Creating agentless outbound campaigns to support Medicaid unwinding efforts

Since April 1, 2023, state Medicaid agencies (SMA) have one year to “unwind” temporary COVID-era changes and return to pre-pandemic ways of working. A major part of that is re-certifying the 91 million members currently receiving Medicaid benefits. For more than a year, Amazon Web Services (AWS) has supported SMAs with in-house Medicaid expertise to identify unwinding issues and develop solutions to address them. The top four concerns that SMAs have shared are outreach and engagement, staffing shortages, returned mail, and reporting capabilities.

With SMAs contacting all their members, contact centers must scale to meet increased demand—however, staffing shortages can make this outreach and call support difficult. A critical focus of the public health emergency (PHE) unwinding is the challenge Medicaid agencies may face with regards to returned mail, which can happen when a member changes their address and the agency does not have the updated address on file. Because of this, members may not get the necessary paperwork they need to renew their coverage. Plus, once the SMA receives returned mail, the Centers for Medicare & Medicaid Services (CMS) requires SMAs to use more than one means of outreach to the member before denying the member coverage.

At least 4.5 million Medicaid members have been disenrolled as of August 11, 2023. Overall, 75% of disenrollments are due to procedural denials, which occur when members have not completed the renewal process successfully. Some states report that they are having contact center agents check a list of members whose mail was returned and then individually call each listed member to verify their address. This manual outbound outreach process can spread staff thin, leaving them unable to sufficiently verify addresses for those with returned mail, and also delay them in responding to inbound questions from callers concerned about filing the right paperwork to get their Medicaid coverage renewed—contributing to long wait times for members and time-constrained employees.

To address these staffing shortage issues and make sure members get their communications needs met, SMAs can use AWS and cloud technology to introduce automation into their outreach process. In this blog post, learn how to deploy a serverless outbound campaign to meet Medicaid unwinding outreach needs and support agency staff members by streamlining the outreach process.

Solution overview: Creating agentless outreach campaigns

Agencies can help automate their outreach programs with the Amazon Connect Outbound Campaign solution. This solution can help SMAs create automated outbound campaigns to connect with their customers for various purposes, such as for returned mail address verification, increasing Medicaid unwinding awareness, interview appointment reminders, and Medicaid eligibility status notifications. One state deployed a similar solution to make 88K automated outbound calls within three days, significantly reducing the workload on their call center agents. If we assume that a call center agent can make about 50 calls a day, to achieve 88K calls over three days, an SMA needs nearly 600 call center agents dedicated to this effort. By automating this outbound outreach process with AWS, the state helped their agents focus on their regular activities while automating the outbound calls.

Watch Getting Started with Amazon Connect Outbound Campaigns:

With Amazon Connect Outbound Campaigns, SMAs can proactively communicate across voice, SMS, and email to quickly serve their members and improve agent productivity, while supporting compliance with local regulations. SMAs can specify the contact list, channel, message, and the pre-recorded audio to play before connecting members to agents for live service.

Agencies can configure the Amazon Connect Outbound Campaign solution to use agents or function agentless. The solution described in this blog post deploys an agentless campaign using AWS Step Functions, a visual workflow service that helps developers use AWS services to build distributed applications, automate processes, orchestrate micro-services, and create data and machine learning (ML) pipelines.

Figure 1 illustrates the architecture of the solution:

Figure 1. The architecture overview of AWS services involved in the workflow, described in detail in the following section.

The solution workflow operates as follows:

1. The state Medicaid agency worker uploads the audience call list to an Amazon Simple Storage Service (Amazon S3) bucket, which is encrypted with AWS Key Management Service (AWS KMS). One way of getting the audience call list is to gather the data from the existing member database.
2. The upload to Amazon S3 launches Amazon EventBridge, a serverless event router, which starts the “Campaign Intake Process” AWS Step Function.
3. The audience call list that was uploaded in Step 1 is stored in the Amazon DynamoDB table for the campaign.
4. Amazon EventBridge launches the “Campaign Outreach Process” AWS Step Function.
5. The “Campaign Outreach Process” Step Function uses the data from Amazon DynamoDB and launches the Amazon Connect contact flow.
6. The Amazon Connect contact flow checks call progress and plays the message. This message is configurable in the “Campaign Contact Flow” within Amazon Connect.

Solution deployment

To deploy this solution, follow the steps in the Amazon Connect Outbound Campaign GitHub repository.

Conclusion

State Medicaid agencies can support their members and staff in the face of staffing shortages by implementing automated outbound calls to support Medicaid unwinding. The solution described here offers a low code, serverless implementation that can automatically scale based on demand.

AWS is ready to support Medicaid agencies as they transform to meet PHE unwinding efforts. Contact the AWS Public Sector Team to learn more.

Health and human services (HHS) agencies across the country are using the power of AWS to unlock their data, improve citizen experience, and deliver better outcomes. See more Health and Human Services Cloud Resources here. Learn more about how governments use AWS to innovate for their constituents, design engaging constituent experiences, and more at the AWS Cloud for State and Local Governments hub.

Read more about AWS for Medicaid agencies:

• 4 ways AWS can help with Medicaid unwinding
• Extracting, analyzing, and interpreting information from Medicaid forms with AWS
• Automating returned mail to keep members enrolled during Medicaid unwinding
• Supporting state agencies with Medicaid unwinding outreach: Creating a multi-lingual two-way messaging system
• How public sector agencies can identify improper payments with machine learning
• Delivering better Medicaid services (and happier teams) with the AWS Cloud
• Using AI to rethink document automation and extract insights

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