A Blueprint for Knocking Down Barriers, Getting Members to Needed Care and Delighting Them In the Process

A Case Study presented by Blue Cross Blue Shield of Arizona at RISE West 2023.

The Challenge

  • Health Plan Program accountability of Member/Provider relationship
  • Health Plan resource constraints
  • Healthcare System burdens and inefficiencies
  • Member Experience
  • Access to needed data
  • It’s not a “tech” problem

Here’s How We Addressed It

Give Members What They Want

“When it comes to conveying important or complex information, building emotional connections, or resolving urgent issues, a phone call is often the more effective option.”

How We Do It

A complete, end-to-end experience for the member takes multiple pieces and a willingness to do what it takes, not stop at the first barrier

  • Provider data – we all know it’s broken, our partner manually verifies and creates a relationship with our providers – gaining trust and access.
  • Provider Match to patient  – Filter out the noise, hone in on the exact right provider (this technology alone would improve our own call center’s capabilities).
  • Scripting & Empathy – ability to schedule, ability to handle additional scenarios
  • Communication – follow up, rescheduling as necessary, data sharing even if it takes faxing.
  • Learn from what we hear and see, implement, do it again. The OODA loop in action

The Results

ReferWell care navigators called members and attempted to schedule them for a colonoscopy, mammogram or both and, if needed, offering to schedule appointments with a convenient, in-network provider while on the phone with the member. Just one month into the engagement, ReferWell far surpassed the goals set by the health plan. The graphic above shows ReferWell’s success compared to the metrics that the health plan selected as KPIs.


ReferWell reached out to 13,383 members 2 times within 30 days


ReferWell scheduled 331 appointments in 31 days


ReferWell scheduled appointments with an 84% show rate for APE and a 75% show rate for BCS

Key Take Aways

Knocking Down Barriers

  • Don’t wait till Q4
  • Think like the member
  • Ask Members their challenges in the process
  • Must be Dynamic!

Getting Members to Needed Care

  • Don’t just tell them how, do it for them.
  • Don’t keep them on the phone for 45 min, it can be done in 5
  • Follow up, Remind, Reschedule

Provide an exceptional experience

  • Empathy – they may vent, that’s ok
  • Experience – Dedicated Care Concierge team
  • Remove the burden…. It’s not just the appointment, what about transportation or other needs?

Care Concierge & Data Analysis

Connection Rate by Day of Week

Takeaway = Focus on outreach/calling on Mondays and Tuesdays

Connection Rate by Time of Day

Takeaway = Focus on outreach/calling hours to mid-morning and early afternoon.

Member Disposition Summary

APE Member Dispositions

BCS Member Dispositions

COL Member Dispositions

Interested in learning more?

If you have any questions or would like to speak to a ReferWell team member to learn more on this topic, you can reach us by phone at (800) 970-5875 or by email at sales@referwell.com.

Want More?

If you would like to learn more about this topic or related topics, check out the Bright Spots in Healthcare Podcast that features Blue Cross Blue Shield of Arizona’s success story on building a better member experience. Or, you can explore our library of blogs and thought leadership articles by clicking here.

How Blue Cross Blue Shield of Arizona is Leveraging ReferWell to Reinvent the Member Journey

Phylicia Schroeder, Manager, Provider Engagement and Quality Analytics at Blue Cross Blue Shield of Arizona Medicare Advantage and Janine Wakim, Head of Operations at ReferWell, join Eric Glazer on his podcast Bright Spots in Healthcare to discuss how the plan is transforming the member journey by instituting a cultural shift putting the member’s needs above the plan’s needs, adding that to accomplish this goal, the plan uses data and predictive analytics to learn about what makes its members unique.

Topics covered during the episode include:

  • Member journey mindset
  • Navigation and physician scheduling
  • Data integration, risk mitigation (as it relates to CAHPS) and
  • Provider engagement

Phylicia and Janine share many bright spots your plan can implement to provide a tailored experience for your members!

Helping Members Who Routinely Don’t Get Access, ReferWell Gets Them Scheduled for the Care They Need

Data shows that when payers provide help in scheduling member appointments with community-based organizations, mental health counselors and other agencies, they directly impact outcomes.

The Critical Role of Human Connection in Creating Equitable Access

Empathy plays an important role in health equity and access to care. In this video, Jada Creer, a ReferWell care navigator, talks about building trust and the role of empathy in her team’s member outreach.

Putting Health Equity Into Action

Many health plans are already advancing health equity by offering their members resources to address social, economic and cultural barriers to care. To get members to use these resources – payers must help beneficiaries leverage these resources in a different way.

We want to hear from you, and learn about your challenges.

ReferWell is dedicated to helping health plans advance health equity by scheduling underserved members for the care they need.

If you’d like to learn more about how we can help guide you through the challenges you face at your plan, let’s schedule a call today.