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Blue Surface

PlanAllies™ Medicare Advantage Use Case Examples

A small subset of your Medicare Advantage call center staff can quickly verify the game-changing enhancements outlined below.


Without risk or commitment, your health plan can experience the impact of tech-supported conversational campaigns on engagement rates, plan literacy and member satisfaction.


This industry-leading performance has been proven with other top M.A. payers. Our scalable, tech-enabled workflows do not require any modifications to your health plan’s I.T. platforms.


Think of this as an incubator for engagement technology and workflows.


PlanAllies’ tech-enabled workflows are informed about all aspects of plan benefits, campaign goals and compliance requirements. Our interactive technology acts as a virtual assistant providing subject matter expertise to call center agents, greatly enhancing their effectiveness and the rapid dissemination of information.


Technology and Workflow Enhancement Use Cases:


Medicare Advantage Welcome Experience

  • Using PlanAllies, your call center will achieve:

    • > 65% meaningful conversation engagement rates

    • 70% increased plan literacy

    • 80% increased plan benefit utilization

    • Average ending NPS score > 9/10

    • A double-digit reduction in short-term disenrollment

  • Achieved with workflows that simplify training and scalability of your call center vs. today

  • With automated outputs

  • And a year one ROI of 2:1 or better

SDOH / HRA Data Collection

  • Using PlanAllies, your call center will demonstrate> 60% member engagement

    • Actionable data vs. Y/N Answers

    • Machine-readable output in a standardized format

  • Human readable SDOH / HRA findings include context and member perceptions

  • Requested supplemental benefits that support member’s needs (when applicable)

  • Average ending NPS scores > 9/10

  • With automated outputs

Performance Boost for Bottom 10% Call Center Agent Performers

  • PlanAllies measures 14 call center agent performance topics on a daily basis

  • Assign your bottom-performing call center agents to campaigns using PlanAllies

  • Within one month, these agents will be the top performers in your call center

Integrated D-SNP EAC Recruiting

  • EAC recruiting will be embedded in existing call center campaigns

  • At the end of each contact, the call center agent rates each member’s “conversational aptitude”

  • PlanAllies technology guides agents through a short subjective assessment of qualifying members’ applicability toward EAC participation

  • Interested, qualifying recruits are delivered with context that enables the formation of committed, long-term EACs

    • Outputs include the enhanced EAC candidates’ demographics, subjective overviews and sample EAC suggestions provided by interested recruits

Integrated D-SNP EAC Campaign Goal Monitoring and Reporting

  • Using PlanAllies, call center agents will conduct “Multitask Engagement”, enabling your health plan to comply with EAC requirements without dedicated EAC-specific follow-up campaigns

  • EAC goals will be quantified population-wide with evidence-based statistics, which PlanAllies will data mine from ongoing call center campaigns

  • These outputs are automated and suitable for CMS submission

High Churn Risk D-SNP Engagement (also applicable to members with low plan utilization)

  • Using PlanAllies, your call center agents will transform inactive D-SNP members into beneficiaries who engage with their health plan and participate with their health provider team.

  • A series of tech-enabled conversations will demonstrate scalable workflows that:

    • Establish a relationship built on trust

    • Support the member with Evelance supplemental benefits

    • Advocate for the member’s ability to live comfortably and independently

    • Reinforce health literacy

    • Emphasize how health benefit utilization (AWV, screenings) supports the member’s lifestyle and aspirations

    • Maintain a regular cadence of communication with high-need members

Diabetes Engagement

  • PlanAllies tech-enabled conversational engagement fosters relationships between call center agents and members

  • Continuity of communication dramatically increases compliance with the following:

    • Coordinating C09: Diabetes Care – Eye Exam

    • C10: Diabetes Care – Kidney Disease Monitoring

    • C11: Diabetes Care – Blood Sugar Controlled

    • D08: Medication Adherence for Diabetes Medications

    • D12: Statin Use in Persons with Diabetes (SUPD)

Or any other high-value engagement challenge your health plan would like to troubleshoot.


 

Introduction

PlanAllies’ synthesis of human-to-human conversation and technology increases the effectiveness and efficiency of member engagement.


Integrated conversational awareness facilitates clearer, more personal conversations that leave members feeling heard and known. We decrease call center overhead and increase revenue for our partners.


Our interactive workflows simplify call center training and scalability, delivering higher productivity at lower costs. And your plan’s engagement is experienced as a pleasant surprise by beneficiaries.


Applicable for all members, PlanAllies is uniquely effective with non-digital and underserved populations and optimized for all call centers.


PlanAllies Technology

A “Virtual Assistant” that is aware of all plan benefits, SDOH & HRA topics and compliance requirements. PlanAllies interacts in real-time with conversations.


Callers are flagged to benefits that match your beneficiaries’ lifestyle and aspirations. Red flags, such as churn, SDOH or HRA risks, are alerted as technology interactively guides your callers through the conversations.


Our goal is to optimize engagement during every call, leaving the Member knowing that your Health Plan knows and cares about them.


Timeline

  • Phase One:

    • Campaign goals, language(s) and data transfer protocols defined and demonstrated:

      • 28 days (14-day lead time after initial data transfer from your health plan)

  • Phase Two:

    • Campaign launch & training: 1 day

  • Phase Three:

    • Troubleshooting and Adjustments, based on campaign outputs: 14 days.

Budget

For less than what a call center pizza & beer night would cost, you can verify these improvements with

a small subset of your call center.






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