Abstract
The recap and recording from our webinar with ACAP and Mountain Health Co-Op showcase practical AI applications that boost member retention, protect mission and members, and keep operations steady amid industry shifts.
“AI being used in healthcare… it’s definitely more of an accelerator, not a replacement. Being able to leverage our already known limited resources, limited workflows, limited staffing models… and being able to apply technology on top of that to truly make all of our superheroes in healthcare even stronger with even stronger superpowers.”
— Renee Malone, Customer Success, Siftwell
Health plans face an unprecedented retention challenges ahead. Between Medicaid unwinding and potential premium tax credit changes, plans are bracing for 20-30% membership losses.
Mountain Health CO-OP, though operating in the Marketplace, faces the same questions Medicaid plans are asking today. In fact, Marketplace plans face these pressures every open enrollment cycle, giving them a head start in retention strategies others will soon need. Their advantage? Proven experience using AI to solve core engagement challenges: identifying which members need intervention, predicting who is likely to respond, and executing targeted campaigns that build trust and drive action.
In this ACAP webinar, Blair Fjeseth, CEO & President at Mountain Health Co-Op, Trey Sutten, CEO & Co-Founder at Siftwell, and Renee Malone, Head of Customer Success at Siftwell, shared the strategic evolution that has led to measurable retention improvements. Over five to six years, Mountain Health increased retention from 68% to the high 80s through a series of deliberate moves, from basic member communications to hyper-targeted outreach, and AI-powered precision targeting that identifies specific barriers like transportation and childcare that prevent members from accessing care.
Key Insights
- Anticipated 20-30% membership losses are driving plans to strategically focus retention efforts on high-value members in specific geographic areas, using risk adjustment data and quality metrics to guide resource allocation.
- Preventive care barriers often stem from practical issues rather than a lack of interest. AI helps identify, for example, members avoiding mammograms faced transportation challenges and childcare constraints, leading to partnerships with Uber Health and childcare solutions.
- Member engagement can improve dramatically with the right approach. In other Siftwell client work, targeting specific populations with tailored phone scripts for wellness visits and immunizations resulted in a 3x improvement in member response rates.
- Resource-constrained teams can amplify their impact through AI-powered member segmentation that identifies which populations are most likely to respond to specific interventions.
- Vendor evaluation should prioritize healthcare expertise, compliance knowledge, and cultural fit over pure technology capabilities. Plans need partners who understand the complexity of health plan operations (Download the deck below for a guide on this).
- Implementation strategy should start with low-risk applications like member engagement and retention campaigns, maintaining human oversight while building organizational comfort with AI tools (Download the deck below for a guide on this).
