Medicare Advantage: Improving the Member Experience Through Patient Engagement

At the end of each year, Medicare Advantage members come to a fork in the road: stay with their current Medicare Advantage provider or find a new option. For the MA plan, this is a critical moment. The plan spent money to attract and enroll this member.

  1. The plan invested time, energy and resources to pay and provide care for this member.
  2. The plan provided care coordination resources to direct members to the best care options and paid for Silver Sneakers to help patients stay healthy.
  3. The plan attempted to leverage its scale and relationships in the market to ensure low cost delivery when the member needed care.

Considering that most sources project it costs between five to 25 times more to acquire new customers than keep existing ones, it’s clear MA plans must do everything in their power to keep members loyal.

Member motivation

Understanding a member’s motivation can help MA plans unlock the secret to customer loyalty. Cost, coverage, doctor choice and quality are obvious considerations. Beyond that, members want assurance that this is the best option for their health. They look for differences in the type of care MA plans provide against the backdrop of their past experience. They envision a plan provider that will help them continue pursuing their personal care goals.

One beneficial way that MA plans can distinguish themselves is to extend the member experience beyond the four walls of the provider world.

Member engagement is patient engagement

For many members, the decision to stick with a plan or find a new option is a commodity choice. Considering how quickly they can get appointments with doctors and how much their co-pay is on each visit is similar to purchasing wheat flour in the grocery aisle- what is cheapest, what is easiest?

MA plans need to help members see a difference beyond convenience and cost, to see that there are products or services that can simplify their lives and help them stay healthier in a new and better way. While an MA plan can wait for members to initiate these interactions, that limits impact to those members who are already predisposed to healthy activity and behavior. Therefore, the prime mover in this continuum must be the plan.

Plans are the ones who create an environment in which members feel like they are getting value from the relationship, contributing to their goals of health and welfare. The new frontier of that environment is member/patient engagement.

Patient engagement consists of three critical aspects:

  • Simple, convenient access to information, education and care outside of a formal care setting
  • Frequent interaction and information exchange, monitoring of care status and other drivers of health including self-care and social determinants of health
  • Support for development of healthy behaviors, resulting in less frequent need for intensive treatment and overall reduction in cost of care

These seem like lofty goals. Most approaches to engaging patients in this fashion have proven to be cost-prohibitive and ineffective, deploying enormous care management infrastructure, outbound call centers, huge data environments—and ultimately, poor results. Many organizations have conducted analysis of their care management expenses only to find no positive ROI.

In this blog series we will explore the critical success factors for patient engagement in the Medicare Advantage world and what it takes to create an environment that differentiates one plan from another. Our goal is to show plans a way to help their members thrive by engaging them in their own self-care while creating experiences that are differentiating and distinctive. This exploration of patient engagement makes it easier for members to choose an MA plan that helps them accomplish their health goals.

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