Utilization, STAR Measures & Outreach Conversion
See exactly which members are leaving their dental benefit unused.
Benefit Analytics tracks every Medicare Advantage member's dental benefit: benefit type (embedded, standalone, supplemental, none), annual maximum, used to date, remaining benefit, preventive coverage percentage, network requirement, visits YTD, and utilization status (non-utilizer, under-utilizer, on track, high utilizer). It identifies non-utilization reasons and feeds the STAR measure campaign engine.
Each member is classified non-utilizer, under-utilizer, on track, or high utilizer with days since last visit and visits YTD.
Annual maximum, used to date, and remaining benefit are tracked per member, with benefit year end countdown for use-it-or-lose-it outreach.
Per-member contribution to dental-related STAR measures (two preventive visits, diabetic enhanced care) is tracked and rolled up.
Open rate, click rate, and conversion-to-appointment are tracked per member and per campaign; ROI per outreach channel is visible.
MA plan ID, member ID, benefit year, dental benefit type, annual maximum, and preventive coverage percentage are loaded per member.
Dental visits YTD, preventive visits YTD, and last visit date drive a non-utilizer / under-utilizer / on track / high-utilizer classification.
Reason for non-utilization is captured where available: no benefit, geographic barrier, financial barrier, fear, awareness, transportation, health, unknown.
Per-member STAR measure contribution and outreach conversion are rolled up to the population dashboard for campaign planning.
“We found 312 MA members with unused preventive benefits three months before year-end. The outreach campaign converted 40% to a visit; STAR measure jumped a full star.”