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Success Stories

Improve HEDIS Scores

Medicaid GAP Closures Gains $1Million Plan Bonus

Case In Point

A national provider of Medicaid health plans teamed with Carenet to increase member engagement, close gaps in care and improve HEDIS scores.

Situation & Opportunity

As Medicaid enrollment and expenses rapidly rise, healthcare organizations are actively seeking cost-effective, efficient and scalable solutions for enhancing member communication, care access, care coordination and service quality.

Due to their transient nature, language and cultural differences, low-literacy rates and logistical barriers such as lack of transportation, telephone and Internet access, Medicaid recipients are a hard-to-reach, underserved population. Social and environmental factors make consistent contact and routine interaction between providers and members difficult.

By expanding outreach efforts, elevating member education and reducing care barriers, the plan could increase compliance with numerous HEDIS measures and close gaps in care ultimately improving its clinical and financial outcomes. With the year quickly coming to an end, they turned to Carenet to swiftly implement a barrier-breaking solution that would generate the measurable results other programs failed to deliver.

Success Strategy

Experts on addressing the unique needs of the Medicaid population, Carenet quickly deployed a high-touch outreach strategy focused on member education and care coordination. Outreach was directed at 30,000 women and children located in two states. Actions taken by Carenet’s expert engagement specialists included:

  • Leveraging every member interaction by addressing up to 10 HEDIS measures per call
  • Educating members on the importance of preventative health measures such as routine screenings, perinatal care, immunizations and well-child exams
  • Uniting members and providers via conference call to schedule appointments
  • Coordinating appointments for multiple measures with the same provider
  • Utilizing the plan’s provider directory to present options for physician selection
  • Capturing a status for each measure addressed including the date and time of appointments scheduled by members
  • Conducting a member follow-up call to confirm appointment compliance

Performance Delivered

Despite obstacles, such as invalid phone numbers and limited physician appointment availability due to year-end timing, Carenet’s steadfast engagement team successfully contacted nearly 8,000 members and scheduled appointments for 40 percent of those reached. As a result,
10 percent of the targeted gaps in care were closed and the plan earned a $1 million state premium.

Become a Success Story

As Medicaid enrollment increases, state budgets tighten, and public demands for improved quality grow, it’s more critical than ever to join forces with a proven partner like Carenet. With more than 25 years of experience with government-sponsored programs like Medicaid and Medicare, Carenet has the know-how needed to cost-effectively optimize your performance and enhance your members’ well-being. You too can become a success story. Contact Carenet today to learn how.