Situation

After a structured discovery project identified the root causes of a regional Medicaid plan’s disenrollment problem, the challenge shifted from diagnosis to the operational question: How do you turn these insights into repeatable action at scale, week after week, without overwhelming the care management team?

The plan had the right people. What they lacked was a targeting system. Without one, outreach was unfocused — care managers working from stale eligibility files that arrived late, contained duplicates, and gave no indication of which members were most urgent. Some members received repeated contact. Others fell through entirely.

The members falling through were MLTSS and ABD populations — the highest-acuity members with the most complex conditions and care coordination needs. Every member lost to administrative error represented premium that wouldn’t return without re-acquisition cost.

Solution

Agilian deployed an automation to extract bulk membership data from the state MMIS portal, creating a complete and current view of which members were coming due for renewal and when. This became the foundation for a monthly Smart List process that gave care managers a single, prioritized, deduplicated file: the right members, segmented by urgency, routed to the right outreach queue before the window to act closed.

The portal automation also made the underlying problem visible for the first time. The plan could see what percentage of state eligibility files contained bad or duplicate data, which members actually needed action versus which had already re-enrolled elsewhere, and what trends were driving disenrollment across each population.

Agilian built the process to be repeatable and self-sustaining. It runs independent of any one analyst, the state file delivery schedule, and the plan IT team. The data foundation gets more precise every month.

Results

Working from accurate lists, the plan’s outreach team reinstated 128 high-acuity members during the pilot.

Behind every one of those 1,125 retained members is a person who stayed connected to their care team, their home-based services, and the plan that knew their history — rather than starting over.

See how the pilot helped the plan find the right members before it scaled. →