Fortune 500 Healthcare Payer Finds $58 Million in Member Growth and Retention Opportunities

Using more data as a competitive advantage

With both competition and cost pressure increasing in their Medicaid business, a Fortune 500 Healthcare Payer used Unsupervised's Automated Data Platform and AI Agents to look for deeper insights that would allow them to improve member growth and retention.

Using Unsupervised for the analysis made it possible to analyze far more data than they ever had been able to do manually. Traditionally, handling large and complex data sets was both a management nightmare and prohibitively expensive. However, AI made it possible to merge and analyze 26 different data sets across four types: member data, usage data, interaction data, and value metrics. These data sets included both first-party and third-party information.

Unsupervised's AI Agents made it possible to sift through enormous amounts of data and extract very specific, actionable insights. For instance, they could identify interactions between plans and member types, target markets, and pinpoint aspects of the member experience that influenced Customer Satisfaction (CSAT) scores, profit, and retention. They were also able to determine what indicators correlated with a prospect's likelihood to enroll.

The outcome of that effort? $58M in opportunities found in the first six months.

Turning Insights to Actions

As the payer connected additional data sets, Unsupervised surfaced ever more granular insights about which customer touchpoints could be optimized for specific groups of prospects, which Medicaid prospects were likely to enroll and engage with plan offerings, and which activities or events correlated with CAHPS scores, profit, and retention.

Dozens of previously unknown insights were identified and used to improve both the patient experience and KPI performance. Things like:

• AI-generating new, hyper-targeted member segments

• Targeting specific groups of members for opt-in to touchpoint channels most likely to be effective for them

• Highlighting a partner who was particularly effective at working with an underserved patient group

• Identifying patterns that led to underperformance in two counties and that could be addressed with improved experience around one diagnosis or one plan.

• Updating online user experiences based on patient insights

That led to both significant business impact and an improvement to the patient experience for over 60 million US Medicare and Medicaid beneficiaries.