Change Healthcare fuses artificial and human intelligence for Medicare Advantage dual eligibility and enrollment

Aug. 8, 2018

Change Healthcare unveiled Dual Enrollment Advocate, a solution to blend artificial intelligence and behavioral science to help solve the challenge of Medicare Advantage (MA) dual-eligibility identification and enrollment. This new technology helps health plans more accurately identify, engage, and enroll MA members who are eligible for both Medicare and Medicaid.

There are 58.5 million Medicare beneficiaries today, and 34% of them live at or below the Federal Poverty Level, indicating many might be eligible for Medicaid. Meanwhile, only about 10.6 million of 19 million Medicare Advantage members are dual-enrolled, representing a significant opportunity for Medicare Advantage plans. The Change Healthcare Dual Enrollment Advocate uses AI to pinpoint those individuals with the highest likelihood to qualify for full or partial dual eligibility. The result is that Medicare Advantage plans can quickly engage with this population and potentially enroll more of them faster.

Health plans traditionally have identified dual-eligible candidates using systems that require manual programming, continual updating, and are limited by small data sets and legacy technology. Dual Enrollment Advocate enables the analysis of massive amounts of data in a fraction of the time otherwise required to identify optimal targets’ dual-eligible status.

This proprietary AI technology is deployed in concert with Change Healthcare member engagement teams, which apply behavioral science that uses intelligence gathered through consumer and expert interviews, focus groups, in-home immersions, and by engaging with beneficiaries. The engagement teams use Member Advocates, targeted mailings, and other outreach methods to more effectively activate dual-eligible members and support them through the enrollment process.

PR Newswire has the full release

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