Not only are older Americans living longer than in past generations, they also have multiple health problems. If Medicare Advantage plans focus on effective engagement strategies that address these issues, they can improve member satisfaction and outcomes, scores for which are weighted three times more heavily than operation measures.
Two out of three older Americans have multiple chronic conditions, accounting for 66 percent of the nation's healthcare spending, according to the Centers for Disease Control and Prevention. And baby boomers are expected to double the population of Americans over 65 in the next 25 years.
Data from a 2012 Medicare report on chronic conditions among Medicare beneficiaries shows that this expanding population is increasingly relying on self-management of their own chronic conditions within their home setting, making member engagement all that much more critical to improving health outcomes. As Medicare Advantage health plans adapt their models of care to meet members in their homes, the CMS Five-Star Quality Rating System can provide a good framework for developing the right support services within the Medicare population.
Among the most serious engagement challenges are poor adherence to physician treatment plans, including prescribed medications, and a lack of personal resources like transportation and limited finances. According to RAND, 40 percent of older adults with chronic conditions, most of them with multiple co-morbidities, fail to adhere to their treatment regimens, and many need help resolving personal, logistical or environmental barriers to adherence.
If MA plans focus on developing effective member engagement strategies that address these issues, they can improve member satisfaction and health outcomes, scores for which are weighted three times more heavily than health plan operation measures in the calculation of the overall star rating. As a result, improvements in these areas alone may have significant financial implications for an MA plan.
When designing member engagement strategies, MA plans can improve a number of key scores with a few different strategies:
Use of technology to monitor patients in between doctor visits. Care for members with multiple chronic conditions is moving from institutional settings to the home. Members can now use at-home monitoring devices that transmit their biometric data (blood pressure, weight, blood glucose levels) to their healthcare providers rather than visit the doctor regularly to perform these tests. By monitoring member data on a daily basis, physicians and care management staff can keep tabs on each member and intervene when necessary to provide telephonic nurse support, education and clinical guidance. At-home monitoring helps to prevent serious health events that lead to hospitalizations and ER visits, while also improving care efficiency. This system of monitoring allows providers to intervene more quickly before an adverse health event.
Personalized one-on-one support and guidance. Unlimited telephonic access to compassionate nurses and/or health coaches with special training in cognitive behavioral counseling techniques, such as motivational interviewing, can provide empathetic support to help members identify and develop plans for overcoming personal barriers. The key is that interactions be satisfying and fulfilling and lead to trusting relationships, in which the members feel safe to open up and talk about themselves and their personal lives. This is where a nurse or health coach can educate a member suffering from health illiteracy or help members with limited resources identify and access relevant community services.
Care coordination. The American healthcare system was originally developed to manage one chronic condition or illness at a time. Today, with two-thirds of the Medicare population suffering from two or more chronic conditions, the system needs to be adapted to provide high-quality, coordinated care for these members. Most Medicare members have multiple care providers. The current system does not facilitate communication between care providers, which leads to care gaps and inefficiencies that result in poor outcomes and higher healthcare costs. A strong care coordination program ensures members have a fully integrated care plan that is shared with their interdisciplinary care team so that they can make the most fully informed healthcare decisions. By keeping members at the center of their care plan, care coordinators are better able to track member activities and organize community resources to achieve optimal outcomes.
With this perfect storm of baby boomers, older people living longer and managing multiple chronic conditions, MA plans are in the position of needing to act quickly to implement solutions which are actionable in a challenging environment. Member engagement best practices can not only improve quality ratings measured by CMS, but can also increase a plan members' overall satisfaction, which itself contributes to higher star ratings.
Mariza Hardin is Vice President of Government Sector Solutions at Alere Health, Inc.