Customer Case Study

How a high-powered Medicare Advantage Plan closed gaps and improved health outcomes with Cleo

INTRO

A strategic launch and partnership that delivered exceptional results

Cleo partnered with this top Medicare Advantage Plan to implement a high-touch, data-driven intervention program. The plan’s goal was to enhance member engagement, close critical data and care gaps, and address severe health risks within the member population to advance key STAR quality measures and reduce avoidable utilization.

THE CHALLENGE

Cleo as a trusted partner for high-risk members

Despite having quality measures in place, the Medicare Advantage Plan faced a critical challenge: a significant portion of its highest-risk member population was unengaged and non-adherent, making it difficult to close essential data and care gaps and directly impacting their ability to advance key STAR quality measures. A robust solution was required to identify, engage, and manage these high-risk members effectively.

THE SOLUTION

Strategic execution with high-touch telephonic outreach

Cleo conducted approximately 130 business days of dedicated telephonic outreach focusing on meaningful member engagement and enrollment.

Key Engagement Success Metrics:

Reach and Enrollment: The outreach successfully reached 3,760 eligible members (14.2% of the total 26,386), resulting in 666 enrolled members.
SNP Focus: Outreach generated higher contact and enrollment among Special Needs Plan (SNP) members, achieving a 21.4% reach rate compared to 9.6% for Non-SNP members.
Conversion Success: Once reached, Non-SNP members demonstrated a higher conversion rate, with a 25.3% enrollment rate compared to 19.5% for SNP members.
Data Gaps Closed: Cleo significantly improved the Plan’s member data by increasing email capture from 57% in the Plan’s e-file to 88% among enrolled members.

Health Pulse assessment and engagement

The program’s foundation was the Cleo Health Pulse, a comprehensive assessment that provides a window into physical, mental, social, and healthcare experiences. This is critical for risk-stratification and program design.

Completion Rate: 74.2% of enrolled members completed their assessment, with 70.8% doing so within the first week. Cleo’s telephonic administration accounted for 82% of completions, proving the efficacy of the high-touch method.
Population Risk Profile: Health Pulse data revealed a high-risk population characterized by a heavy chronic condition burden, polypharmacy, high fall risk with functional limitations, and substantial social and behavioral health needs. These insights were mapped directly to key measures.

Specific high-touch interventions in an integrated approach

Cleo delivered tailored education, resource navigation, and behavior-change coaching to address the major risk factors identified, supporting members in accessing care and improving self-management.

Preventing Falls & Restoring Mobility

Interventions: Cleo arranged home health Physical Therapy/Occupational Therapy (PT/OT), coordinated durable medical equipment (wheelchairs, walkers, PERS), and implemented home safety modifications.

Managing Complex Chronic Conditions & Polypharmacy

Interventions: Cleo conducted medication reviews, coordinated multi-specialty care, provided disease-specific education, and supported adherence to treatment plans.

Addressing Social & Economic Barriers

Interventions: Cleo secured non-medical transportation, coordinated financial assistance, and connected members to meal delivery and community resources.

Improving Mental Health & Reducing Isolation

Interventions: Cleo screened for anxiety, depression, and loneliness; connected members to behavioral health providers and support groups; and coached caregivers to sustain engagement.

Supporting Nutrition & Physical Activity

Interventions: Cleo enrolled members in supplemental fitness programs, arranged dietitian consults, and created incremental activity plans tailored to physical limitations.

THE RESULTCleo's integrated approach translated risk insights into tangible, measurable results for the Medicare Advantage Plan:

96%

of enrolled members engaged within the last 90 days

~23

the average number of days between interactions for high-risk members, compared with 27–31 days for medium- and low-risk members

🏥

Reduced falls and ER visits, eliminated recurring 30-day readmissions, increased independence (e.g., members rejoined community exercise programs), and strengthened home safety through emergency alert systems and durable medical equipment

🩺

Improved blood sugar control, reduced dizziness and chronic pain, enhanced medication adherence, completed annual medication reconciliation with de-prescribing/dose adjustments, and reduced avoidable hospital use.

💵

Closed care gaps caused by cost and access barriers, secured non-medical transportation and meal delivery, reduced out-of-pocket expenses, and enabled timely completion of preventive screenings and specialist follow-ups.

🤲

Decreased loneliness and anxiety, improved coping skills, increased participation in support groups, and strengthened member confidence and satisfaction, leading some to refer family members for enrollment.

🍎

Enabled safe weight loss, improved diet, initiated in-home physical therapy and exercise programs, restored mobility (e.g., cleared for hip replacement surgery), and improved strength for daily activities.

WHY THIS MATTERS

Cleo's personalized support and care coordination delivered results

The partnership with Cleo provided this high-powered Medicare Advantage Plan with a robust solution to identify, engage, and manage its highest-risk members. By leveraging data-driven screening and high-touch coaching, Cleo achieved high sustained engagement and delivered concrete results across medical, social, and behavioral domains, directly advancing key STAR performance measures and improving the health and quality of life for the enrolled population.

The Caregiving Effect on Star Ratings - Medicare Advantage

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