Medicare Advantage Plans – Keys to Success

There are several critical considerations for payers looking to build top quality, high-performing and competitive Medicare Advantage plans.

Communication is Key to Success for Acquiring and Retaining Medicare Advantage Members

Ongoing communication is critical to successfully address members’ needs.

“Open Enrollment gives Medicare Advantage (MA) members the opportunity to experience their health plan and decide if another plan better meets their needs. Loyalty to a new plan is tested by these early experiences. This makes it more important than ever that health plans ramp-up the educational efforts to clearly communicate their benefits to help members make the right choice for them initially.” – Deft Research.

Communication needs to be bidirectional, and the ability to stimulate this engagement is imperative. For MA members, satisfaction increases when they feel well-informed and engaged in their healthcare process.

This is also true for healthcare organizations. Silos still affect payers’ and providers’ ability to maximize interdisciplinary approaches to complex issues. It’s the old adage, “One hand doesn’t know what the other hand is doing.” All the data in the world cannot reduce duplicated efforts or missed opportunities to engage the provider or MA member. Payers must provide real-time, actionable data to their MA provider networks and the providers must use the information to improve patient outcomes, leverage new reimbursed benefits and lower costs.

Supplemental Benefits are a Necessity to Managing Social Determinants of Health

Payers and providers are making it a top priority to tackle social determinants of health (SDOH) for better population health outcomes. Many MA health plans have taken advantage of CMS rules regarding new reimbursements addressing SDOH by introducing supplemental benefits and that address “whole life care” and not just short-term medical needs.

Ultimately, addressing SDOH can help minimize or eliminate gaps of care, especially for high-risk, high-cost MA members.

How do you address these disparities? Offer care at the local level. Plans offering care solutions that address isolation, food insecurity and environmental factors impacting chronic conditions help provide MA members with alternative solutions and community resources to fill care gaps. Simple solutions such as carpet cleaning and air conditioners for asthmatics, Meals on Wheels for isolated seniors, and transportation to doctors’ appointments make a material impact on quality of life, as well as overall well-being for large demographic groups. Medicare Advantage plans need to empower their members to engage with new supplemental benefits and create benefits for SDOH that are left unaddressed.

Is Technology the Silver Bullet?

From interpreting data to improving patient engagement, technology plays a meaningful role in building a successful MA plan. The implementation of AI, voice assistance, telemedicine, and other technology also requires the consideration of member communication, readiness for change, and lasting, meaningful engagement. Leveraging automation and data to deliver impactful care pathways is not one size fits all. Though AI is still in the early stage of use in healthcare, the potential impact is promising. The ability to incorporate new, alternative benefits rapidly in response to member needs and changing regulations also requires a modern technology infrastructure.  Payors who cannot keep up with constant change will inevitably be left behind.

I’m excited to see how Medicare Advantage plans continue to improve care and create new opportunities for their members.