Derrick Dale

CareOregon

March 2004

Churning of MembersIssues

• Care disruptionsCare disruptions

• Managing for stability rather than CrisisManaging for stability rather than Crisis

• Administrative expenseAdministrative expense– Multiple handlingMultiple handling

• The MD OfficeThe MD Office• The PlanThe Plan• The StateThe State

Developing Approach• Create Patient file earlyCreate Patient file early

– Out-reach for Early interventionOut-reach for Early intervention• Welcome Call TriageWelcome Call Triage

» Based on Eligibility Risk Adjustment and/or Based on Eligibility Risk Adjustment and/or Premium Category (OR has 13 categories)Premium Category (OR has 13 categories)

– Medical Conditions firstMedical Conditions first» Medical Questionnaire Medical Questionnaire

– Retention second Retention second » Eligibility date (State can provide file also)Eligibility date (State can provide file also)» Diary for follow upDiary for follow up» IncentivesIncentives» Call backCall back

MedicaidEnrolled,

ButBefore

EnteringMSO

First Six MonthsPlan Experience

Average ExperienceAfter Six months

Average Premium

First Year Plan Enrollment

EarlyIntervention?

CostPattern

Early Intervention and Early Intervention and Member RetentionMember Retention

RetainRetainMembersMembersLongerLonger

Retention Strategy• MailingMailing

– Send telephone card (for 30 minutes of time)Send telephone card (for 30 minutes of time)• Needs an activation numberNeeds an activation number

– Call-in to get activation numberCall-in to get activation number

» InexpensiveInexpensive

» 20% return20% return

– Go through the renewal process and needGo through the renewal process and need

• Proactive Outbound Call (evening shift)Proactive Outbound Call (evening shift)– Timed 60 days before eligibility expiresTimed 60 days before eligibility expires– Explain benefits of requalifing on timeExplain benefits of requalifing on time– 35-40% connect rate after 4 attempts35-40% connect rate after 4 attempts

Results

• After 6 month on Program– Many addresses and phone numbers

incorrect– About 10-15% stay

• 3-4 months longer• About 5% increase in enrollment

– Plan Cost:• Estimated $40-55 per retained member

Conclusion

• Helps continuity

• Saves hassle• Off three months, then on again• Retroactive eligibility• Reinforces state approach

• Reaches and helps very few

• Need Plan/State to collaborate to reach 35-50%