National MA Plan Increases Net Revenue by $2 Billion by Maximizing Dual Eligibility Enrollment

First, the team leveraged its industry-leading AI predictive model to identify prime targets for dual eligibility. This model predicts with up to 93% accuracy those individuals with the highest likelihood to qualify for full or partial dual coverage.1

Customer

A national non-profit Medicare Advantage plan providing coverage for more than 6.8 million members

Challenge

Identifying and enrolling members eligible for full or partial dual coverage in Medicare Advantage and Medicaid

Products

Dual Enrollment Advocate™
Recert Complete®

Results

  • Realized >$2 billion in net revenue over 20 years
  • Identified and approved 270,000+ new dual-eligibles
  • Recertified 2 million dual-eligible members
  • Passed $3.7 billion in Part B savings to qualified members
  • Increased plan tenure among assisted members by more than 50%

The Customer: 

A national nonprofit Medicare Advantage plan with more than 6.8 million members partnered with Change Healthcare to better identify and enroll dual-eligible members for full or partial coverage with Medicare Advantage and Medicaid.

The Challenge: Identifying and Enrolling Dual-Eligible Members With Limited Resources

The health plan recognized that it did not have the workflow, capacity, or government relations expertise to manage and complete this member engagement outreach project in-house. The plan’s leadership sought a vendor capable of supporting the full identification, enrollment, and recertification process for all its dualeligible members.

The Solution: Using Predictive Analytics and Behavioral Health Insights to Support Member Enrollment

To meet the health plan’s needs, Change Healthcare deployed an end-to-end dual-eligible identification and enrollment process driven by predictive analytics and business intelligence. The team implemented two solutions—Dual Enrollment Advocate™ and Recert Complete® —to help the plan accomplish its goals.

First, the team leveraged its industry-leading AI predictive model to identify prime targets for dual eligibility. This model predicts with up to 93% accuracy those individuals with the highest likelihood to qualify for full or partial dual coverage.1

Once members were identified, the team launched a comprehensive, multi-channel outreach initiative to connect with those members. The outreach relied upon insights gleaned from more than 370 hours of behavioral health research on how to engage and activate members. Empathetic member advocates helped members complete the eligibility, education, and enrollment process.

In addition to screening members for eligibility and helping them complete their applications, Change Healthcare’s workflow also included proactive case management, quality assurance, and application submission. Along with monitoring members’ Medicaid approvals, the team also conducted ongoing monitoring and supported the annual renewal process.

Change Healthcare has more than 20 years of government relations expertise and deep industry knowledge. As a result, the team was able request and file all necessary extensions and appeals without issue, advocating on members’ behalf to ensure successful enrollment.

The Results: Enrolling 42,000 New Dual-Eligible Members and Addressing SDoH Barriers Yields Better Outcomes

The result yielded a significant increase in the health plan’s revenue, as well as multiple benefits for its dual-eligible members. The solution also helped the health plan gain back valuable agent productivity while reducing redundant member outreach.

The program has yielded an impressive return on investment (ROI) since its inception more than 20 years ago:

  • Realized >$2 billion in net revenue
  • Identified and approved 270,000+ new dual-eligible members
  • Recertified 2 million dual-eligible members
  • Passed along $3.7 billion in Part B savings to qualified members
  • Increased plan tenure among assisted members by more than 50%

After the program’s initial success, the health plan chose to implement two additional Change Healthcare solutions: Part D Complete™ and Community Advocate™. These solutions facilitate member enrollment in Medicare Part D and help to offset many negative social determinants of health (SDoH) by enrolling eligible members in programs to improve their quality of life.

The team helped an additional 150,000 health plan members find and enroll in programs that provide economic assistance, yielding an estimated $795 million in additional member value from benefits such as prescription drug discounts and utilities assistance.

1. Change Healthcare internal data. Results may vary by payer plan and member demographics.

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