Medicare changes are here to stay. 3 ways health plans can support members through them

Annual enrollment period is upon us, and many Medicare beneficiaries are encountering changes in their provider networks, benefits and plan offerings.

These changes can understandably create uncertainty, particularly for seniors who depend on predictable access to care and medications. The forces driving these shifts are not particularly new: rising medical and pharmacy costs, changing regulatory requirements and growing pressure on plans to deliver both affordability and value. The urge to understand these shifts as a phase that ends with the next administration or some entity finally reigning in big industry offenders is tempting, but that’s not reality. Keeping Medicare viable is going to require constant reform, so we should expect disruptions to continue.

While much of the discussion of change has focused on the operational challenges facing health plans, the most important question is what these changes mean for members and how health plans can help them navigate transitions successfully.

Roughly 10% of all Medicare Advantage members across the country — nearly three million Americans — have already been affected by plan pullouts and network changes over the past two enrollment cycles as plans overhaul or redesign their offerings to remain financially viable in the face of rapidly climbing medical and pharmacy costs. While this has kept many plans solvent, it has also created real pain for real people.

While plans often view these shifts through the lens of market sustainability, beneficiaries experience them more personally. They want to know whether their doctor is still in network, whether their medications are covered and whether they can continue receiving care without interruption. Those concerns are understandable, but they are only one part of a broader transformation occurring across Medicare Advantage.

Providers, brokers and health plans are all adapting to changing market conditions while working to meet the needs of the populations they serve. In this environment, stronger partnerships and better coordination aren't just nice to have, they're essential. Health plans have a responsibility to ease the pains caused by these market disruptions. There are three things worth doing right now.

Lean into technology to prevent surprises

First, redirect consumer innovation efforts toward technologies that members want to use, and others that help catch problems before they occur. Seniors are no longer the technology holdouts that too many people still assume. Plenty of members well into their 80s are navigating apps just fine, assuming the design and experience is intuitive. Speaking from experience, they will use apps that help them price-check medications or find the right care.

Behind-the-scenes tech is just as important in the current market. Health plans can get ahead of consumer concerns with algorithms that flag which members are about to lose access to a provider, benefit, or medication before their renewal letters go out and get a real person or a clear next step in front of those members early.

Build stronger partnerships across the healthcare ecosystem

Second, plans should build provider and broker partnerships that are actually partnerships. That means bringing providers into network and benefit design conversations early so plans and provider organizations can work together to support members through changes. Plans and providers will not always define success in the same way. Strong partnerships create a process for resolving those differences without compromising access, affordability or quality.

Health plans must also recognize the expanding role brokers and advisors play in helping members navigate change. Brokers today are doing more service work than ever. Health plans should ensure they have the tools, information, and incentives needed to help members successfully navigate change. When trusted advisors are equipped to serve beneficiaries effectively, members are more likely to understand their options, avoid disruptions and maintain confidence in their coverage.

Make navigation simpler and more personal

Third, health plans need to make healthcare navigation simpler, more proactive and more personal. Too often, members only learn about changes after they have already been impacted by them. Health plans should be using data, digital tools and human support to identify potential disruptions early and engage members before a problem arises. Whether a member is changing plans, losing access to a provider, transitioning between programs or managing a new health condition, the experience should feel guided rather than overwhelming.

Technology can help, but it is only part of the solution. Members still value trusted support when making important healthcare decisions. That support may come from a broker, care navigator, customer service representative or clinician. The goal is the same: ensuring members understand their options, can access the care they need and feel confident about the next step in their healthcare journey.

Members have a part to play, too. Those who come out on the other side of a transition having experienced the fewest surprises will be the ones who have actively engaged in the process. They’ve confirmed their doctors are still in-network, that their prescriptions are still covered, and have contacted their plan if something looks off. Plans should be seeking these points of contact. A member who is given an opportunity to ask questions in autumn is a lot less likely to be caught off-guard come January.

A successful transition is one where members don't experience coverage surprises, gaps in care or confusion about where to turn for help. The market will continue to change, and more disruptions will inevitably come. The health plans that stay beside their members through it all will be the ones those members choose to stay with.

Gary Culp is senior vice president of government markets at Blue Shield of California.