Preventive Care Doctor Match

Client Mobile Web

Preventive Care Doctor Match

Concept

Members identified with a care gap are those missing age-based or diagnosis-based annual screenings or vaccines. Closing these gaps improves member health outcomes and supports our organizational performance goals by increasing care gap closure rates, which contribute to achieving Centene’s Marketplace Star Rating goal of 4.0.

Opportunity 

To improve member health outcomes, Ambetter needs members to engage with communications in ways that feel positive and self-motivated. Currently, care gaps are only shared through cold outbound calls or casually mentioned during unrelated service calls—an approach that results in low engagement, limited care gap closures, and high campaign costs.

Solution 

As a result, our solution must create an easy and self-serving actionable flow while not decreasing the follow-through rate, and if possible, instilling trust and promoting action within the initial step of being shown the doctor matches.

Goals

• Continue to improve a member’s self-serve capability, from notification to action
• Create an experience that encourages preventive care
• Promote customized content that is relevant and specific to a member
• Ensure the right information is prioritized according to the business concerns, while also recognizing the importance of the content to the members.

Actions

• Test the effectiveness and response of several nudges to see which nudge gets the best click rate
• Mock the nudges and variables we have today to put into execution
• Work with the Design System team to stay by the new patterns
• Work with Transactional Emails and Guide teams to make sure the DocMatch flows from end to end
• Capture ideas for future innovation to promote, connect, and serve our members

To Start

Our first iteration was to simply change the communication of preventive care procedures from phone calls to website notifications inside the Member’s portal. By recommending preventive care procedures through the Member’s portal, we decreased Customer Care costs and improved the members’ experience with a less intrusive way to give care recommendations. The notification would have a small amount of text detailing the procedure and its health benefits and then a call to action to take the member to our doctor search that would have a list of pre-searched specialists in the member’s area. 

Our first user testing came back very positive, with 62% of members saying that they like the reminder and the ability to take action from the notification.

To Scale

So with the positive feedback from the first phase,  we were thinking about how to make this care suggestion even easier for our members. Well, the current notification had the members sent out to another experience in which they would be doing the self-navigating and evaluation of the doctors for their care before even reaching out to a doctor and completing the care procedure. Chances were that we were losing members along the way.

So we started with these questions:

• What’s the best way to reach out to our members outside of the portal?
• How might we help members identify a provider with whom they’ll have a good care delivery experience so that they get timely access to necessary care?
• Can we increase care gap closure rates by matching members with providers who can close the relevant care gaps?