Addressing social isolation and loneliness and keeping medication costs low are on the list.
The door has closed on the Medicare Annual Enrollment Period for 2023, and the numbers are in.
For 2023, the average beneficiary had more than 40 Medicare Advantage (MA) plans from which to choose, more than double the number available just four years ago. Nationwide, almost 4,000 Medicare Advantage plans were available for individual enrollment this year, a 6% increase over 2022.
There is no reason to believe the upward trend will end any time soon. The MA market is both popular with seniors and lucrative for insurers, with 28 million enrollees and counting. MA comprises $427 billion, or 55%, of federal Medicare spending. Meanwhile, the competition for members is only getting stronger.
As a result, simply covering the financial costs of care and treatment for seniors in these plans will not be enough to stand out from the pack. MA plan leaders that expect to remain competitive in 2024 must act now to elevate the member experience and the value they provide.
Here are five steps that plan leaders should be taking as they shape their strategy:
Members are more than their health issues and expect to be treated as such. Social determinants of health (SDOH) have been shown to have a major impact on health in general. They include low-income levels, poor access to transportation and food insecurity, all of which can force some seniors to choose between meeting basic daily needs and paying for essential medications and healthcare. Progressive MA plans connect members with government programs and community resources to help pay utility bills, alleviate food insecurity and access free or low-cost transportation for medical appointments to eliminate barriers to maintaining or improving health.
In some instances, MA plans are contracting with vendors to provide in-home physician visits and in-home urgent care services for seniors with mobility or transportation challenges. Such initiatives help keep members healthy and out of the hospital. It’s an approach that not only improves health outcomes and continuity of care but also lowers costs for members and plans.
Mental health is a major factor in physical health, and research shows that loneliness and isolation, which are common among seniors, can affect outcomes in chronic health conditions such as diabetes and heart disease. Loneliness and isolation can increase the risk of heart attack or stroke by 30%. Some MA plans offer their beneficiaries “companion care” visits: someone who comes to help do the laundry, clean the house, walk the dog or even just spend time chatting over coffee. Measures like these have been shown to improve mental and physical health days as well as medication management.
The last thing seniors or their providers want is to call an MA plan with a minor issue and get stuck in a never-ending series of button pressing and elevator music, only to have to wait days for an answer. This is an area where small, geographically focused MA plans can distinguish themselves in 2024: by making it easier for seniors and their providers to get the assistance they need. Small plans may find they have greater agility than larger plans to put a personal touch on the member experience by, for example, reaching out to new members with a welcoming phone call within 24 hours of enrollment or making the beneficiary’s first appointment with their primary care provider. Leading plans also make it easy to reach a live person on the first call and to receive answers to their concerns within 24 hours.
In a turbulent economic environment, higher costs for goods and services across the board are even harder to manage for seniors, most of whom are on fixed incomes. Plans that help seniors ease healthcare costs will put themselves in a much more competitive position for 2024.
This year, a provision in the Inflation Reduction Act took effect that ensures all Part D enrollees with diabetes will pay no more than $35 per month for insulin. While this is a step in the right direction, some plans are going even further and offering zero-dollar copays for insulin. After all, as good as the cap is, it’s still $35 a month, and every penny counts. As one senior told me recently, “Copays for insulin take away from my party money.” Some plans also offer zero-dollar copays for specialist visits for eye, dental and hearing care and have begun to include dental care as part of standard MA plans, not just plans for dual-eligibles or those with special needs.
When it comes to keeping healthcare costs low, nothing beats keeping seniors off medication and out of the hospital. Incentivizing members to adopt healthy lifestyle practices, such as getting more exercise and making healthier food choices, is another way MA plans can give themselves a competitive edge while promoting member health. Some plans, for example, are hiring dietitians to visit doctor’s offices, senior centers and other venues to provide education on how exercise and nutrition can help seniors with prediabetes keep from progressing to full-blown disease. Leading plans are also forging incentive-based contracts with providers to see their MA patients more often, helping to catch health issues early.
One of the biggest complaints seniors have about MA plans is that they come across as “cookie cutter,” with little differentiation by market — even when it’s clear that seniors’ needs can vary according to where they live. In Georgia, for instance, there is a great need for benefits that help seniors more effectively manage diabetes. The state has among the highest rates of diabetes in the country. Smart MA plans will brainstorm ways to address Mrs. Jones’ needs in Georgia, which are likely to be different from Mr. Smith’s needs in Iowa. Some plans have begun covering over-the-counter medications, telemonitoring and telemedicine, gym memberships and caregiver support in response to national and regional health trends to stay ahead of the curve.
Plans can also set themselves apart by providing case management services to help members make doctor appointments and ensure post-discharge instructions are understood and followed. More and more, progressive plans also are coordinating transitions of patients from acute care settings to rehabilitation and other levels of care to protect continuity of care and maintain a seamless care experience.
Just over half of all MA plans received a four-star rating for 2023, compared with 68% in 2022. One reason for the drop: The Centers for Medicare and Medicaid Services (CMS) has put a heavier weight on the member experience in determining Star Ratings. By proactively taking steps to elevate the member experience in 2023, MA plans can increase seniors’ access to healthcare, raise their Star Ratings, and attract more members to stay ahead of the competition.
Suzanna Roberts is CEO, Sonder Health Plans, Inc., based in Atlanta.