Case Study
Health Plan
How large national health plan used next best actions to close 27% more care gaps.
Overview:
The client wanted to close gaps in care using HEDIS and claims data to help members live healthier lives and reduce medical spend.
Challenge:
Outbound outreach with a call to action to log onto the portal or call a member services agent was not generating the desired gap closure results.
Solution:
Created a next-best action capability using analytics and machine learning to rank gaps in care opportunities for the member services agent to share and discuss with the member during an inbound call.
Result:
- Provided millions of offers to members each day.
- Allowed agents to work with members when they had time.
- Closed 27% more care gaps resulting in millions of dollars of gap value capture compared to only outbound engagement.
