Clarity Performance Solutions logo in brand colors of grey, dark blue and light blue.
Clarity Performance Solutions logo in brand colors of grey, dark blue and light blue.

MEMBER ENGAGEMENT

Heart Failure, System Failure

Rethinking CHF Engagement for Better Outcomes

For payers and TPAs, congestive heart failure (CHF) is more than just a clinical condition—it’s an operational and financial challenge. CHF members represent one of the highest-cost, highest-risk groups, often cycling through emergency rooms and hospital readmissions, despite being enrolled in care management programs.The problem? Traditional engagement strategies aren’t working.Despite best efforts, CHF readmission rates remain stubbornly high, adherence is low, and HEDIS/Star scores suffer. This isn’t just a member issue – it’s a system failure in how we engage, educate, and support individuals living with CHF.It’s time for payers to rethink their approach to CHF engagement.

Why CHF Member Engagement Fails

Managing CHF requires continuous, proactive engagement. However, the standard approach misses the mark in three key areas:
1. Too Little, Too Late: Engagement Only Starts After a Hospitalization

CHF is a progressive condition—without timely interventions, members will end up in the ER. Yet, many plans wait until after a hospital admission before intensifying outreach efforts.

Fact: Nearly 25% of CHF patients are readmitted within 30 days of hospital discharge. (ncbi.nlm.nih.gov)

Once they’re readmitted, the damage is done—health plans face penalties, higher costs, and lower quality scores.

2. Generic Outreach Doesn’t Resonate

Most CHF engagement strategies rely on standardized call scripts, mailers, or emails—but these channels fail to account for the unique needs of CHF members.

  • Did they receive and understand their discharge instructions?
  • Do they have a caregiver to help manage medications and diet?
  • Are they experiencing worsening symptoms that require early intervention?

Fact: Personalized engagement improves adherence rates by up to 40% compared to standard outreach. (healthaffairs.org)

Members don’t need reminders. They need support that feels human.

3. Social Determinants of Health (SDOH) Are Overlooked

For many CHF members, managing their condition is more than a medical challenge—it’s a lifestyle challenge.

  • Transportation barriers prevent members from making follow-up appointments.
  • Food insecurity makes it impossible to maintain a heart-healthy diet.
  • Medication costs force members to ration or skip essential prescriptions.

Fact: Members with unmet social needs are 60% more likely to be hospitalized for CHF-related complications. (cms.gov)

If your CHF engagement strategy doesn’t address these real-life barriers, it’s not a strategy… it’s a checkbox.

Rethinking CHF Engagement

To reduce hospitalizations, improve HEDIS compliance, and control costs, health plans need a smarter, data-driven approach to CHF engagement. That means:
  • Predictive Analytics to identify high-risk members before they hit the ER
  • Personalized, multi-channel engagement that adapts to member preferences
  • Proactive interventions—not just reminders, but real support in medication adherence, diet management, and symptom monitoring

The Clarity Solution

Clarity Performance Solutions helps health plans and TPAs close CHF gaps by combining predictive analytics to prioritize high-risk members, personalized AI-driven outreach to improve response rates, and multi-channel engagement through text, email, calls, and caregiver coordination. By implementing proactive interventions that remove barriers before they impact care, Clarity shifts CHF management from a reactive approach to a proactive one. This strategy helps payers and TPAs lower readmission rates, improve HEDIS scores, and drive better health outcomes while reducing costs.

Drive CHF Engagements for Better Outcomes

Now with Clarity Performance Solutions.

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