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Saturday, Sep 23, 2023

MPulse’s Tech Has Medicaid in Mind

Since April 1, millions of low-income Americans have been thrown off the rolls of Medicaid, the government-sponsored health plan for the poor, as Covid-era protections expired and people were required to re-enroll or lose their coverage.

And according to a study from the Kaiser Family Foundation, nearly three-fourths of those taken off the rolls so far were not removed on income merits but because  of myriad paperwork snafus – from not receiving renewal instructions to not being able to produce the required documents on time.

The disenrollment process – also known as redetermination – has hit health plans with Medicaid enrollees hard. Enter mPulse.

The Woodland Hills-based digital health tech company specializes in digital engagement with enrollees of its health plan customers.

For nearly a decade, mPulse Mobile has engaged health plan members, reminding them to schedule health screenings, take their medications on time, maintain lifestyle changes to improve health outcomes and make sure they are using all the health care resources available to them.

The goal: to improve outcomes for those members, thereby helping its health plan customers save money.

The company has grown in step with the explosion of digital engagement avenues with health plan and provider-group customers, especially with the spread of telehealth and digital health-monitoring apps.

Medicaid redetermination

And now, mPulse Mobile is diving in with this latest effort, aiming to use its expertise in engaging health plan members to get them to re-enroll successfully in state-run Medicaid programs.

“Since April, we have reached out to over 7 million members with one-way and two-way (text-messaging) channels,” said Bob Farrell, mPulse Mobile’s chief executive. “We’re able to pull in information from them as well as sending them messages instructing them how to renew or re-enroll” in Medicaid.

The company has implemented 110 specific digital-engagement programs specifically for this Medicaid redetermination process.

Farrell said that many of the members the company reaches on behalf of its health plan customers don’t even know what Medicaid redetermination is, let alone that they have to take action to re-enroll.

During the Covid pandemic, the federal government suspended annual renewal requirements for Medicaid enrollees, which allowed the rolls to swell to a record 85 million earlier this year from 71 million at the start of the pandemic. But on April 1, that federal exemption ended and states were required to go through the rolls of the Medicaid programs they administer to weed out those who are no longer eligible. The process must be completed by June of next year.

But some states are tackling this aggressively, automatically removing those enrollees who do not respond or fail to meet all the paperwork requirements by strict deadlines.

Most of those who are disenrolled have been members of various health insurance plans, impacting the plans’ revenues.

One of those, Long Beach-based Molina Healthcare Inc., lost 93,000 members during the second quarter and projects losing as many as 400,000 members by the time the re-enrollment process is closed.

And this despite the managed health care giant’s best efforts to retain those members.

“When we talk to health plans, they are looking for resources on what’s out there to ensure that the highest number of patients can fill out the paperwork and get in,” said Taylor McPartland, chief executive of ScaleHealth, a Palms-based health innovation technology platform that assists health plans, providers and others looking to improve health outcomes.

Guiding members

Farrell said much of mPulse Mobile’s digital engagement with health plan members is focused on getting them to go through the renewal process as much as possible in advance of state-imposed deadlines.

But even when those members are disenrolled from Medicaid, they can re-enroll, provided they supply all the proper documentation. Farrell said that 62% of the health plan members it has worked with have successfully re-enrolled.

And Farrell noted mPulse Mobile’s work also includes helping those health plan members who are legitimately kicked off the rolls because their income exceeds the threshold.

“If they lose Medicaid coverage, there’s a special election period to enroll in another plan, be it a state exchange (Obamacare) plan or even a group health plan, and we help them through this,” he said.

Revenue boost

Farrell said that mPulse Mobile does not get paid for each health plan member it retains – or re-enrolls – in Medicaid. Rather, the company operates on a subscription model, where its health plan customers pay a fee to use its digital-engagement platform.

During the second quarter, mPulse reported that this subscription revenue increased 159% over the same quarter last year, indicating that more health plans have signed up with mPulse, in part to help boost the retention of their members on Medicaid rolls.

While the privately held company did not provide actual quarterly revenue numbers, Farrell said mPulse Mobile is on track to reach $60 million in annual recurring revenue – primarily subscription revenue – this year.

The company, which was founded in 2014, has been majority-owned by Boston-based PSG Equity since late 2021.

Farrell said that despite the boost from Medicaid redetermination, most of the company’s revenue still comes from its traditional digital-engagement programs, which have multipled over the years as communication technology has improved.

McPartland, the Scale Health chief executive, said that telehealth programs in particular require more digital engagement.

“A 15-minute telehealth session can’t live forever in a silo; it must be accompanied by more continuous engagement and monitoring,” McPartland said.

With the Medicaid determination process due to wrap up next year, mPulse Mobile has already launched another initiative: digitally engaging patients of health plans and health care provider groups – including physician practices and hospitals – to steer them away from emergency rooms when appropriate.

This emergency room-diversion program is aimed at reducing the number of times patients go to an ER for non-life-threatening situations.

“Each time a person goes to the ER, it costs health plans a lot of money and the care is often not as good quality as care provided in other settings,” Farrell said.

Emergency rooms

In addition, he pointed out that emergency rooms are often overcrowded, meaning longer wait times for everyone, including for those who really need the emergency care.

There are a lot of alternative options for patients with non-life-threatening injuries, conditions or illnesses, he explained.

“Patients can go to urgent-care facilities, or – especially now after the pandemic – engage health care practioners through telehealth services,” Farrell said. In other cases, patients could be steered to their primary care physicians or even to pharmacies.

He added that mPulse’s new software and artificial intelligence platform helps winnow down the options, asking patients a series of questions until a clearer picture emerges of the patient’s condition. Then the platform comes up with the most appropriate treatment avenue for the patient.

“The bottom line, if folks don’t know about these options, right now they just go to the emergency room,” Farrell said. “And while we don’t want to put people at risk by denying them necessary emergency care, for most people, there are better options.”

Hannah Madans Welk
Hannah Madans Welk
Hannah Madans Welk is a managing editor at the Los Angeles Business Journal and the San Fernando Valley Business Journal. She previously covered real estate for the Los Angeles Business Journal. She has done work with publications including The Orange County Register, The Real Deal and doityourself.com.

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