Skip to main content

At Softheon Technologies, we help health plans ensure their members are receiving the right care in the right place. Our commitment, as you would expect, extends to members’ mental and behavioral health. That means we support health plans and their efforts to be sure members are receiving the care they need to help with mental health conditions, also in the right place.

Take, for example, our work with a leading national plan’s commercial population.

The plan sought to affect trends for adult members or members over 18 years old with mild behavioral health diagnoses such as depression and anxiety by redirecting them to more appropriate care settings. In short, our collaboration to drive members with mild and moderate mental health diagnoses to virtual mental healthcare worked. For these members, the lift for virtual behavioral health visits was 127 per 1,000 members per year. The lift for non-behavioral health visits to virtual care was nearly 30 per 1,000 members per year.

Let’s take a deeper dive to show you how.

The COVID-19 pandemic exacerbated an already increasing trend of mental health needs. Mental health episodes can result in shorter-term spikes in costs such as emergency department and inpatient and unmanaged mental health can lead to declining self-care and management of other chronic diseases. Knowing this, our health plan client wanted to invest in promoting mental health services to their members with a history of mild to moderate mental illness.

How Softheon Measured the Plan’s Impact

The health plan used the Softheon platform to measure the impact of its program. Internally, Softheon had two departments working on this project:

  • The Client Programs and Analytics team analyzed the data and
  • The Engagement Experience Expertise (E^3) team used the data insight to tell the story that explains the whole picture.

With a short-term goal of increasing virtual mental health utilization and a longer-term goal of cost avoidance, Softheon segmented the plan’s 150,000 national commercial members with a mild behavioral health diagnosis documented in a claim since January 1, 2019, into seven cohorts. Based on our analysis of member demographic, clinical, specific behavioral health diagnosis and utilization data, Softheon created seven cohorts:

SegmentSegment NameSummary Description% of PopulationPopulation Size
1Help Me Harper“Extraordinary high utilizers, older commercial members”1.2%1,869
2Anxious Anita“Younger women, utilization trends point to these members being healthier, highest rates of General Anxiety Disorder”2.7%4,262
3Down Drew“Average commercial age men and women living in affluent, low-poverty areas with low to moderate RX spend. Tenured with medical plan and bigger ‘families’ (dependents)”11.5%18,258
4Busy Bree“Primarily women of all commercial ages, the lowest amount of bipolar disorder rates, overall low utilization including preventative care, live in higher poverty areas”19.5%31,122
5Cardiac Carrie“Mostly women with high PCP visits rates and cardiovascular disease. High RX spend but low to moderate ER usage”17.6%28,065
6I’m Fine Frank“All male cohort who are younger, newer medical plan members and healthier based on utilization and RX use. Live in semi-affluent areas”17.2%27,442
7I’m Fine Fran “All female cohort who are younger, newer medical plan members, and have few or no dependents. Lives in affluent areas”30.4%48,421

Each of the seven cohorts were directed to different interventions. As you can see in the chart above, the Busy Bree group is mostly female, of all ages, lowest amount of bipolar disorder, low utilization, and higher poverty areas. It is a group whose characteristics suggest more social determinants of health impacts such as lower median income and higher urbanization.

Together with the health plan, we created customized collateral and messaging to use in February 2021 with a 6-month re-nudge in August 2021. We compared Busy Bree cohort members who:

  • Only engaged with the February 2021 collateral,
  • Only engaged with the August 2021 collateral,
  • Engaged with the February and August 2021 collateral, and
  • Engaged with neither collateral.

We found the Busy Bree members directionally used more virtual behavioral health services until the $0 benefit ended in June 2021. Similar to many health plans in the country, this plan was providing a $0 telehealth benefit to its members in response to Covid-19. This benefit expired in mid-2021. Primary care physician utilization by these members increased after the benefit change, but additional behavioral health services did not. 

Campaign Trends: Virtual Behavioral Health Visits per 1,000 Member per Year

The Softheon analysis also identified optimization opportunities for the Busy Bree cohort, which were to include more concrete price estimates for this group and dive deep into claims to determine if these members are now being managed by their primary care physicians.

Campaign Trends: Primary Care Visits per 1,000 Members per Year

Likewise, Softheon analyzed the other six cohorts, creating customized messaging and identifying optimization opportunities. With Down Drew and Cardiac Carrie cohorts, we determined these members will use telehealth but are not loyal to a telehealth vendor partner over their known providers. The driving difference between these member cohorts and the other cohorts is their age, chronic conditions, and dependents on their plans. For the Fine Frank and Fine Fran cohorts, these members are more likely to continue accessing virtual behavioral healthcare if they get engaged early in the calendar year. The key difference for these cohorts (Fine Frank and Fine Fran) are younger commercial members, higher income, no dependents, and relatively healthy otherwise when compared to the other cohorts.

After we completed the analysis, we saw huge improvements in member outreach from February 2021 to February 2022. We saw a 14% increase in open rate with an open rate as high as 42.5% and our click-through rates doubled peaking at 6.2%. Our improvement came from applying learnings from our outreach in 2021.

As you know all too well, health plan members often make sub-optimal choices when deciding whether and how to access care. Our nationwide behavioral health study shows that Softheon can help your members make the better choice to access virtual mental healthcare. To learn more, visit

Anne Taylor is the manager of the E^3 (Engagement Experience Expertise) department within Client Services. She uses creativity, industry knowledge, and expertise to deliver client program optimization and strategy. Previously, Anne worked in clinics, hospitals, and health systems, leading process improvement initiatives.

Anne has a master’s degree in Health Care Administration and Management from the University of Cincinnati and a bachelor’s degree in Community Health from the the University of Illinois Urbana- Champaign.