AI Paired with Behavioral Science

Challenge

The company is experiencing a high churn rate across their MA plans, most notably highest in DSNP members. The new team is comprised of 3 individuals with the expectation they utilize existing Medicare Advantage business functional groups for data and reporting, marketing, retention, sales, etc. These 3 individuals own product design and strategy, yet they need to advocate DSNP best practices across a multitude of areas to improve DSNP retention and associated CAHPS scores. The greater MA business apparatus has yet to understand and account for the differences in MA and DSNP populations from an operations perspective.

Solution

ProspHire mobilized a team of DSNP and MA operation and product experts to assess, identify, and prioritize areas of immediate interventions utilizing behavior science to prevent voluntary disenrollment. Simultaneously, ProspHire team members consulted client IT and Artificial Intelligence (AI) vendor teams in the identification and preparation of key data elements for AI analysis. Long-term, AI patterns were fine-tuned and explained by the ProspHire team to allow for client DSNP product owners to quickly identify and intervene on retention and CAHPs trends at the member level.

Result

The initial assessment conducted by the ProspHire team resulted in three interventions expected to contribute a conservative estimate of 24% reduction in voluntary disenrollment, equating to a 6x ROI based upon 2021 YE revenue. 5 KPIs were incorporated into the AI model from which AI patterns were calibrated for both retention and CAHPS. A final playbook was delivered to the client of prioritized behavioral science interventions based on initial model output. ​

Outcomes

  • Fast and sustained ROI with higher retention, increased revenue and improved experience
  • Immediate results in limited resource settings
  • AI delivers insights with zero lag
  • AI platform is indefinitely scalable to new business needs

Client Overview

The client is one of the largest Medicare Advantage (MA) product portfolio owners in the country operating across 25 states. A new department within MA product was recently established to focus directly on DSNP product management with P&L responsibilities.

Let’s have a conversation

Mike Yetter

Managing Director
[email protected]
Name

Stars Performance Improvement

ProspHire is adept at driving continuous improvement to optimize Stars performance. Through data driven analyses and clearly defined strategies, our team of seasoned subject matter experts implement interventions to increase Stars ratings and maximize rebate potential.
Learn More About Stars Performance Improvement