AI Member Retention

Members rarely leave a plan. They leave one problem the plan never heard about.

Disenrollment is usually traceable to something specific and fixable: a drug that suddenly costs more, a denial nobody explained, a physician who left the network, an ANOC letter the member couldn’t parse. Each of those is resolvable in a single conversation — the covered alternative, the actual copay, an in-network doctor booked before the call ends.

Switching is also a clinical event. A member who leaves mid-treatment loses the oncologist who knows the case, restarts prior authorizations, and often goes weeks without a medication while the new plan catches up. A member who stays is a member whose care does not restart from zero.

The conversation has to happen inside the ANOC or OEP window, before the decision is made. Today the plan learns the reason from a disenrollment report months later, too late for the member and too late for the next benefit year.

Every 1% of churn is roughly 130 members at $13K in annual revenue.

Reaching every at-risk member inside a several-week window has not been staffable, so plans have managed retention as an analysis problem rather than a conversation.