Specialized Networks Open Broad Opportunities for Patient Engagement

You initiate an information search on Google. You find an article, click on it, and low and behold, an advertisement embedded in the article is related to a search you did on Amazon just the other day! Stranger yet, a coupon book from Target shows up in your mailbox featuring a deal on just the product you’ve been thinking about. What is this black magic? It’s behaviorial research and predictive marketing analytics at work of course—sophisticated algorithms tracking your behavior in order for companies to seed the products and services you were just on the cusp of wanting.

Whether we love the personalization or hate the loss of privacy, one thing is for certain—this kind of intelligence about us as consumers has become so ingrained in our lives, we expect it. It’s hard to believe our healthcare, especially from a payer perspective, hasn’t caught up yet.

Medicare Advantage Special Needs Plans may change that

Historically, MA plans have not been successful at changing networks and crafting new products around specific populations. Chronic diseases have been managed as a subset of the overall population, with specific care management practices and outreach efforts tailored to this group. However, these members have historically been considered within the context of the overall population, leveraging the same doctors, networks and benefit designs as other members.

That’s what makes 2018 so interesting. In addition to other innovations and changes in benefit design and risk, Medicare Advantage plans can develop Special Needs Plans (SNPs), networks tailored to the needs of a specific population. From the CMS website:

Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

This means that all the benefit and network structures, the supporting services, care management and transition support, specialist and primary care and telehealth and telemonitoring can be designed for a single group. In particular, if the overall network is structured as an HMO, the bulk of patients seen by a practice or clinic may be treated under this program.

Member engagement in the SNP framework

Today, physicians and their teams must sort through a variety of programs and care protocols, depending on a patient’s insurance, primary care and network affiliation and health status. Thus, specific care programs or monitoring services can be difficult to manage. If 1 in 50 patients who are seen each day are eligible for special programs, the likelihood of offering those programs, educating patients, preparing them for engagement and being able to answer questions is extremely low. Therefore, patient engagement programs fall apart at the physician office or on the lack of physician endorsement.

Now, consider the benefits of an SNP.

If most patients within a practice are in the same network, eligible for similar programs, have similar benefit structures and are being treated for similar issues, engaging patients in additional programs that are beneficial to their health becomes a standard part of practice culture.

  • Most patients will receive education and endorsement on the way out the door
  • Integrating care management information from engagement programs into EMRs and into care plans has a real return in terms of care quality
  • Office and nursing staff do not have to juggle dozens of programs in an attempt to meet the demands of a broad range of patients

It might not be quite as tailored as the Google search that leads to a Target coupon, but members in an SNP are suddenly receiving healthcare services in a much more personalized way. A way that not only improves their health outcomes, but also creates an incredible amount of loyalty (or “stickiness”) to the plan itself.

Innovation like this is not a panacea for what ails American healthcare; it will not cure all ills. But, what at first glance looks like an afterthought at the bottom of an annual memo may have the potential to recreate the care context for chronically ill patients. SNPs could relieve provider frustration, open the doors to new innovation and move the practice and delivery of care closer to home for millions of Medicare patients.

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