Carenet’s Engagement Programs Are Transforming Healthcare: Delivering Performance-Driven Results

With nearly 25 years of customer-relationship management (CRM) experience in the healthcare sector, Carenet knows that nothing drives lasting change more than a genuine, personal connection. And, they have the results to prove it. Customized to each client’s specific needs, Carenet’s engagement programs effectively combine continual, personalized outreach with finely tuned CRM practices to fully engage patients and members. This improves population health outcomes and client ROI.

Carenet’s engagement specialists and skilled registered nurses, each averaging 15 years of experience, cultivate trusted one-to-one relationships with individual patients and members, educating and empowering them to take an active role in their healthcare. The team proactively and consistently connects with members via multiple touch points, strategically timed throughout the year.

“Our trained specialists keep an eye out for our customers, ensuring they have the support, tools, and information they need to thrive,” says Vikie Spulak, executive vice president, “and we keep checking back with them, making sure they’re on track and taking the actions needed to maintain or enhance their health.

Multiple Touch Points Multiply Engagement: Forty percent of seniors have unreported and untreated chronic conditions. By raising annual physical exam compliance among this population, a Medicare Advantage (MA) Plan can accurately identify and treat high-risk members, ultimately improving member health and reimbursement rates. Various compliance initiatives are conducted by the MA Plan, such as direct mail, newsletters, and website announcements, but they are often unsuccessful in connecting with the member. One MA Plan recently turned to Carenet to help effectively reach members and increase compliance.

To address this, Carenet’s engagement team executed a multi-touch outreach strategy focused on building solid relationships with members and coordinating their care. Using direct, personalized contact, the team connected one-on-one with more than 40,000 members at multiple times through a variety of touch points. The first step included a member/RN consult regarding chronic conditions, preventative measures, annual exams, check-up preparation, and general health concerns. An appointment with their primary care physician was then scheduled and door-to-door transportation arranged, if needed.

After the appointment date, a follow-up call was made to ensure the member kept the appointment. If not, the engagement specialists rescheduled it for them. Finally, a few days after, the member was contacted again about the exam to ensure compliance and answer any questions.

The collection of this data allowed the MA Plan to understand the behavior and the relevance of clinical oversight of their population and identify successful motivators. Through this feedback, the program could be refined to net the best results. Moreover, Carenet improved the MA Plan’s performance by 200% and, through successful risk adjustment analysis, generated approximately $9 million in annualized adjustments.

Screenings and Savings Amplified: Another national MA Plan that is aligned with Carenet protects member health and boosts its rating through increased breast cancer screenings. Millions of women aged 65 and older are not participating in disease prevention and early detection clinical services like mammograms. By increasing compliance and by controlling costs, a plan can reduce unnecessary illness, improve care quality, and maximize their Centers for Medicare & Medicaid Services (CMS) star ratings.

Again, multiple MA Plan attempts, such as mailers, newsletters, and automated reminders, did not yield the results needed to increase patient compliance and its CMS star rating. With limited program time and aggressive goals, a fast fourth-quarter solution for reaching members and elevating their HEDIS Breast Cancer Screening measures by year-end was needed

Carenet quickly implemented a multi-touch member outreach strategy featuring numerous interactions between their engagement specialists and thousands of plan members. Touch points included annual screening education, procedure explanation, appointment scheduling with a physician and the radiology center, and additional follow-up steps.

Effective engagement amplified member screenings with Carenet, surpassing the targeted goal by 165 percent. By modifying member behavior, the Plan’s star rating was boosted and positioned them to qualify for the quality bonus payment available to high-performing health plans. The engagement program generated potential revenue of $2 million (for a 10k member plan).

“Each conversation we have with a member is a valuable educational and relationship-building moment,” commented Spulak. “Nothing is more rewarding than delivering a level of personalized service that exceeds a member’s expectations and supports them on their journey toward optimal health and well-being.”

CRM Centric : Carenet President John Erwin attributes these and similar success stories to the company’s extensive customer-relationship management experience. “After 15 years of developing West Corporation Outbound into the country’s largest outsourced contact center, I saw a seismic opportunity to apply the CRM framework that made West so successful to the healthcare industry.”

Erwin and his team of CRM experts took Carenet, a patient-management center within the Christus Santa Rosa Hospital system and developed it into a top CRM advocacy organization. Today, Carenet is an award-winning healthcare services company with more than ten million members nationwide. The company was named an Inc. 500 Fastest Growing Company in America for the past two years and anticipates making the list again this year.

Inside and Outside Experience: The Carenet team has extensive CRM experience inside and outside the healthcare industry, having worked with both healthcare institutions and Fortune 500 companies. Within the healthcare industry, they’ve collaborated with a range of markets from government programs, like Medicare and Medicaid, to hospital systems, health plans, the military, and employers.

“Our collective experience enables us to bring a unique perspective and remarkable results to the world of healthcare. By leveraging best practices from the healthcare and Fortune 500 arenas, we’re able to formulate high-performance solutions that transform the patient experience and deliver exceptional ROI,” says Erwin.

A Pivotal Position for Driving Change: Carenet’s advantageous position of working with providers, payers, and patients/members every day enables them to effectively unite all the major stakeholders to produce a more efficient, results-driven experience. “By leveraging these relationships, we’re able to deliver exponentially higher value for all,” explains Erwin. “Because we’re so deeply entrenched with all the key players, we know how to generate powerful solutions that produce measurable results.”

An intimate knowledge of each stakeholder’s challenges and opportunities enables the company to create customized solutions that net healthy outcomes for everyone. As Carenet continues to expand, so do their engagement programs. “We challenge ourselves to develop new strategies for engaging our clients’ customers at a much higher level,” adds Erwin. “By combining our unique personalized support with our unmatched CRM experience, progressive technology, and performance-driven solutions, we are driving change. Our clients can count on us to help transform their business and deliver the results needed to remain competitive in today’s ever-changing world of healthcare.”

[From the August/September 2011 issue of AnswerStat magazine]