The Client Challenge

A $2.5 billion regional health plan identified its dual Medicare-Medicaid plan as a critical growth area, given limitations across other lines of business (LOBs) and the long-term impact dual eligible membership would have on its business.

The payer lagged behind competitors in the duals market, with limited year-over-year growth. Despite significant attention on the duals market, the payer lacked a proactive strategy for dual member recruitment, relying solely on external factors for growth.

  • Large population centers throughout the state ceded to competition
  • Higher-than-expected member costs
  • Poor care coordination and quality outcomes
  • Low overall membership growth
  • High member attrition, especially among new members

Navigating to Next: The Solution

Chartis analysis across current membership and statewide trends identified opportunities with current members (including up to 8,000 duals look-alike transitioning members) and a net-new opportunity of 11,000 dual-eligible beneficiaries each year. A competitive member-network analysis confirmed the health plan’s capacity to compete in key geographic areas it hadn’t prioritized previously. The analysis also clearly laid out the payer’s strengths and weaknesses compared to its peers’ strategies. Counties were identified where the plan could compete immediately, was at risk of membership attrition due to emerging network deficiencies, or could drive competitive membership acquisition through targeted network strategies.

The payer partnered with Chartis to deploy a member growth and retention framework focused on cultivating relationships with members. Together, we developed a roadmap of interventions to build more proactive capabilities in member engagement, network, and care management. The roadmap concentrated on current and newly enrolled members and included phased action plans for proactive member messaging, stronger care coordination relationships, and a more complete network based on member preferences and utilization.

Navigating to Next: Key Components



Gather understanding of current market performance



Analyze performance against key competitors’ membership and network footprints



Develop comprehensive understanding of current membership strategy and gaps



Assess and prioritize key strategic growth gaps



Build roadmap for progressive improvement of membership relationships and support



Initiate roadmap implementation through targeted action plans across key functions

Client Impact

With this proactive growth strategy and roadmap, the payer is positioned to grow its plan’s market share statewide, improve member engagement through marketing and care coordination activities, and begin to address cost containment challenges through innovative care management programs. With a geographic-based strategy and a roadmap to significantly improve member retention and support regulatory compliance, the payer will have a stronger platform from which to compete over time. In the long term, the revenue potential includes $142 million in members supported and transitioned from other LOBs, in addition to organic growth among the duals membership.

The new roadmap and supporting plans would lead to rapid projected growth:

new duals members per year

$44 M

new revenue per year

$142 M

in additional revenue from members transitioned from other LOBs

How We Are Making Healthcare Better

With insights gained from operational and market analysis, the plan is well positioned to drive network and member engagement strategies that will expand its ability to serve duals members in a sustainable way.

Jade Christie-Maples, Associate Principal, Chartis

Next Intelligence

Membership growth and success for duals plans can be supported by:
  • Proactive Strategy: Up-to-date market-level approach and intentional infrastructure informed by unique market drivers and regulatory dynamics
  • Capabilities & Performance: Coordination across core functions, including innovative programming
  • Competitive Membership & Network Insights: A deeper market landscape understanding, driving results across lines of business

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