A multi-year partnership spanning ACA and Medicare Advantage — with results validated by actuarial analysis and a control group.
2023 – Present
1M+ Members
Actuarially Validated
Hear directly from the team about the strategy, the challenges, and the measurable outcomes achieved through the ReferWell partnership.
Prefer to read? You can download the full case study pdf below.
42,575 members outreached in Year 1
vs. ~35% ACA industry average
vs. 15% target — exceeded by 47%
Validated by actuarial analysis
Following Year 1 success, the health plan expanded ReferWell’s scope across multiple lines of business. Each population returned distinct results.
Consistent operational performance with 2023, with improved ROI as the health plan’s ACA market share declined from 90% to ~80% — concentrating HCC revenue capture on a more targeted member population.
Exceptional returns driven by higher per-member HCC values, more stable member tenure, and ReferWell’s targeted engagement approach for the MA population — age-appropriate, empathetic, and outcomes-focused.
From a focused ACA pilot to a year-round member engagement program spanning ACA and Medicare Advantage.
ReferWell began with approximately 35,000 ACA members, tasked with scheduling Annual Wellness Visits for a hard-to-reach population with high churn and limited claims history.
We exceeded every KPI — including a 69% appointment show rate against a 35% industry average — prompting the health plan to expand the program mid-year to include 5,000 Medicare Advantage members.
Results were validated by the health plan’s actuarial department using a control group.
Based on Year 1 results, the health plan expanded ReferWell’s engagement across multiple lines of business, with full-year programs for both ACA and Medicare Advantage members.
Medicare Advantage delivered an 8:1 return, driven by higher per-member HCC values and ReferWell’s specialized engagement approach. ACA improved year-over-year as market dynamics concentrated HCC capture on a more targeted member pool.
ReferWell continues to serve the health plan’s ACA and Medicare Advantage populations. The program has evolved into a comprehensive, year-round member engagement function — spanning new member onboarding, Annual Wellness Visits, care gap closure, and pre-CAHPS retention campaigns.
ROI analysis for the 2025 program year is currently in progress.
— Health Plan Executive • Said at program launch in 2023
Download the complete case study — including actuarially validated ROI results, campaign performance data, and the full story of a three-year partnership that transformed member engagement.
Year-by-year ROI results across ACA, MA & Medicaid
Actuarial methodology & control group approach
Connection, engagement & impact rate benchmarks
How ReferWell achieved a 69% show rate vs. 35% average
Real member stories from care navigators
2025 program structure & ongoing engagement model