Industry

Healthcare

The Challenge:

When Managed Medicare members were at risk of losing drug coverage and needed reminders about their past due premiums, problems ensued for this health plan client

In-house agent teams were overwhelmed by the volume of calls required
Compliance regulations stipulated multiple reminder contacts within 10-day timeframe
Loss of coverage could jeopardize chronic condition treatments and long-term outcomes
Potential decrease in plan incentive payments for covering at-risk population

The Solution:

Main Statement: ResultsCX created a strong outbound soft collections team focused on helping at-risk Medicare members maintain drug coverage:

Agents offered multiple options for helping members get current on premiums
Long-tenured agent team approached each call with empathy, focused on ensuring the best possible client outcomes
Team size ensured client could achieve compliance with contact timeliness requirements
Offshore and subsequent nearshore staff approached helping members with strong sense of responsibility and commitment to effectivenes

The Results:

Main Statement: Soft collections team consistently helps members maintain drug plan enrollment, protecting outcomes and client incentive payments:

Contacted nearly 26,000 members during most recent calendar year of engagement
Connected successfully with 7.42% of these members in past year
75% of lapsed members receive as many as three attempts within contact time window
On average, 50% of members helped to immediately get current with overdue premiums
45 at-risk members assisted on average monthly, protecting client income from ongoing Medicare incentive payments