Engagement that ends in a completed action
Health plans do not lack outreach. Members get texts, voicemails and scripted calls every month, and the care gaps stay open.
86Borders does the other kind of work. Local Care Coordinators reach the member, solve what is in the way, and follow through until the care has actually happened.
A contact attempt is not engagement
A dialed number, a delivered text or a voicemail is easy to count, and it moves nothing. We define engagement as a completed action: the mammogram done, the refill picked up, the primary care visit kept, the result in the member’s record.
That definition changes the work. A coordinator measured on completed actions spends the call understanding why the member has not gone, and stays on the problem until it is solved.
The model: four steps, one coordinator
Every member moves through the same four steps with the same person, so nothing is lost in a hand-off.
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Engage and activate
We start with verified contact information and the people a member already trusts. The first conversation is about the member, not the measure, and it ends with an agreed next step.
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Address social needs
Transportation, food, diapers and housing come first when they are what stands between the member and the visit. Coordinators connect the help and record the need for the plan.
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Close gaps in care
Preventive screenings, medication adherence and provider appointments are booked around the member’s life, with reminders and a call the day before.
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Track results
Every interaction is logged and every outcome tracked in ConnectAllCare. We confirm the result and follow up until the need is met.
What a coordinator actually does
Six kinds of intervention cover most of what keeps a member from care.
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Preventive screenings
Mammograms, colorectal exams and diabetic retinal exams, scheduled, reminded and confirmed as completed.
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Medication adherence
Refill follow-up and statin support, working from pharmacy data to call when a fill goes quiet.
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Provider appointments
Finding a doctor, booking the visit, and rebooking it when life gets in the way.
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Social needs
Diapers, food, housing and transportation, connected before they derail the care.
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The whole household
Several family members engaged in one outreach, so one trusted call closes more than one gap.
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Follow-through
Confirming results with the member and the provider, and following up until the need is met.
ConnectAllCare: the platform behind the coordinators
ConnectAllCare is our own platform. It exists to make each coordinator’s conversations count, never to replace them.
How the data reaches a result
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Plan and clinical data
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One household view
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A coordinator’s call
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A completed action
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A tracked result
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Relational household view
Family members are linked, so a coordinator sees every open gap under one roof and can reach a household in one outreach.
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Smarter contact management
Verified, prioritized contact information: the number that works, kept current with every call.
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Data integration
Eligibility files, ADT feeds, EMRs, labs and pharmacy data in one place, so the open gaps are known before the phone rings.
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Follow-through tracking
Every interaction logged and every outcome tracked, so the plan sees exactly what was completed.
The goal we hold ourselves to is 100% resolution.
What it changes for the plan
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Stronger quality scores
Closed HEDIS® gaps and better adherence feed the measures behind CMS Star Ratings.
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Lower total cost of care
Care that happens on time prevents some of the ER visits and readmissions that follow when it does not, and conditions documented at real visits make risk adjustment more accurate.
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Loyalty and retention
A member helped by a real person has a reason to stay with the plan, and a better story to tell when the satisfaction survey arrives.
Member education publications
We also produce professionally written member publications, such as a healthy-aging magazine. A plan can customize them, co-brand them or publish them fully under its own name.
See what this would look like for your members
Bring the measures and the populations that matter most this year. We will walk through how the model would run for them.
Talk to us