In many ways, Medicare Advantage (MA) is a great model for the future of value-based care. Innovative payers in this area succeed by including localized healthcare delivery, robust resources, and benefits to address the social determinants of health. The success of these plans even led the Centers for Medicare and Medicaid Services (CMS) to try to replicate a “Medicare Advantage-like alternative payment model,” according to Modern Healthcare.
However, even the most advanced models can still overlook a critical element — an effective beneficiary engagement strategy. Optimizing this process is built around three core areas: access, engagement, and education.
A powerful engagement strategy starts with access. Access is the first step to understanding and aligning on treatment plans. After all, how are beneficiaries expected to manage their care if they cannot readily and easily communicate with their doctor and care team?
While in-person appointments may be necessary for certain visits, a growing number of Medicare beneficiaries use and prefer digital communications. Unfortunately, even forward-thinking MA plans underdeliver on these digital tools, likely to the widespread, often mistaken, and ageist stereotype that older patients can’t effectively use technology. Meanwhile, data from HealthMine shows that although 47 percent of beneficiaries prefer digital communication, only 34 percent are given that option.
According to Bryce Williams, President and CEO of HealthMine, “It is clearly important that Medicare Advantage plans meet beneficiaries on their terms and cater to preferences. Through better communications, plan members can be incented to take health actions that improve their clinical outcomes.”
Two of the most powerful digital tools are telehealth and patient portals. As Graham Galka, Senior Vice President of Strategy & Innovation at Privia Health, noted, a robust telehealth platform should be built around flexibility, integration and security, and training and support. The platform should include both scheduled and immediate care options
These tools can be especially effective in care management programs. For example, primary care physicians can check in with their patient-beneficiary following discharge from a hospital. The care team can use telehealth for follow-up care, reviewing test and lab results to ensure comprehension and clarify next steps. Some patient portals automate this process to help ensure continuity of care.
Once beneficiaries have access to care, the next step is to enhance engagement. Engagement takes many forms, but hinges on proactive outreach. Reminding beneficiaries of important health screenings, sharing new tools to help manage their care, even closing care gaps using patient-reported data are all effective engagement strategies.
One way to discover which tools are most effective is through patient advisory councils. Similarly, many payers offer helpful engagement tools. One survey found that “49 percent of respondents said their payers communicate with them about important screenings. Forty-seven percent of respondents said communication is about improving health, 21 percent about a patient’s chronic condition, 19 percent about a beneficiary’s health risks, 16 percent about a member’s state of health, and 11 percent about how to lower health-related costs.”
These communications not only benefit patients by keeping their healthcare top of mind, but also decrease no-shows. A study published in Patient Prefer Adherence found that “appointment reminders have the potential to increase appointment attendance. Consequently, improved patient appointment attendance may result in improved health outcomes for patients, improved clinic efficiency, as well as increased revenue.”
Once beneficiaries are engaged, providers should offer educational resources, especially for beneficiaries with chronic or complex conditions. Using an evidence-based protocol for diabetic patients, for example, can help beneficiaries better understand — and therefore better manage — their condition.
Payers already offer many of these useful programs. As Amy Cheslock, President of Privia Medical Group — Georgia and Cumberland Region, notes, payers provide “additional benefits” to “connect beneficiaries with accessible services in their communities to address the social determinants of health.” CMS also offers useful tips for education through its “Beneficiary Engagement Toolkit.”
Ultimately, the engagement of Medicare beneficiaries comes down to meeting patients where they are. Understanding their preferences and finding tools to meet these demands are great first steps for physicians looking to improve their performance with Medicare Advantage.
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