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Healthfirst: Hitting quality targets and keeping members healthy

For health insurer Healthfirst, high-quality healthcare is about more than paying for care: it’s about keeping members well. Healthfirst manages public and commercial health plans, working to keep their diverse members healthy. One way they promote members’ health is through ‘live call’ campaigns: a Healthfirst representative telephones members to encourage them to keep medical appointments, collect a prescription or arrange a post-natal visit, for example.

As well as being the right thing to do, Healthfirst faces financial consequences if members don’t stay healthy. Under regulations called HEDIS, public payers reimburse insurers like Healthfirst based on the quality of care members receive. If members become sicker because of poor quality care, Healthfirst is reimbursed at a lower rate. Live call campaigns help members get needed care and can bolster revenue if managed seamlessly.

Healthfirst recognized that their live call campaigns were not working as well as they might. Campaigns were complex and decentralized and the campaign tool had poor tracking and reporting capabilities, making it difficult to understand the calls’ impact on members’ health. Healthfirst leadership wanted to improve campaign processes and tools, but needed a clear picture of how current methods were working.

Our experience in healthcare quality regulation made us a great partner. We conducted stakeholder interviews to understand how the team manages live call campaigns, created a current-state process map, and identified areas for improvement. Our work paves the way for Healthfirst to enhance their live call campaigns, improve members’ health, and succeed financially in the HEDIS quality regulations.

Contact the Americas healthcare team


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