doctor's office 32%
42%
Friend or family member who is a healthcare professional 26%
39%
Health or symtom checking app 19%
29%
Pharmacist 17%
26%
Nurse hotline 14%
26% Source: Right Place, Right Time.
Check with insurer 11% Altarum, Oliver Wyman, Robert
22% Wood Johnson Foundation,
January 2017
0% 10% 20% 30% 40% 50%

NOTE: 95% Margin of error = ±3%. Variables include Q27_* by xLowIncome.

Trust
From:

1 2 3 4
It develops from The partner is It involves putting It requires having
past experiences regarded as oneself at risk, confidence and
and prior reliable, through disclosure security in the
interactions dependable, and of information, caring responses of
concerned with reliance on the partner and the
providing expected another, or strength of the
rewards sacrificing the relationship
present in order to
see benefits later

Trust in close relationships.

By Rempel, John K., Holmes, John G., Zanna, Mark P.
Journal of Personality and Social Psychology, Vol 49(1), Jul 1985, 95-112
Measuring Trust

1 2 3 4
Past Reliable, Disclosure of Confidence and
Experiences Dependable, Information, Security in
and Prior and Concerned Reliance on Caring
Interactions Sentiment analysis Another Responses
Engagement rates of responses to Response and Success capturing
and number of open-ended intent analysis for and understanding
previous dialogues questions questions that natural language
reveal barriers,
SDOH impact or
challenges
Trust in close relationships.
By Rempel, John K., Holmes, John G., Zanna, Mark P.
Journal of Personality and Social Psychology, Vol 49(1), Jul 1985, 95-112
 Respect Improves Outcomes
Feeling Disrespected Linked to Medication Non-Adherence

80%
70% 75%
Percentage of Patients

60% 65%
50%
40%
30%
20% 26%

10% 13%
0%
Medication Non-Adherent Diabetes Not Well-Managed (HbA1c Over 7)
Feels Respected Does Not Feel Respected

NOTE: Medication non-adherence p < .001; HbA1c difference is not significant, but statistical power is limited Source: Right Place, Right Time.
by the small number of people in the disrespected diabetic group (n=53). Both comparisons control for Altarum, Oliver Wyman, Robert Wood
age, gender, and income. Variables include Q73 and Q77 by Q80. Johnson Foundation, January 2017
Design Programs to Build Trust

Meet members Tailor content Ask questions Follow

where they are to fit the hard- and listen through
Channels, to-reach Barrier Act on insights and
languages, population Identification, barriers, intervene
frequency population and after negative
SDOH impact,
segment-level experiences
health literacy
response analysis
Building Trust At Scale
“Hi, this is (Plan Name). Hope you're doing well and taking
care of your physical and mental health during this difficult
time. We're trying to understand how our members are
managing the challenges of social distancing (staying home,
keeping 6 feet apart outside home, avoiding crowds, wearing
a mask, etc.)​ Tell us how you're staying safe.​”
Building Trust At Scale
“Hi, this is (Plan Name). Hope you're doing well and taking
care of your physical and mental health during this difficult
time. We're trying to understand how our members are
managing the challenges of social distancing (staying home,
keeping 6 feet apart outside the home, avoiding crowds,
wearing a mask, etc.)​ Tell us how you're staying safe.​”
"I am so thankful for how much you are concern about me,
as your member. And glad to tell you as for now I am doing
well, staying home. Though once in a while Worried about
my eyesight. God bless you all in your effort to serve well all
your client. I appreciate and again thank you so
much for your concern"
 Outcomes
National Payer – EOY Gap Closure
• 77,000 previously unengaged members
across multiple MA plans
10pp
IMPROVEMENT in A1c Controlled (C15)
testing completion (19.5% v. 9.0%)

• Had received monthly touchpoints via

mail, email, IVR, and live calls
4pp
IMPROVEMENT in Nephropathy (C14)
completion (18.4% v. 14.%)
• Open HEDIS gaps at Dec 13, 2019

• Two-week multi-phased outreach with

barrier identification and assessment
• Compared with ~30K group that received
the standard December outreach
2pp
IMPROVEMENT in Colorectal Cancer
Screening (C02) completion (9.4% v. 7.2%)
Dec 13-31, 2019, mPulse group vs comparison (~30K members)
 Outcomes
National Payer – In-Home Risk Assessments
70
Additional Completed
• 8,568 previously unresponsive members
across multiple plans Assessments

• At least 12 previous attempts to schedule in-

home risk assessments via phone, postcard,
and email 12%
Self-Reporting
• Received interactive text messages to inform Barriers
them of the benefit and asking them to
schedule an assessment

• Automated follow-ups, with connections to 900+

Member-Identified
live staff to help schedule, and barrier
assessment if a member still didn’t schedule Barriers
 Outcomes

Kaiser Permanente – Med Adherence Rx REFILL RATES

50%
• 12,000 previously non-adherent members (p < 0.001)

40% 44%

• Previous live and IVR calls, email, one-way 30%

SMS 30%
20%

• Two-way SMS refill reminders and barrier

10%
assessment
0%
• Supported by live pharmacists able to Comparison Group
complete refills and answer questions vi JMIR Mhealth Uhealth 2018;6(1):e30

• Published data in JMIR Mhealth Uhealth

2018;6(1):e30
Analyzing Hard-To-Reach
Member Responses
Sentiment Analysis

Very Negative Negative Neutral Positive Very Positive

Intent 10% Geographic

Analysis Analysis
36%
21%

4%
22% 7%

Information Clarification Negative Confirmation

Negative Sharing Neutral Sharing
Positive Confirmation Positive Sharing
What’s Next?
Member Experience in 2020-23 Stars
Measure Weight Change Overall Weight Change*

4.5 66%
4 62%
4 59%
2020 54%
3.5 Stars
46%
3
41%
2021 38%
2.5 Stars 34%
2 2
2
1.5 2022
1.5 Stars
1
2023
0.5
Stars
0
Member Experience Measures 2020 Stars 2021 Stars 2022 Stars 2023 Stars
Member Experience Measures All Other Measures

*For Non-SNP MAPD

Stars Member Experience Measures
Part C Measures Part D Measures
Call Center-Foreign Language Interpreter
Getting Needed Care
and TTY Availability
Getting Appointments and Care Quickly Appeals Auto-Forward*
Customer Service Appeals Upheld*
*Retiring
Rating of Health Care Quality Rating of Drug Plan for MY2020
Rating of Health Plan Getting Needed Prescription Drugs (2022 Stars)

Care Coordination
CAHPS
Complaints about the Health/Drug Plan
Every measure here impacts the
Members Choosing to Leave the Plan Improvement Measures
(5x Weighted)
Plan Makes Timely Decision about Appeals
Reviewing Appeals Decisions
CMS considering Net Promoter Score
Call Center-Foreign Language Interpreter and TTY (NPS) as future Stars measure
Availability
 Key Expected Changes to Stars (As of 5.22.2020)
2021 Star Ratings (MY2019) 2022 Star Ratings (MY2020) 2023 Star Ratings (MY2021)
• Transitions of Care (Pending)
New
• None • None • Follow-Up after ED Visit for Patients with Multiple
Measures:
Chronic Conditions (Pending)
Returning: • None • Controlling Blood Pressure (1x) • Plan All-Cause Readmissions (1x)
• Adult BMI Assessment
Retiring: • None • Appeals Auto-Forward • Rheumatoid Arthritis Management
• Appeals Upheld
• Plan All-Cause Readmissions (Yr.
Temporarily • Controlling Blood Pressure (Yr. 2/2 Display) 2/2 Display) • Care for Older Adults – Functional Status
Removed: • Plan All-Cause Readmissions (Yr. 1/2 Display) • COA – Functional Status Assessment (Yr. 2/2 Display)
Assessment (Yr. 1/2 Display)
• SUPD permanently decreasing to 1x
• Statin Use in Persons with Diabetes (SUPD) = 3x • SUPD = 3x
Weight • MX measures increasing from 2x to 4x
• Member Experience (MX) measures increasing • Controlling Blood Pressure = 1x
Changes: • Controlling Blood Pressure = 3x (2nd Yr. Back)
from 1.5x to 2x (1st Yr. Back)
• Plan All-Cause Readmissions = 1x (1st Yr. Back)

• 5% guardrails
Cut-Points: • HEDIS & CAHPS = re-applying 2020 Stars • Mean resampling
• (Outlier deletion delayed until MY2022)

• HEDIS & CAHPS = 2020 Stars rates & ratings

• Improvement measures’ “hold
• Improvement measures to use 2020 Stars
harmless” expanded to all plans
improvement scores for HEDIS & CAHPS
COVID-19 regardless of rating
• “Too new” contracts remain “too new”
Impact: • 2020 HOS delayed
• CMS can re-apply measure-level 2020 Stars if data
• HEDIS & CAHPS submissions still
integrity issues exist
expected
• CMS can re-apply overall 2020 Stars if needed

MY = Measurement Year
What Does It Mean for Member
Engagement?
Now: Driving Specific Key Actions

Med
Chronic
Risk HEDIS Adherence
Condition
Assessment Screening Refills, 90-Day
Self-
Completion Completion Supply, Mail
Management
Order, etc.
What Does It Mean for
Member Engagement?
Soon: Eliminating Blind Spots and Intervening for Experience
Wider
and ongoing
Transitional
Post-visit off-cycle
Care Measure
outreach surveying of
outreach
CAHPS
questions
Plus the
Negative
HEDIS, Med
sentiment and
NPS-focused Adherence,
experience
touchpoints and CCM
interventions/
programs
follow-up
from Now...
• Engage Hard-to-Reach Members
• Measure Trust When Possible
• Trust Drives Improved Outcomes
• Identifying Blind Spots in Member Experience is Critical
• The New Challenge for Hard-to-Reach Members: Experience
Questions?
 THANK YOU!
Chris@mpulsemobile.com Rex.Wallace@rexwallaceconsulting.com