Early Q1 Preventive Visits Reduce Avoidable Costs by $640 PMPY and Improves Adherence by 14%

By Sai Balusu

Executive Summary

N1 Health’s multi-year, multi-market analysis of Medicare Advantage and ACA members shows that completing a preventive visit in Q1 leads to a $640 PMPY reduction in avoidable medical expenses and a 14% increase in medication-adherence rates compared to those who complete a visit later in the year. This represents an annual savings of $6.4M for every 10,000 members.

Health plans often wait until mid-year to engage these members and get them to complete a preventive visit, missing a critical early window when behavior and trust are easiest to influence. This often leads to Q4 sprints with members being bombarded by a large number of messages coming from all parts of the health plan organization.

This post outlines what health plans should do instead, and how N1’s consumer data and predictive models enable health plans to change their operational workflows and implement coordinated engagement campaigns early in Q1. This ensures that members receive care sooner and leads to increased visit completion rates, improved CAHPS and Star ratings, and reduced long-term medical costs.

Key Insight: Early Q1 Engagement Leads to Increased Cost of Care Savings

Across multiple health plans and lines of business, members who completed a preventive visit in Q1 had significantly improved outcomes vs similar members who completed the same visit later in the year — including a reduction in avoidable medical spend by $640, and a 14% increase in medication adherence. Our analysis defined preventive visit types as inclusive of general preventive visits, Annual Wellness Visits (AWVs), and Well Child Visits (WCVs).  

Early engagement isn’t just “nice to have”, it directly drives measurable outcomes. For every 10,000 members that complete a visit early, a health plan stands to save $6.4M in medical costs annually.

Table 1: Clinical outcomes in members that completed a Q1 visit vs later in the year1

Outcome MetricPercent Decrease
ED Visits9-13%
ED Days13-21%
IP Visits17-40%
IP Days19-50%

1 Please find detailed description of statistical methodology and outputs of analysis below.

Early Q1 engagement isn’t just clinically beneficial; it creates operational breathing room and sets the entire year up for success. Today, most members are inundated in Q3 and Q4 with overlapping outreach for AWVs, quality gap closure, medication adherence, and other initiatives. That concentrated surge of messages overwhelms members, creates confusion, and dilutes engagement.

By shifting preventive outreach into Q1, health plans can smooth operational demand across the year and build stronger habits with members earlier, before outreach fatigue sets in. Members who complete preventive visits in Q1 establish better care patterns, respond more consistently to future outreach, and face fewer downstream barriers to follow-through. In addition, with members receiving fewer overlapping messages later in the year, the remaining Q3–Q4 outreach becomes more effective and less abrasive, reducing member frustration while improving plan performance and retention.

What Health Plans Should Do Next

Health plans should treat January through March as the foundation-building period for member behavior. Early engagement isn’t just about closing one visit; it’s about helping members get the right support from day one by addressing their specific care barriers and building strong long-term habits for their care. This is especially critical for rising risk and historically unengaged members who benefit most from structured guidance about the healthcare services they can access earlier in the year.

The beginning of a new plan year often serves as a natural reset for members, prompting them to reprioritize health, revisit care decisions, and adjust routines. Combined with plan-related changes—such as PCP selection, benefit updates, or medication changes—this period can reveal engagement barriers like transportation limitations, caregiving demands, or gaps in digital access. By identifying these circumstances early, health plans can pair preventive visit scheduling with proactive, tailored support such as personalized supplemental benefit guidance (e.g., free transportation for medical appointments), mail-order pharmacy enrollment, and member education that improves medication understanding and care literacy. This early, personalized support builds trust, reduces abrasion, and sets members up for sustained success throughout the year.

Most health plans cannot — and should not — attempt to engage all members at once. Operational capacity, call-center bandwidth, care management, and provider scheduling constraints make blanket outreach impossible. Instead, health plans must use individual level data and predictive models to identify specific needs members have and prioritize the member outreach accordingly. Without this prioritization, outreach becomes diluted and ineffective.

How N1’s Technology and Services Make This Possible

Early-year engagement only works when health plans know which members to prioritize and what support each member needs. N1 makes that possible through three core capabilities:

  1. Predictive models that identify rising-risk and hard-to-reach members
    • Our models analyze thousands of factors such as social risk, care patterns, utilization, gaps, adherence signals, chronic conditions, life transitions, and pinpoint members who are most likely to:
      • Delay preventive (inclusive of preventive visits, AWV visits, PCP visits)
      • Experience avoidable ED or inpatient events
      • Become non-adherent and have open gaps in care
      • Churn from the plan
  2. Member-level data that uncovers each person’s unique needs
    • We leverage hundreds of data elements per member on life events, behavioral indicators, and household characteristics, that reveal what barriers members are facing right now, including:
      • Recent moves or PCP changes
      • Digital divide indicators
      • Transportation constraints
      • New medications and care transitions
      • Health literacy challenges
      • Caregiver or household burden
  3. Personalized outreach workflows that scale
    • Our Customer Success and Data Science team convert these model outputs and member insights into tailored outreach strategies that meet members where they are:
      • Outreach that adjusts to the member’s risk, preferences, and barriers
      • Recommended timing and channel mix for each member
      • Content templates that speak to the member’s real situation

These capabilities allow Health Plans to operationalize Q1 outreach at scale; not by contacting everyone, but by prioritizing and focusing on those members who need it the most and will drive measurable improvements in retention, cost of care, and Star ratings.

N1 brings the expertise of designing and running these programs across the industry for nearly a decade. We bring the best practices in intervening early, supporting members from day one, building long-term care habits, and meaningfully impacting member outcomes. By aligning predictive intelligence with personalized engagement, our product enables a proactive Q1 strategy that consistently improves retention, adherence, CAHPS, and lowers avoidable medical expense.

If you want to understand which members to prioritize in Q1, and how much financial value is at stake, we can run this analysis on your population within days. Let’s talk about building your Q1 engagement plan!

Proactive Q1 engagement applies to both high-risk members, and new members. Check out this article to understand how the right New Member Engagement strategy can lead to 2-5% increased retention. In addition, an upcoming article will highlight how N1 can combine both strategies to identify the right members that need to be engaged early in the year and ensure a tailored member engagement strategy that leads to long-term member retention, reduction in avoidable medical expenses, and improvement in the overall member experience.

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Statistical Methodology

To quantify the true impact of early-year preventive visit engagement for members, we aggregated and analyzed multi-year datasets from multiple health plans spanning different geographies and lines of business. The objective was to isolate the causal effect of members completing a preventive visit in Q1 on downstream cost of care and quality outcomes.

To do this fairly, we used a technique called propensity score matching, which ensures we’re comparing apples to apples—not healthier, more engaged members against those who were already at higher risk. This method controls for factors like age, chronic conditions, past utilization, social risks, transportation difficulties, digital access, health literacy, household characteristics, income indicators, and more. After matching, all covariates were balanced within a 3–5% standardized difference, indicating strong comparability. The results were statistically significant (p < 0.001), meaning the observed retention lift is unlikely due to chance.

This reduces bias and ensures the difference in outcomes reflects the impact of engagement timing, not pre-existing differences in the populations. It gives us confidence that the $640 annual reduction in avoidable medical expenses, and the 14% increase in medication-adherence rates are truly driven by early engagement and not external factors. It’s a rigorous approach health plans can trust to represent a real, viable opportunity.

Early Q1 Engagement of New Members Drives 2-5% Higher Plan Retention

By Sai Balusu

Executive Summary

New ACA and Medicare Advantage members who receive personalized, proactive outreach and complete preventive visits in Q1 show a 2–5% higher retention rate by the end of their first plan year, according to N1 Health’s findings across multiple health plans. For every 10k new members, this retention lift translates up to $6m of retained revenue and up to $1m of margin.

This insight matters because health plans often wait until mid-year to engage new members in completing a preventive visit, missing a critical early window when behavior and trust are easiest to influence. Building member trust with early coordinated engagement directly influences CAHPS, Stars, and long-term medical cost trends.

This article outlines what health plans should do to provide new members a best-in-class experience to increase retention, and how N1’s consumer data and predictive models can enable this through personalized, high-impact engagement at scale.  

Key Insight: Early Q1 Engagement for New Members is a Critical Retention Lever

Q1 is uniquely powerful. Across multiple health plans and markets, new members who complete a preventive visit in Q1 show 2% to 5% higher retention compared to those who engage later or not at all.1

1 Please find detailed description of statistical methodology and outputs of analysis below.

During Q1, members are forming impressions, resetting healthcare habits, and deciding whether the plan experience feels simple or frustrating. We’ve all been there, right? Historically, outreach campaigns start in Q3–Q4 which is much too late to influence trust, utilization, or satisfaction for the plan year. The cost of inaction in Q1 is increased avoidable medical cost, decreased member retention, and worse quality ratings.

Early engagement isn’t just “nice to have”, it directly drives measurable outcomes. For every 10k new members, this retention lift translates up to approximately $6m in retained revenue and up to $1m in margin – before accounting for additional downstream savings related to avoiding preventable medical events, increased quality gap closure, and improved Star ratings.

Personalized, proactive engagement matters. Identifying new members’ specific needs, addressing barriers to care, and delivering coordinated, personalized communications are key strategies to boost preventive visit rates and reduce disenrollment and dissatisfaction.

What Health Plans Should Do Next

To provide a differentiated new member experience and stay competitive in the market, health plans need to run a proactive campaign in Q1 targeting new members early with personalized messaging aligned to their specific needs, encouraging them to schedule a preventive visit, and help them overcome any hurdles they face in their care journey.

  • Use predictive models to identify who is least likely to engage on their own — and what channels/times are optimal.
  • Remove barriers by providing quick PCP/AWV appointment scheduling links, PCP selection support, In Home Assessment options, and benefit education tailored to each member.
  • Monitor engagement in real time and adjust frequency, messaging, outreach channels, and time of day based on lift.

This creates a high-trust first experience and increases the likelihood of long-term plan engagement.

How N1’s Technology and Services Make This Possible

The biggest challenge most health plans face is not knowing enough about these members because they are new to the plan and therefore lack any historical data. This prevents health plans from creating tailored messages and delivering a positive, unique, member-centric experience. Instead, health plans blast one-size-fits-all onboarding messages to all their new members, increasing member abrasion and eroding member trust.

This first engagement is uniquely powerful to create a successful long-term relationship with the member and earn durable member trust. N1 helps health plans maximize the impact of this first engagement by using predictive models and individual-level consumer data to pinpoint which new members need early engagement and what unique message will resonate the most for each member.

We operationalize the entire workflow—identifying members, prioritizing outreach, creating personalized messages, and orchestrating channels. This makes proactive Q1 new member engagement personalized, scalable, measurable, and outcome driven.

Health plans using our approach consistently see higher AWV completion, stronger member retention, and lower avoidable cost in members’ first year on the plan. For example, a national ACA plan using N1’s data and models to personalize their new member experience, saw a 46% increase in new member AWV completion rate, and a 3% increase in retention rate compared to the established control group.

Q1 is the time to act! If you are interested in understanding the retention, Stars, and financial upside for your New Member population, our team can run a cohort analysis and build a ready-to-execute Q1 New Member Engagement plan. Reach out to our team to see how predictive, personalized new-member engagement can work for your plan in just a few weeks.

Proactive Q1 engagement applies not just to new members, but also to historically unengaged, and high-risk members. An upcoming article will highlight how N1 can help identify the right members (new, unengaged, and/or high risk) that need to be engaged early in the year with a tailored member engagement strategy to ensure members are retained long-term, reduce avoidable medical expenses and improve the overall member experience.

____________________________________________________________________________________________________________________________________________

Statistical Methodology

To quantify the true impact of early-year preventive engagement for new members, we aggregated and analyzed multi-year datasets from multiple health plans spanning different geographies and lines of business. The objective was to isolate the causal effect of new members completing a preventive visit in Q1 on downstream retention and experience outcomes.

To do this fairly, we used a technique called propensity score matching, which ensures we’re comparing apples to apples—not healthier, more engaged members against those who were already at higher risk. This method controls for factors like age, social risks, transportation difficulties, digital access, health literacy, household characteristics, income indicators, and more. After matching, all covariates were balanced within a 3–5% standardized difference, indicating strong comparability. Results were statistically significant (p < 0.001), meaning the observed retention lift is unlikely due to chance.

This reduces bias and ensures the difference in outcomes reflects the impact of engagement timing, not pre-existing differences in the populations. It gives us confidence that the 2%–5.5% lift in retention is truly driven by early engagement—not external factors. It’s a rigorous approach health plans can trust to represent a real, viable opportunity.

N1 Health’s HITRUST R2 Renewal: Data Security Leadership

By Taylor Yarn, Chief of Staff, Head of Information Security at N1 Health, Jacob Luria, President at N1 Health, Hannah Reale, Delivery Lead at N1 Health

In today’s interconnected healthcare landscape, data security isn’t just a best practice – it’s a necessity. At N1 Health, we understand this implicitly. That’s why we’re thrilled to announce we’ve achieved HITRUST Risk-based, 2-year (R2) Certified status for the second consecutive time. This significant accomplishment underscores our unwavering dedication to safeguarding sensitive patient data and upholding the highest security standards in the healthcare industry.

What Does HITRUST R2 Certification Mean for You?

HITRUST R2 certification isn’t easily earned. It represents a rigorous, widely recognized security framework that evaluates an organization’s ability to manage, protect, and control sensitive information. For N1 Health, achieving this certification means we’ve met stringent regulatory requirements and industry-defined best practices for data security. Specifically, it validates our commitment to:

  • Data Privacy: Protecting patient information from unauthorized access, use, or disclosure.
  • Data Integrity: Ensuring the accuracy and completeness of patient data.
  • Data Availability: Maintaining continuous access to critical data systems and information.
  • Compliance: Adhering to relevant regulations like HIPAA, GDPR, and other applicable standards.

Why is HITRUST R2 Certification So Important?

In the increasingly digital world of healthcare, data breaches are a constant threat. HITRUST R2 certification provides our clients and partners with the confidence that:

  • Your Data is Safe with Us: N1 Health employs robust security measures to protect sensitive patient information.
  • We Prioritize Compliance: We are committed to exceeding the highest standards of data security and regulatory requirements.
  • Our Solutions are Trustworthy: N1 Health delivers reliable and secure technology solutions that support the delivery of exceptional healthcare.

N1 Health’s Ongoing Commitment to Security

Our second consecutive HITRUST R2 certification isn’t just a one-time achievement; it’s a testament to our ongoing investment in data security. We continually invest in:

  • Advanced Security Technologies: Implementing cutting-edge firewalls, intrusion detection systems, and encryption technologies to protect our systems and data.
  • Regular Security Assessments and Audits: Conducting ongoing security assessments and penetration testing to proactively identify and address potential vulnerabilities.
  • Comprehensive Employee Training and Awareness: Educating our employees on security best practices and the critical importance of data protection.
  • Continuous Improvement: Regularly reviewing and enhancing our security controls to adapt to the ever-evolving threat landscape.

The N1 Health Promise

At N1 Health, we understand that data security is paramount in the healthcare industry. Our repeated HITRUST R2 certification demonstrates our unwavering commitment to protecting patient information and providing our clients with the highest level of trust and confidence. We will continue to invest in our security infrastructure and strive for excellence in data protection, ensuring your data remains safe and secure in our hands. We believe that security is not just a feature, but a fundamental principle upon which we build our solutions and relationships.

How to Improve Medicare Star Ratings Using Data Insights

By Jacob Luria, President at N1 Health, Nick Kamireddy, Senior Director, Strategic Partnerships at Arcadia 

Medicare Star Ratings play a crucial role in assessing the quality and performance of health plans. Improving your Star Ratings means enhancing the quality of care you provide to members, increasing engagement, and driving better outcomes.

A data-driven approach is paramount to this endeavor because it provides the context necessary to identify performance gaps, deliver personalized members experiences to rectify them, and monitor your progress over time. Let’s explore how you can harness data to improve your payer Star Ratings and the overall member experience.

Identify performance gaps and opportunities through personalization

Health plans have tremendous amounts of data that are available to drive member Star gains. Use data analysis tools to identify patterns or outliers that indicate opportunities for improvement. Extract insights from healthcare data such as:

  • Claims data: Analyze patterns in care utilization and delivery through performance metrics such as readmission rates and length of stay. Then, plan personalized improvement by tailoring treatment plans to identified individual risk profiles.
  • Electronic health records (EHR): Use clinical data, including treatment plans and outcomes, to track member progress over time. With this EHR data, you can develop customized treatment plans to accommodate individual member needs based on their clinical history.
  • Member satisfaction surveys: Identify ways to improve the member experience based on their direct feedback through satisfaction surveys. The specific concerns or preferences raised in these surveys may provide clear opportunities for improvement.
  • Benefit utilization: Track the use of health insurance benefits, such as diagnostic tests and specialist visits, to understand member adherence to recommended services. Based on any patterns identified, develop a plan to proactively address member health priorities through preventive screenings or services and education programs.
  • Engagement and touchpoint histories: Touchpoint history across various channels, such as telehealth consultations or a member portal on your website, can reveal important engagement data to guide future member outreach efforts. Implement this data into your member communications plan to craft outreach around their habits and preferences.
  • External consumer data: Gain a comprehensive understanding of members’ needs and preferences by integrating external consumer information with health data. These insights into their lifestyles and behaviors outside the healthcare system can help you address social determinants of health (SDoH) and tailor health promotion efforts to individual needs.

Analyze this data to not only identify gaps in preventative care services, disease management, and other offerings, but also reach members where they are.

Target interventions based on data analysis

Data analysis empowers providers to plan their approach to personalized care — but to improve your Star Ratings, you must act on the insights gathered from your analysis. After identifying performance gaps and member needs, target key interventions such as:

  • Care management programs: Using data about high-risk members and complex health needs, work with providers to implement care management programs by assigning care coordinators to monitor members’ health statuses and educate members in need. Arcadia recommends using dedicated care management software to support cohort identification, resource allocation, and impact measurement.
  • Preventive care initiatives: Promote preventive care measures, such as immunizations and health screenings, and use benefit utilization data to target your outreach. This might include feedback mechanisms like member reminders to ensure they are notified and aware of relevant preventive care services.
  • Medication adherence campaigns: Improve member adherence to prescribed medications by educating and reminding members about the importance of adhering to their recommended medication regimen. Use pharmacy refill data and member self-reports to identify members at risk of non-adherence and offer medication counseling and other support programs to encourage adherence.
  • Chronic disease management programs: Identify members with chronic conditions who are not meeting quality benchmarks and plan interventions to support improved outcomes. Offer member self-management tools, remote monitoring devices, and other resources to go a step beyond personalized care plans and empower members to actively manage their long-term health conditions.
  • Benefit Utilization Campaigns: Offer members specific benefits related to their personas to increase likelihood of positive, value-add encounters so drive higher plan experience scores. Using consumer data allows for personalized offers that drive member satisfaction.

Additional data, such as digital personas that are aligned to benefits, help predict the best content and channels for campaign communications. For example, you may tailor content to resonate with a specific persona’s health needs and concerns. Then, deliver this content via a channel that this persona is active on based on member engagement and touchpoint histories.

Monitor Star Ratings over time

Improving your Star Ratings is important for delivering the highest quality of care possible, which directly impacts enrollment, retention, and reimbursements. However, you must sustain these gains over time to deliver high-quality care and maintain a competitive edge.

To do so, facilitate continuous monitoring of your Star Ratings and the factors impacting it. Healthcare payer analytics solutions are invaluable tools that support this process through the following capabilities:

  • Data integration and aggregation: By centralizing data across various sources, payer analytics solutions provide a comprehensive view of performance data relevant to Star Ratings. This way, you can analyze your performance from every angle and benchmark your performance against industry standards.
  • Predictive analytics: High-risk members are most likely to impact Star Ratings. Payer analytics solutions can identify these members and help providers proactively target interventions to prioritize care management efforts for high-risk populations.
  • Workflow optimization: Healthcare payer analytics solutions can identify opportunities to streamline workflows, such as reducing administrative processes and enhancing care coordination. These process improvements allow you to make better-informed care decisions, enhancing the overall quality of care provided.

Regularly monitoring your Star Ratings also empowers you to adapt to changing healthcare conditions as necessary to meet evolving member needs and industry standards. Data insights from an extended period can help you identify long-term trends and patterns affecting care and engagement. This way, you can predict individual members’ needs to connect with the non-engaged.

Data is the backbone of informed decision– making in member care and engagement. Meaningful improvements to your processes and care delivery will be reflected in your Star Ratings, making it a focal point for measuring enhancements to your quality of care. Invite feedback from members to prioritize their experience and drive improvements not only to your Star Ratings, but to their overall care experience.

N1 Health wins coveted KLAS Research Peak Award for Innovative, Scaled Use Cases

N1 Health was pleased to present two Points of Light case studies with great partners Tyler Creager Traci Massie in Salt Lake City this week with our efforts earning the K2 Peak Award.

These case studies represent the best of personalization in health care – increasing member engagement to primary care, creating stable revenue growth for key product lines, and adding abilities for care givers to meet members where they are. This award demonstrates how campaigns of 150,000 member campaigns can be personalized and earn tremendous business results.


“I congratulate the newest winners of the K2 Peak Award for outstanding payer-provider collaboration. This recognition serves as a testament to the remarkable possibilities that emerge when healthcare executives and their partners unite with a shared goal of enhancing healthcare outcomes” – Adam Gale, CEO of KLAS.

Changes to Medicare Advantage Creating More Challenging Business Environment

While attending the Medicarians Conference in May 2024 it has become clear – Medicare Advantage is a more challenging business than in the years before.

N1 Health shared perspectives on how AI and personalization not only drives a better member experience – it does so with less cost to drive more effective outcomes. It is clear many plans are embracing this opportunity to rethink key business process and ways to meet their members where they are and others are not.

We believe that those who adopt the practices of successful consumer-driven organizations will be the winners of Medicare Advantage in the post 2024 world.

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