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Three Ways to Monitor the Health of Medicare Advantage Plan Members


A new survey from HealthMine reveals shocking findings about connecting with Medicare Advantage members who have chronic conditions.



Only 16% of Medicare Advantage (MA) plan members with chronic conditions say their plan knows when their personal health is getting better or worse, according to a new survey conducted to better understand Medicare Advantage members’ perceptions of their relationship and effective use of their health plan.

According to the survey from HealthMine, 46% responded that their plan never communicates with them about their chronic condition, and another 19% noted communication only one time per year. Despite these low numbers, 62% say their health plan does know them well.

The survey, fielded in June/July 2018, polled 781 Medicare plan members aged 65 and older with a chronic condition who are enrolled in a Medicare Advantage and/or Supplemental plan. The margin of error was 3%.

According to the National Center for Chronic Disease Prevention and Health Promotion, three in four Americans aged 65 and older have multiple chronic conditions. Top chronic conditions self-reported by Medicare members were hypertension (66%), hyperlipidemia (42%), and diabetes (25%).

“Medicare Advantage executives’ job is to align risk and quality management,” says Bryce Williams, CEO of HealthMine. “It means setting up a health plan with a network and benefits that manages members in a quality way, and adjusts for the risk the plan is managing. If plans fall short-that is ultimately reflected in Star Ratings and HEDIS quality measures.”

If members feel that their health plan knows them, but doesn’t actively communicate with them or help them manage their chronic conditions, it is an opportunity for plans to take action, according to Williams.

“Actively managing care enables payers to check off which patient services were completed and which are still needed so they can proactively identify gaps in care as well as adhere to HEDIS quality measures,” he says.

Williams offers three ways to connect with MA patients with chronic conditions:

  • Properly identify who they are, what conditions they have, and the quality of care they are currently receiving.
  • Understand what else (from a clinical and service perspective) can be done to improve their health and satisfaction.
  • Understand their thoughts, feelings, and what they are willing to do about their condition, so we can help make these life actions easier. (e.g., scheduling an appointment, refill prescriptions, etc.). “Communicate about what needs to be done and make it easy to do,” Williams says.
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