The Financial Impact of Engaging and Retaining Medicaid Members

In this five-minute Insights Brief video, I share Eliza’s approach to engaging and retaining Medicaid members to ensure continuity of coverage and improvement of financial and clinical outcomes. Eliza’s member engagement delivers proven results to Medicaid MCOs. For example, one MCO projected retention of 6,400 members — an estimated $1.1 million in savings!

What is Medicaid Member Churn?

Medicaid member “churn” is the term used to describe the unnecessary administrative disruption of healthcare coverage, resulting in the cycling on and off the Medicaid program throughout the year.

As one researcher put it, “Medicaid enrollment is like a leaky sieve; every year millions of people enroll, only to subsequently lose their coverage, despite still being eligible, because of inefficient and cumbersome paperwork requirements.”

Churn is the result of incorrect mailing addresses, confusion navigating the system, limited access to assistance or means to renew, unpaid premium payments, missed deadlines due to busy lives, and in some states, work requirements. Whatever the reason, the impacts on members and health plans are significant.

Medicaid members who churn are likely to experience worsening health due to limited access to providers, services, and medications. When an individual is uninsured, preventive care is likely to go by the wayside and management of chronic conditions falters, resulting in gaps in care, increased ED utilization and a higher chance of expensive inpatient hospitalizations.

Churn affects departments across health plans, from clinical, to quality, to marketing and operations. Administrative expenses associated with re-enrolling members include welcome and onboarding costs such as ID cards, welcome packets, PCP assignment, and welcome calls. Plans have estimated this to be $100 per member.

What Is the Impact of Medicaid Member Churn?

From a quality perspective, Medicaid members that do not meet the continuous enrollment criteria cannot be included in the HEDIS denominator, reducing the plan’s ability to measure and track quality improvement over time. This also means that all the hard work and planning put into reminding members to close care gaps go unrecognized, potentially affecting quality scores.

Research has shown that medical expense goes down with the number of months enrolled. As you can see here, the average cost of an adult member in the first month of enrollment is $705, and by month 12, it is down to $326. The more churn in the membership, the higher the medical expense because the plan is never getting out of those initial higher cost months.

How Is Medicaid Member Churn Addressed?

Eliza’s retention programs address churn related to loss of coverage due to missed renewal periods, work requirements and premium payments. We partner with health plans to proactively remind Medicaid enrollees that they are coming up on their renewal period and provide clear direction on how to renew their coverage. Medicaid MCOs have had great success with our multi-touch, multi-channel approach, which has been effective in improving retention by 10–18% compared with those not engaged.

The addition of Medicaid work requirements, premium payments and lockout provisions for noncompliance will augment the need for retention efforts throughout the year to prevent any lapse of coverage. Eliza can notify affected members about ‘work requirements’ and provide education on how to maintain coverage by going through the state attestation process. Similarly, in those states that require premium payments, Eliza can help members understand what costs they are responsible for and remind them when payments are due to ensure they stay covered.

What Is the Financial Impact of Addressing Medicaid Member Churn?

We have found that a multi-touch, multi-modal approach works best in getting members to take action. Members who only received a letter from the state notifying them of their renewal date had a 50.6% retention rate. A member's likelihood to take action increased by 4% when the member received two touches — a letter from the state and an automated call, letter, or email. The retention rate went to 57% when the member received three outreaches (a state letter, a plan letter, and an automated call or email from the plan).

Finally, I want to share with you a case study. We did a financial impact analysis on a retention program we ran for a mid-sized health plan that serves Medicaid and D-SNP members. Those that Eliza outreached had an overall 28% higher rate of retention than members that did not get the Eliza outreach. Based on our assumptions, we projected that over the course of one year, the plan would retain an additional 6,400 members resulting in $1.1 million in bottom-line savings.

It is safe to say that member retention efforts are a sound investment that not only provides significant savings for health plans, but also ensures continuity of care for Medicaid beneficiaries that rely on their coverage for essential preventive care, management of chronic conditions, and life-saving medications.

For more information on how Eliza can help you ensure retention of your Medicaid enrollees; email us, or call us directly at 1-844-343-1441


Are you interested in learning more about how you can reduce churn and improve member retention?  Read our eBook, "Eliza for Medicaid: Personalized Engagement for Improved Medicaid Outcomes" 




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