Member-Centered Care Yields 81% ROI for Medicare Advantage Plan
About the Client
- Plan Type: Multi-Line
- Plan Size: ~15M members
- Geography: National
Issue
A Medicare Advantage plan aiming to improve its Star Ratings selected Sagility to implement a whole-person, member-centric care model for two high-impact call types, Primary Care Provider (PCP) Change and Provider Locate, as part of the engagement services that Sagility operated Trained agents went beyond basic inquiries to support members proactively and directly by identifying appropriate providers and scheduling appointments. This approach helped to close care gaps, improve access to primary care, and enhance Star performance measurably.
Action
Sagility supported the launch of a pilot program designed to improve member satisfaction and positively impact Star Ratings by delivering a differentiated service model through modernized, member-centered call engagement.
As part of this initiative, we conducted whole-person care and motivational interviewing workshops for managers and executives. Beyond training, Sagility also partnered with the client to define clear success criteria and performance expectations for both managers and front-line agents, ensuring consistent adoption and measurable results.
Impact
The health plan achieved measurable outcomes by participating in the pilot, including:
- 81% return on investment (ROI)
- 3X appointment scheduling improvement
- Closure of care gaps, resulting in meaningful member experience
- Program expansion to more than 200 existing Medicare advocates
The program ultimately enabled advocates to close care gaps proactively and to drive meaningful member engagement that affected the bottom line.
Return on investment, through improved operational efficiency and care gap closure
Appointment scheduling improvement, accelerating access to care proactively
Advocates, who expanded the program and demonstrated scalability and organizational confidence in the model
