Welltok Closed Nearly 50% of Targeted Gaps in Care and Increased Star Ratings with Data-Driven Solution

Company Challenges Medicare Advantage Plans to Take Year-Round Approach to Activating Members and Closing Gaps

Welltok, an enterprise SaaS company, has issued a call to action for Medicare Advantage Plans nationwide: Mind the Gaps in 2020. With advancements in technology and the ability to predict who may have a gap in care and who would be most receptive to an intervention, plans can now take a more proactive approach to gap closures. Welltok is working with plans large and small to power quality initiatives year-round and is helping increase Star ratings as a result.

“Many organizations concentrate their gap closure efforts towards the end of the year, but there is an opportunity to focus on key gaps and outreach campaigns in the first quarter,” said April Gill, Senior Vice President of Market Solutions for Welltok. “We are encouraging plans to ‘Mind the Gaps in 2020’ with a more holistic approach to closing gaps starting early in the year. Our work with Medicare Advantage plans has proven that a data-driven strategy can enable more precise targeting and drive more actions to close gaps. This work translates directly to greater efficiency and spend optimization.”

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Welltok leverages its proprietary consumer data, including social determinants of health, and advanced analytics to understand members and reach individuals with the communications and resources that will motivate action. The company’s Consumer Activation Platform runs 1,000 predictive models a minute to identify potential barriers, individual risks and needs, and member receptivity to interventions. The platform then delivers a highly personalized, calendarized experience that drives and rewards the highest value actions year-round to close a gap like flu vaccination, asthma management, preventive screenings, and annual well visits.

For example, Welltok helped a large national health plan close diabetes gaps by nearly half with a multi-touch campaign. Outreach occurred over the course of the calendar year, beginning in the spring and ending in the fall. As a result, 86% of members indicated intent to complete targeted health actions including an eye exam, blood work and nephropathy screening.

Welltok worked with another national plan to conduct a multi-channel campaign that activated members with up to three gaps to close. Members received interactive digital voice calls and direct mail with educational messaging to drive health screenings for colorectal cancer, diabetes, mammography, spirometry and more. Members were reminded to get a test, confirm appointments and/or provide a Net Promoter Score (NPS). With this timely and personalized intervention, the health plan successfully increased 1 Star rating across 10 screening measures.

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“What sets our solution apart is the ability to supplement a plan’s clinical data with social and environmental insights. Social determinants and other variables are highly predictive of member needs. We apply machine learning to pinpoint and prioritize the quality gaps to close – and how to reach the member to do so,” added Gill. “In fact, you may be surprised by factors that impact medication adherence.”

Sample insights applied to a medication adherence initiative include:

• Younger, unmarried Medicare members with a lower socio-economic status are at higher risk for being non-compliant with their maintenance medication
• Seniors who voted in general elections (especially early or absentee) are more likely to participate in a medication adherence program if prompted by a live agent or interactive digital voice
• Seniors who are more likely to be impacted and improve adherence after intervention live in an area with a high percentage of widowed people

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