AWS re:Invent 2025 - Enabling government to streamline & ensure healthcare coverage with data-WPS208

Enabling Government Healthcare Coverage with Data-Driven Strategies

Overview

This presentation by Covered California, the state healthcare exchange for California, showcases how they leveraged data, analytics, and AWS services to improve customer experience and retention. The key focus areas include:

1. Streamlining the eligibility determination process to reduce customer friction
2. Implementing personalized outreach and communication strategies to drive retention

Improving Eligibility Determination

Challenges

• 33% of customers were exiting the eligibility determination process due to discomfort with credit checks
• Potential for fraud, waste, and abuse in the system

Solution

• Partnered with Secure, a solution that uses biometrics and document verification instead of credit checks
• Integrated AWS services like Amazon Textract, Amazon Recognition, and Amazon SageMaker to power the identity verification process
• Deployed a seamless, passive verification flow that validated 98% of customers without any additional action

Results

• Reduced customer exit rate from 33% to nearly 0%
• Identified and removed approximately 5% of fraudulent transactions
• 85% of customers now go through a passive verification process

Personalized Outreach and Retention Strategies

Challenges

• Short average customer tenure of 14 months
• Uncertainty around federal healthcare subsidies expiring, potentially leading to a 33% drop in membership

Approach

• Developed a risk scoring model using data analytics and machine learning to segment customers based on factors like age, income, and premium changes
• Created thousands of personalized email, SMS, and IVR messages tailored to each customer segment
• Integrated the personalized outreach with the Amazon Connect contact center to provide customized support

Results

• 5x increase in call volume and 125% more website traffic after the initial personalized outreach campaign
• 3x improvement in customer retention rates in the first two weeks

Technical Implementation

• Used R on Snowflake to model customer risk scores and audience segments
• Integrated Salesforce, AWS Lambda, Amazon DynamoDB, and Amazon Connect to deliver personalized messages and agent support
• Leveraged AWS services like Amazon Textract, Amazon Recognition, and Amazon SageMaker for the identity verification process
• Planned future enhancements include deeper Salesforce integration for self-service and agent assistance

Business Impact

• Enabled Covered California to better serve its mission of providing affordable, high-quality healthcare to all Californians
• Improved customer experience and retention, helping to maintain coverage during a time of uncertainty around federal healthcare policies
• Reduced friction and fraud in the eligibility determination process, allowing more customers to successfully enroll
• Demonstrated the power of data-driven, personalized strategies to engage and retain customers in the public sector

Key Takeaways

• Partnering with the right technology providers who share the organization's mission and values is crucial for success
• Transforming data into actionable insights that drive meaningful customer experiences is a key differentiator
• Leveraging cloud-based services and modern analytics techniques can help government agencies deliver personalized, efficient, and secure services