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A Regional Health Plan Used Advanced Analytics to Reduce Disenrollment by 22% and Increase Star Ratings


Challenge 

A regional health plan serving both Medicare Advantage and Dual Eligible populations began to see a decline in their membership.

They sought to reduce voluntary disenrollment, while increasing its Star Ratings. Its membership consisted of 2,500 Medicare Advantage enrollees and 6,700 Dual Eligibles.

Solution

The health plan partnered with Welltok’s analytics team to accomplish the following:

  • pinpoint individuals most likely to disenroll 

  • identify likely causes of disenrollment 

  • target outreach to retain individuals

Welltok leveraged its proprietary consumer database to supplement the client’s data and create a longitudinal view of each Medicare recipient.

Welltok stratified the population based on likelihood to disenroll and likely cause of disenrollment. The team also identified key predictors, including financial factors, clinical conditions, retention activity e orts, and percentage of claims for out-of-network providers.

Upon analysis, Welltok provided a prioritized list of individuals for retention outreach to the client.

Results 

Welltok’s advanced analytics capabilities effectively identified individuals who were at-risk of disenrolling, which led to successful proactive retention efforts. The top 10% of the population identified were over 2X more likely to disenroll than average.

The outreach efforts decreased the monthly average AEP disenrollment rate by 0.6% - 1.2% year over year, resulting in:

Highlights:

  • 22% reduction in disenrollment rates

  • $25M to $97M in premium retention

  • Improved Star Ratings for disenrollment measure from: 2.5 to 4 Stars 

  • Increased overall Star Ratings from: 2.5 to 3 Stars 

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