Closing Gaps in Medicare: Tips and Recommendations

Disclaimer: Virgin Pulse and HealthComp are now Personify Health

Recap from AHIP 2023 

As Medicare Advantage membership continues to grow at an incredible pace, health plans face challenging new dynamics to maintain or grow Star ratings and increase medicare advantage retention. At AHIP 2023, Personify Health and Mass General Brigham Health Plan took to the stage to discuss how health plans can deliver a member-centric experience that provides a return. 

Members are changing faster than health plans can – leveraging claims data is no longer enough 

For years, experts have loved to compare the health insurance industry with other sectors like retail. Often, those other industries get praised for creating seamless customer experiences, while health plans are seen as burdened by legacy complexities that disrupt the member experiences and drive-up costs. One way to combat this disruption is implementing robust strategies for medicare advantage member retention on par with other industries.

And sure, payers have their fair share of regulatory realities that make retailers’ splashy engagement methods not wholly applicable. Yet, health plans can learn from retail brands’ digital strategy adjustments that help them find and communicate with hard-to-reach audiences. The secret? Deep consumer-level data that then enables the brand to meet members in the moments that matter most. 

In the past decade, multiple brands have exceptionally engaged hard-to-reach audiences, including older populations.  

Take RV dealerships, for example, which utilized virtual tours and simplified buying experiences to restore travel plans during 2020 and beyond, promoting adventurous—but still relatively safe— activities and visits to grandchildren. 

Other examples include brands that the senior population may have previously been unfamiliar with and that used consumer-level data to make them more user-friendly. Instacart, for example, created a Senior Support Service line that engaged dedicated live support to help seniors create an account, add items to their cart, and complete their online orders. 

What these and other brands have gotten right is that they acknowledge that seniors aren’t fragile populations who sit around at home taking meditations all day. They’ve used consumer-level data to meet members where they are and deliver experiences that help them live their lives to the fullest. 

For health plans, moving from a single data point, such as claims data, to a complete picture of a member using consumer-level can mean the difference between gaining or losing a Star rating point. It can significantly boost medicare advantage staffing and reduce gaps in care for the medicare population.

Consider this. Our 20 years of experience and deep data set show that email works best for welcome messages for seniors. They like the point of reference and ability to bookmark links. In contrast, an IVR call can better support medication adherence with a warm transfer to remove barriers. And your ‘Welcome to Medicare’ preventive visit communication delivers ROI by including the voice of people from their community. Claims-only data would never be able to give you this level of insight. 

“When you use tech tools, the channels aren’t usually the problem. It’s the consumer-level data that’s the problem. If you don’t have the data, you can’t drive a coordinated approach that drives ROI on your communications,” shared Jeff Jacques, Chief Medical Officer at Personify Health. “You can only improve health when it is communicated so that the person on the other side knows what to do and can take action.” 

Ready to learn more about what Medicare Advantage health plans can learn from consumer brands? Read this light paper from Fierce Healthcare and Personify Health


Although member experience measures have been a component of the Stars ratings for years, past limitations and assumptions have led to health plans treating all members equally. 

Two reasons why health plan member communication strategies fail: 

  1. Missing consumer-level data 
  2. Lack of personalization 

Medicare Advantage members are not homogenous populations. More than one in six Americans are 65 or older, and no two are alike. But the plan they are on, Medicare, was designed to pay bills, not designed around health. Equity can be the difference between health and disease, revenue and risk. 

For many health plans, missing member phone numbers, addresses, and emails is the first barrier to delivering a personalized experience. VP Activate eliminates this barrier, and through Personify Health’s data set, we can predict, with up to 90% accuracy, members at risk of care gaps like overdue age-based or seasonal screenings and vaccines and late medication refills – and automatically motivate them to take action. How? Through multi- channel communication campaigns personalized to the individual. 

And, the approach is not just one-sided of pushing out information – that’s where many member communication campaigns fail – they don’t recognize the member’s unique needs beyond a channel. VP Activate leverages social determinants of health data and predictive analytics to enable health plans to identify which members are likely to have problems related to education and literacy and lack of material resources such as access to healthy food or transportation, among other social needs. This approach enables Medicare Advantage health plans to provide a whole cycle campaign designed to engage and help members navigate their unique situations. 

Examples of Health Plans Leveraging Consumer-Level Data and Multi-Cycle Member Communications in Action 

In theory, adding consumer-level data to your claims data enables a holistic view of your Medicare Advantage members. But, in practice, you need the data and multichannel, multi-cycle communications to retain members and close gaps in care. 

At AHIP, we shared a few examples from our customer stories to help show the impact of an effective Medicare Advantage member engagement strategy – no matter your size or goals. 

Top National Payer Generates over $9M in ROI with Targeted Quality Initiatives

One of the nation’s largest payers sought to improve their Medicare Quality measures and gain ROI on their improvement initiatives. Their ultimate goals were to support member centricity and improve overall member satisfaction. See how the health plan improved medication adherence, HEDIS, Star Ratings, and other quality measures -> 

National Health Plan Used Targeted Member Outreach to Close 48% of Its Diabetes Gaps in Care 

One of the nation’s largest health plans sought to increase health outcomes and close known diabetes gaps in care for over 190,00 targeted members. See how the health plan closed nearly half of the open diabetic gaps in care -> 

Build a Medicare Advantage Member Engagement Strategy with Personify Health

When done well, a member experience strategy is an effective approach that enables you to connect with your members in the moments that matter, achieve business goals, and deliver a personalized experience. By leveraging claims data, consumer-level data, and multichannel, multi-cycle communication channels, Medicare Advantage health plans can create a member experience that enables members to thrive and create a long-term roadmap that fosters strong Star ratings. 

But there is no one-size-fits-all approach to Medicare Advantage member engagement: Yours needs to reflect the individuals in your plan. And with so many factors to consider, building an effective member experience strategy optimized for your health plan and member needs may feel overwhelming. But Personify Health can help. 

Personify Health works with health plans to help these organizations create member experiences that deliver a return. VP Activate empowers health plans with the data and communication channels you need to personalize, modernize, and create a competitive advantage while boosting Star ratings. To learn more, book a demo with one of our health plan experts today. 

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