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86Borders

Engagement that ends in a completed action

Health plans do not lack outreach. Members get texts, voicemails and scripted calls every month, and the care gaps stay open.

86Borders does the other kind of work. Local Care Coordinators reach the member, solve what is in the way, and follow through until the care has actually happened.

Illustration of a coordinator’s desk: a telephone, a notebook checklist, a neighborhood map with an orange route, a mug and a lamp
Illustration of a wall calendar with one day circled in orange and a pencil

A contact attempt is not engagement

A dialed number, a delivered text or a voicemail is easy to count, and it moves nothing. We define engagement as a completed action: the mammogram done, the refill picked up, the primary care visit kept, the result in the member’s record.

That definition changes the work. A coordinator measured on completed actions spends the call understanding why the member has not gone, and stays on the problem until it is solved.

The model: four steps, one coordinator

Every member moves through the same four steps with the same person, so nothing is lost in a hand-off.

  1. Engage and activate

    We start with verified contact information and the people a member already trusts. The first conversation is about the member, not the measure, and it ends with an agreed next step.

  2. Address social needs

    Transportation, food, diapers and housing come first when they are what stands between the member and the visit. Coordinators connect the help and record the need for the plan.

  3. Close gaps in care

    Preventive screenings, medication adherence and provider appointments are booked around the member’s life, with reminders and a call the day before.

  4. Track results

    Every interaction is logged and every outcome tracked in ConnectAllCare. We confirm the result and follow up until the need is met.

Illustration of a pill bottle, a weekly pill organizer and a stethoscope

What a coordinator actually does

Six kinds of intervention cover most of what keeps a member from care.

  • Preventive screenings

    Mammograms, colorectal exams and diabetic retinal exams, scheduled, reminded and confirmed as completed.

  • Medication adherence

    Refill follow-up and statin support, working from pharmacy data to call when a fill goes quiet.

  • Provider appointments

    Finding a doctor, booking the visit, and rebooking it when life gets in the way.

  • Social needs

    Diapers, food, housing and transportation, connected before they derail the care.

  • The whole household

    Several family members engaged in one outreach, so one trusted call closes more than one gap.

  • Follow-through

    Confirming results with the member and the provider, and following up until the need is met.

ConnectAllCare: the platform behind the coordinators

ConnectAllCare is our own platform. It exists to make each coordinator’s conversations count, never to replace them.

Illustration of a laptop showing three houses joined by orange lines

How the data reaches a result

  1. Plan and clinical data
  2. One household view
  3. A coordinator’s call
  4. A completed action
  5. A tracked result

  • Relational household view

    Family members are linked, so a coordinator sees every open gap under one roof and can reach a household in one outreach.

  • Smarter contact management

    Verified, prioritized contact information: the number that works, kept current with every call.

  • Data integration

    Eligibility files, ADT feeds, EMRs, labs and pharmacy data in one place, so the open gaps are known before the phone rings.

  • Follow-through tracking

    Every interaction logged and every outcome tracked, so the plan sees exactly what was completed.

The goal we hold ourselves to is 100% resolution.

Illustration of a small wooden footbridge over a creek

What it changes for the plan

  • Stronger quality scores

    Closed HEDIS® gaps and better adherence feed the measures behind CMS Star Ratings.

  • Lower total cost of care

    Care that happens on time prevents some of the ER visits and readmissions that follow when it does not, and conditions documented at real visits make risk adjustment more accurate.

  • Loyalty and retention

    A member helped by a real person has a reason to stay with the plan, and a better story to tell when the satisfaction survey arrives.

Illustration of three magazines with illustrated covers

Member education publications

We also produce professionally written member publications, such as a healthy-aging magazine. A plan can customize them, co-brand them or publish them fully under its own name.

See what this would look like for your members

Bring the measures and the populations that matter most this year. We will walk through how the model would run for them.

Talk to us