Preventive Care Doctor Match

Client Mobile Web

Preventive Care Doctor Match

Concept

Members identified as having a care gap are individuals who are missing age-based or diagnostics-based annual screenings or vaccines. Closing care gaps is important for members – better health outcomes! – and it helps us improve care gap closure rates, which can increase our overall Star Rating towards the Centene goal for Marketplace of 4.0 Stars.

Opportunity Statement

A member needs to positively interact with communication from Ambetter because we want members to see and/or take action in positive and self-serving ways. Today, Care Gaps are only communicated to a member via outbound phone calls from a Care Manager (cold calls) or when a member calls in for an unrelated intent (member services representative will mention the care gaps listed on a member’s account during the conversation). Because of this, care gap closure rates are low and the care gap closure campaign costs are high.

Solution Statement

As a result of this, our solution absolutely must create an easy and self-serving actionable flow while not decreasing the follow-through rate plus 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 full cycle 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 in Cycle 13
• Work with the Design System team to stay by the new patterns
• Work with Transactional Emails and Guide teams to make sure the DocMatch flow 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.

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?