Opportunity

A leading PBM sought to elevate its member experience by extending white-glove support through its member care advocates. The PBM faced challenges in driving healthy behaviors with its members, ensuring adherence to prescribed therapies, resolving prior authorization denials efficiently, and capturing member sentiment and clinical insights. Addressing these areas was critical not only for improving member satisfaction but also for reducing costs associated with non-adherence and therapy delays.

Action

The PBM leveraged Ushur to deploy multi-channel outreach campaigns to encourage healthy behavior and protect costs. Using SMS texts with secure links to Ushur’s Invisible App, a user-friendly and HIPAA-compliant digital channel for information exchange and two-way communication, the PBM was able to better guide members to better outcomes.:

• Member Check in : Automated monthly outreach to members, enabling them to easily call or schedule time with their assigned advocate.
• Medication Adherence: Intelligent identification of treatment gaps with options to call, schedule an appointment or notify them that are no longer taking that RX.
• Prior Authorization Denial Notifications: Proactive alerts for prescription denials due to missing paperwork, giving members immediate pathways to resolve issues and avoid therapy delays.
• Member Survey: A digital feedback loop that captured member perspectives on member care advocate performance, with the option to leave a Google review, driving transparency and quality improvement.

Impact

The PBM was able to scale personalized, white-glove engagement without increasing administrative burden. The client realized measurable improvements across critical areas:

• Higher Engagement through White-Glove Service: Drove 25–30% completion across multiple journeys, engaging nearly one-third of members through automated digital channels—far outperforming the slow, low-yield cold-calling approach.
• Member Satisfaction: Automated monthly check-ins fostered trust and satisfaction, proactively resolving queries, offering 24x7 support, and enabling live agent escalation.
• Improved Adherence: Automated outreach helped identify and address non-adherence early, reducing the risk of costly care escalations.
• Faster Resolution of Prior Authorization Denials: Proactive communication reduced member frustration and therapy delays.
• Actionable Feedback: Performance surveys and public review options created a feedback-rich environment that drove service improvements.