Health Plans

Health Plans

Kaviva Solutions for Health Plans

How is your Health Plan Surviving the Storm?

To keep consumers and earn new ones, cultivate brand promoters, and keep the business profitable, health insurers must improve digital engagement strategies. They can no longer rely on siloed approaches in a seamless digital world.1 To stand out in the crowded marketplace, health plans must think and act like retailers — but with a holistic healthcare perspective.

Your Challenge

With an ever-changing healthcare landscape, building loyalty with members has never been more important. Health plans must face challenges head-on, or risk being left behind. The question is not how to keep up, but rather how to transform your business and keep it profitable. This requires you to balance and leverage an overwhelming set of competing priorities in a way that positions you as a market leader.

Your Opportunity

Kaviva offers a 360 solution unlike any other to help you achieve your health plan goals. Our platform allows you to seize key opportunities to build loyalty and long lasting relationships with your members by helping you:

  • Engage members in critical moments of their consumer journey
  • Personalize messaging for diverse populations with unique needs
  • Deliver real-time communications via user’s preferred channels
  • Acquire data and insights to help improve program outcomes

1 https://www.accenture.com/t20170127T025410__w__/us-en/_acnmedia/PDF-35/Accenture-As-Digital-Health-Intensity-Increases-Loyalty-Suffers.pdf

MEDICARE

Your Challenge

Medicare plans need to stay ahead of the ever changing and uncertain regulatory landscape. Declining Medicare reimbursement and a shift toward value-based payments requires new strategic direction. It’s essential that Medicare plans develop new strategies to capture and retain “leading-edge” and especially, “trailing-edge” Baby Boomers, the next wave of Medicare enrollees, who will need new tools to stay activated in their health care and engaged with their health plan throughout their coverage lifecycle.

Star Ratings have also become a key factor that will significantly impact enrollment and retention outcomes. It appears likely that health plans receiving fewer than 4 Stars in 2017 will have relatively slower enrollment growth than plans with 4+ Stars.1 Plans that strategically leverage health engagement technology will gain a competitive edge for increased profitability.

1 http://healthcare.mckinsey.com/assessing-2017-medicare-advantage-star-ratings

Your Opportunity

  • Improve Star Ratings
  • Drive Behavior Change
  • Close Care Gaps

Kaviva’s unique solution addresses key areas of the Center for Medicare and Medicaid Services (CMS) Star programs to help you increase performance by helping your members manage chronic conditions, stay healthy and improve their member experience. Our precision-infused technology can help you stay ahead by helping you understand important factors, like which members are likely to leave the health plan next year.

Kaviva’ s Solution for Medicare helps:

Acquisition & Retention
  • High-touch engagement with members during AEP Lifecycle
  • Welcome & On-Boarding
  • Member Profiling
  • Member Satisfaction & Disenrollment Survey
  • Pre & Post ANOC Communications
Quality Improvement & Performance
  • Star Power™ (Medicare Star Rating)
  • HEDIS Outreach
  • Post Hospital Discharge
  • Optimize Medical Loss Ratio
  • HOS (Health Outcomes Survey)
  • CAHPS (Consumer Assessment of Healthcare Providers and Systems)
Revenue Optimization
  • HCC/Risk Score Optimization
  • Go Green
  • Coordination of Benefits (COB)
Disease Management & Prevention
  • Health Risk Assessments
  • Chronic Condition Self-management
  • Preventive Care Programs
  • Wellness, Nutrition & Fitness Programs
  • Post-Hospital Discharge
  • ER Utilization & Avoidance
  • Gap closure
Insights & Analytics
  • Actionable analytics to measure results & guide strategy development

MEDICAID

Your Challenge

Medicaid enrollment does not always translate to utilization of available health benefits. Due to rising costs, the concept of Medicaid expansion now faces potential obstacles, while reining in the costs remains a highlighted challenge that the Federal Government may soon push down to the states. Never in the last 150 years has increasing engagement been so critical to individual and public health.1

1 Medicaid Engagement Article, Wellsource 2017

Your Opportunity

  • Engage Members
  • Reduce Costs
  • Optimize Adherence
  • Increase Care Access

Kaviva can help ignite your engagement strategies and increase care access for health for hard-to-reach populations. Our technology will help you identify the unique needs of each individual member and potential barriers, in order to connect them to the proper healthcare resources. We will help you change lives as a Medicaid health plan, increasing Medicaid participation and engagement for a big impact on healthcare costs, outcomes, and the health of every person you insure, to get them the care they need.

Kaviva’ s Solution for Medicaid helps:

Member Retention
  • Omni-channel, high-touch engagement with members
  • Welcome programs
  • Robust member profiles
  • Early barrier detection
  • Education for Health literacy
  • Care program education
  • Benefit awareness
Quality Improvement & Performance
  • HEDIS Outreach
  • Satisfaction & outcomes surveys
Disease Management, Prevention & Reduce Costs
  • Identify health status and risk
  • HRA
  • Chronic Condition Self-management Programs
  • Preventive Care Programs
  • Wellness, Nutrition & Fitness Programs
  • Post-Hospital Discharge
  • ER Utilization & Avoidance
  • Adherence Programs
  • Gap closure
Insights & Analytics
  • Actionable analytics to measure results & guide strategy development

COMMERCIAL

Your Challenge

Individual health coverage commercial health plans need differentiation to stay ahead of the competition now more than ever before. With an uncertain future for Health Care Reform, they need to remain competitive, yet profitable by retaining and engaging with their current members in innovative and holistic ways to avoid losing them.

Gaining a deeper understanding of members, building trusted relationships during the AEP lifecycle, identifying outliers and achieving higher levels of sustained engagement across the care continuum is key for health plans to ensure an increased pool of win-backs year after year.

Your Opportunity

  • Improve Retention
  • Increase Profitability
  • Reduce Costs

Digital health reached a tipping point in 2016. Kaviva understands the importance of building a consistent and cohesive consumer journey at every point during the IHC sales cycle. We understand the healthcare consumer better than anyone, will help segment your member population more intelligently and build the right kind of personalized connections that will truly resonate with your prospects and members via our 360º platform. We will also help you understand key retention factors, like which members are likely to leave the plan next year.

Kaviva’ s Solution for Commercial helps:

Acquisition, Retention & Customer Experience
  • Intelligent segmentation for better marketing strategies
  • Highly targeted communications
  • Benefits Marketing + Education
  • Consumer Surveys
  • Message Retargeting
  • Enrollment Marketing Campaigns
  • Enrollment Conversion
  • Digital Fulfillment
  • Deadline Reminders
  • Agent/Retail Facilitation
  • Welcome/Onboarding
  • EOB
  • Payment Reminders
  • Identification of providers and access
  • Triage to HP Member Channels
  • Redetermination/Renewal
  • Digital benefits ID Cards
  • Benefit reminders
  • COB
Health Management & Quality
  • HRA
  • Identify health status and risk
  • Health Prevention Programs
  • Disease Management Programs
  • Wellness, Nutrition & Fitness Programs
  • Screening, Medication and benefit reminders
  • Provider Lookup
  • Adherence
  • ER Utilization Management
  • HEDIS Outreach
  • Member Satisfaction & Disenrollment Surveys
Insights & Analytics
  • Actionable analytics to measure results & guide strategy development

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