Member Outreach

Health insurance plans — both public and private — are rapidly expanding upon implementation of the Affordable Care Act. Plans are enrolling large volumes of new members, including new Medicaid recipients, individuals who were previously uninsured, and people with complex health care needs. Additionally, federal oversight for Medicaid and Medicare plans has made the member experience increasingly important, as plans are rated based on satisfaction, enrollment, and health care outcomes.

We have prioritized the member experience across all levels of services we provide for health plans. Our member outreach offerings include the following:

  • Welcome calls to engage members upon enrollment
  • Member satisfaction surveys
  • Medication adherence outreach calls
  • Targeted Adherence Counseling
  • Comprehensive and targeted medication reviews
  • High-risk medication interventions
  • Health risk assessments
  • Appointment scheduling and reminders
  • Referral follow-ups
  • Benefit coordination

Whether your organization is looking to simply engage and assist members, or develop targeted solutions to improve health outcomes, we can provide a solution to meet your needs. Our resources include the following:

  • A customer service contact center
  • A clinical call center functionally operated by pharmacists and pharmacy associates at UMass Medical School
  • Multilingual staff and translation/interpretation services

Examples of Our Solutions

Our team launched an outbound call function in support of a Targeted Adherence Counseling program for a national health plan.

  • Recruited, trained, and deployed staff resources in fewer than 30 days.
  • Immediately achieved and maintained an average call completion rate of greater than 50 percent (excluding member records with invalid phone numbers).
  • Within one month, more than doubled the number of members called.
  • Completed more than 31,000 calls to members during the first six months of operation.

We implemented outbound call services for a Florida-based pharmacy benefits risk-management company to obtain consent from providers regarding prescription changes.

  • Beginning in the first month of operation, UHealthSolutions met or exceeded all client requirements and expectations.