Check out this infographic about the impact Medicaid churn has on an individual's health and their health plan's bottom line. Member enrollment continuity has positive health and financial outcomes. Reducing the amount of unnecessary churn inflicted on the U.S. healthcare system will not only reduce costs but, also help maintain and improve the health status of many Medicaid recipients like Jane. Follow her story and discover the millions of dollars in healthcare costs saved from a simple HMS Eliza retention program.

1. eliza@hms.com
1.844.343.1441
elizacorp.com
REDUCE MEDICAID CHURN
ENGAGE WITH HMS ELIZA
is the disruption in
healthcare coverage, due to eligibility
changes and/or administrative problems.
It is the constant on and off of Medicaid
coverage throughout the year, causing
gaps in care, which can have detrimental
effects on the health and well-being of
members and put additional financial
burden on the healthcare system.
CHURN IMPACTS OUTCOMES
Renewal notice
mailed to Jane
Outreach reminds
Jane she is up
for renewal
Updates her mailing
address and
opts-in for SMS
Jane never receives
paperwork, incorrect
mailing address
Jane happily renews and
remains with existing MCO
Jane does not renew and her
Medicaid coverage lapses
Jane’s diabetes goes unmanaged
Prescriptions not filled
Doctor’s appointments missed
Disease management and
social care management
services discontinued
Jane ends up in the
emergency room
RESULT: Jane’s diabetes
is under control/managed.
Jane is happy!
$1 spent on diabetes
meds results in $7 less
on other services
RESULT: Jane is sicker = your
bottom line and quality scores
are negatively impacted!
Hospital checks Medicaid
eligibility and re-enrolls Jane
in previous MCO
60% of members
do not recall
receiving their
renewal paperwork
For more information on how HMS Eliza can help you reduce
churn in your Medicaid population, contact us today.
FINANCIAL HEALTH STATUS QUALITY CLINICAL OPERATIONS
3
1.
Swartz, Katherine, et al. “Evaluating State Options for Reducing Medicaid Churning.” Health affairs (Project Hope), U.S. National Library of Medicine, July 2015. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4664196/.
2.
Ku,L., et al. “Continuity of Medicaid Coverage in an Era of Transition”, ACAP, Nov. 2015, [Video Webinar], Retrieved from https://www.communityplans.net/Portals/0/coverageyoucancounton/briefing.html
[Fig1]
Ku, L. et al. ‘Continuity of Medicaid Coverage in an Era of Transition’, ACAP, Nov. 2015, page 3, [Working Paper]. Retrieved from http://www.communityplans.net/Portals/0/Policy/Medicaid/GW_ContinuityInAnEraOfTransition_11-01-15.pdf
3.
Sokol, M C, et al. “Impact of medication adherence on hospitalization risk and healthcare cost.” Pubmed.gov, U.S. National Library of Medicine, June 2005. Retrieved from www.ncbi.nlm.nih.gov/pubmed/15908846.
4.
Fitch, K, et al. “Medical claim cost impact of improved diabetes control for medicare and commercially insured patients with type 2 diabetes.” Journal of managed care pharmacy: JMCP, U.S. National Library of Medicine, Oct.
2013. Retrieved from www.ncbi.nlm.nih.gov/pubmed/24074007.
5.
Swartz, Katherine, et al. “Evaluating State Options for Reducing Medicaid Churning.” Health affairs (Project Hope), U.S. National Library of Medicine, July 2015. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4664196/.
6.
Agency for Healthcare Research and Quality. “Emergency Room Services-Mean and Median Expenses per Person with Expense and Distribution of Expenses by Source of Payment: US, 2014.” Medical Expenditure Panel Survey
Household Component Data, 2014. Retrieved from https://meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp
7.
Pfuntner, Anne. “Costs for Hospital Stays in the United States, 2010.” Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Jan. 2013, Statistical Brief #146, retrieved from www.hcup-us.ahrq.gov/reports/stat
briefs/sb146.pdf.
Member IDs not linked causing
administrative complexity and
disruption in plan services
Costly ER visit and inpatient stay
Savings
$804 – $1,260 annually
per patient due to
reduced complications
from type 2 diabetes
Revenue Retained
$330 monthly
4
Costs
$400 re-enrollment costs5
56-Year-Old
Female
M E M B E R P R O F I L E
MEET JANE
Has Type 2
Diabetes
Eliza
®
Case Study: Financial Impact Analysis
Regional Health Plan, Medicaid and D-SNP Population
AVERAGE LENGTH OF
DISENROLLMENT
3MONTHS
AVERAGE MONTHLY
CAPITATION
$
330FOR MEDICAID
ENROLLEES
AVERAGE MONTHLY
CAPITATION
$
1,100FOR D-SNP
ENROLLEES
ADMINISTRATIVE COST
TO RE-ENROLL
$
100
MEDICAL LOSS RATIO +
ADMIN COST RATIO
95%
62%
44%
94%
44%
Medicaid D-SNP
Reached Not Reached
100%
80%
40%
20%
0%
HIGHER OVERALL RETENTION RATE
22%FOR THOSE REACHED WITH AN ELIZA
RETENTION PROGRAM VS. NOT REACHED
RESULTS DELIVERED
IMPROVEMENT FOR MEDICAID18%
FOR D-SNP50%
RetentionRate
LEARN STRATEGIES
TO REDUCE CHURN
AND IMPROVE
OUTCOMES
PLAY VIDEO
bit.ly/MedicaidChurn
of members who lose coverage come
back on the plan in less than six months1
50%
annual churn rate reported by a large MCO2
59%
PROJECTED 6,400 MEMBERS RETAINED ANNUALLY =
$1.1M IN ESTIMATED ANNUAL SAVINGS
$1,500 ER visit6
$9,000 hospitalization7
Average Monthly Medicaid Costs for Adults
$800
$700
$600
$500
$400
$300
$200
$100
$0
$
705
$
512
$
326
Months of Year Enrolled in Medicaid
1 2 3 4 5 6 7 8 9 10 11 12
[Fig1]
ENROLLMENT CONTINUITY HAS
POSITIVE HEALTH AND FINANCIAL OUTCOMES
Lost Revenue
$330 monthly