Overview
The VSC is providing a service that addresses and closes “gaps” in a member’s medication adherence. Health Guides (HG) will execute outbound calls to members to understand their top barriers in taking their meds as prescribed, then provide information or recommended actions that will address and lower those barriers.
What is a healthcare gap?
Healthcare gaps are situations where people are unable to get the healthcare they require because of different barriers like not enough doctors, not enough money, not enough knowledge, or living too far away from medical facilities. These gaps can cause differences in people's health and stop them from getting the right medical care they need to stay healthy or manage their conditions well.
Medication Adherence Gap
Medication adherence gap refers to a disconnect between what a healthcare provider recommends for taking medicine and what the member actually does. This gap can occur when people forget to take their medications, skip doses, or stop taking them altogether before completing the prescribed course.
Gaps Intervention Workflow
Health Guides will address the following barriers that are resulting in a member’s med adherence gap:
- Side effects: Member not taking meds because of the side effects they produce.
- Cost: Member not taking meds because of their cost.
- Refills: Member not taking meds because of untimely refills.
- Forgetfulness: Member not taking meds because they forget to do so.
VSC Outbound Campaign
Health Guides will attempt 3 calls to a gaps member.
If successfully connected to the member…
- The HG will have the member participate in a survey that identifies the biggest barrier in their medication adherence.
- The HG will provide support for the biggest barrier, which includes sending resources via email.
- HGs will follow up with the member in a week to understand their progress and set expectations.
- If a member is on track with their meds, support for the member will continue via automated email pathway.
- If a member continues to experience gaps in their med adherence, the HG will continue to provide high touch support.
If unsuccessful…
- HGs will leave a voicemail message and send an email invitation to set up a call with a HG.
- If all 3 attempts are unsuccessful and no call is scheduled, the member is removed from the campaign.
Customer Support-specific workflows
If a gaps member calls into support…
Confirm that you are speaking with a gaps member
A key identifier that you're speaking to a gaps member is if they say they’re returning a call (or received a VM) in regards to their prescription management or health journey with Vida.
In order to differentiate between gaps members and members in our prescribing services, ask “are you currently receiving your prescriptions directly from a Vida pharmacist or another provider?”
If a prescribing member, they’ll likely need to speak to their prescriber. Follow the KB articles in this section.
Action: Warm transfer the member to a Gaps HG during business hours at 833-903-6400. If outside of business hours, relay callback information to the member.
Script:
During VSC Business Hours (Monday to Saturday from 8am-8pm ET)
I’ll be happy to transfer you to one of our Health Guides. They will assist you further on your medication. I’ll place you on a brief hold while I connect you.
Outside VSC Business Hours
Our health guides are happy to assist you further on your medication. You can reach them at 833-903-6400 Monday to Saturday from 8am-8pm ET. If you are unable to connect to a Health Guide, you can leave a voicemail and they will call you back.
If a gaps member emails support…
Forward inquires to healthguide@vida.com
CC healthguide@vida.com on the ticket
Macro Response:
I’ll be happy to forward your inquiry to our Health Guides for further assistance with your medication adherence. Please let me know if you have any questions.
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