Most Likely to Switch: Marketing/Product Model
What feeds the high switch-risk score?
A directional model built by Marketing & Insurance Product. It is not an eligibility or plan-suitability determination.
Plan-change sensitivity history
Provider / pharmacy network disruption indicators
Prescription drug cost sensitivity
Recent service or friction signals
Prior AEP shopping behavior
Local competitive pressure
Recency of agent contact
Real implementation would need carrier data feeds, member consent, and model governance review.

Members identified by Marketing and Insurance Product teams as more likely to shop, switch, or need plan review based on plan-change sensitivity, service activity, prescription/pharmacy impacts, provider-network considerations, and local market factors.

Mock prioritization model

Model refresh date

Sept 25, 2027

Marketing/Product switch-risk mock

Members scored

350

Premier priority

Recommended window

Oct 1–20

Premier Early Booking

Model confidence

Directional

Mock indicator only

Agent action

Review & schedule

Why members are prioritized

Mock signals composing the directional switch-risk score.

Plan-change sensitivityProvider/pharmacy disruption indicatorsPrescription drug cost sensitivityRecent service/friction signalsPrior AEP shopping behaviorLocal competitive pressureLack of recent agent contact

Switch-Risk Score and Priority Recommendation are directional indicators. This prototype does not determine actual eligibility or plan suitability. Always confirm member intent before discussing specific products.

Recommended action mix

For the 42 premier-priority members.

Book Premier Early Review28

Call within 48 hours9

Send approved SMS nudge14

Service-to-review appointment4

Premier priority members

Sorted by directional switch-risk score.

Open outreach planner

Member	Risk	Tier	Why prioritized	Recommended action	Outreach	Appointment	SOA
Eleanor Watkins M-100201 · Cook County · Medicare Advantage Choice PPO	91	T1 · Premier Priority	PCP network disruption + high Rx sensitivity	Book Premier Early Review	SMS sent	Booked	SOA · Needed — not started
Marcus Powell M-100208 · Cook County · Medicare Advantage HMO	88	T1 · Premier Priority	Provider network change + new chronic condition	Call within 48 hours	SMS sent	Pending	SOA · Needed — not started
Robert Chen M-100202 · DuPage County · Medicare Advantage HMO	86	T1 · Premier Priority	Drug tier change + preferred pharmacy impact	Call within 48 hours	Not started	Unbooked	SOA · Needed — not started
Patricia Gomez M-100203 · Lake County · Dual Complete	84	T1 · Premier Priority	LIS status change + frequent service calls	Schedule service-to-review appointment	Voicemail left	Pending	SOA · May be needed
Doris Whitman M-100209 · DuPage County · Medicare Advantage PPO	82	T1 · Premier Priority	Premium increase signal + Rx sensitivity	Book Premier Early Review	Email sent	Booked	SOA · Sent to member
Henry Sato M-100210 · Lake County · Medicare Advantage HMO	79	T1 · Premier Priority	Prior plan dissatisfaction signal	Personal outreach call	Call task	Unbooked	SOA · Needed — not started
Esther Bloom M-100219 · DuPage County · Medicare Advantage PPO	73	T1 · Premier Priority	Three maintenance medications + formulary change	Book Premier Early Review	SMS sent	Pending	SOA · May be needed