Conversational Outreach for Comprehensive Medication Review (CMR)

Challenge

As one of the largest health insurance payers in the U.S., this payer takes customer consent and communication regulations very seriously. Given these strict SMS guidelines, leveraging two-way conversations was initially seen as too risky. As a result, their Medicare Stars team relied on outbound calls, emails, direct mail, and one-way SMS to engage members. However, this approach limited interaction since members could not respond or engage meaningfully. To improve outreach, they needed a solution that could quickly adapt to members’ scheduling needs. Their goal was to engage the hard-to-reach population to complete Comprehensive Medication Reviews (CMR).

Solution

Given the payer’s strict approach to member consent and communication compliance, Drips was required to integrate with their custom SMS management platform. This also included accessing their Enterprise Preference Management Platform (EPMP) data set to meet rigorous consent requirements, ensuring that all outreach adhered to strict opt-in policies. Drips partnered with the team to develop a targeted CMR outreach program using a conversational approach to drive engagement and improve response rates. By replacing their one-way SMS system with a conversational solution, Drips enabled two-way engagement, allowing members to respond and complete their CMR with a pharmacist at their convenience. Despite the challenges of working within such a highly regulated environment, this partnership proved that meaningful, compliant engagement is achievable even within the most conservative organizations.

Results

Drips received authorization to launch the program following rigorous reviews, including SMS, machine learning, and privacy approvals. By incorporating a conversational approach alongside existing outreach efforts, engagement and response rates improved significantly, increasing both transfer rates and CMR completions among the hard-to-reach population.