Wapping it All Up: The Member Engagement Program for Medicare Advantage Plans

In a previous post, we explored the imperative that Medicare Advantage plans build a trusting relationship with members. But trust is earned, so MA plans must become member-centric. Building better, more authentic relationships with members, introducing services, information and education that support the members’ goals of better health is the way to win their trust. In turn, members respond by considering other programs offered by the plan, and shed the skepticism that has historically prevented them from pursuing mutually beneficial utilization improvement.

Sound like a unicorn? It’s not.

Member engagement: a situational analysis

As people age, the frequency of their interaction with the healthcare system is an important factor in determining the quality of care.  While a middle-age member living with diabetes may not experience a change in his or her overall health status for years, elderly members may see changes within a few weeks or months that substantially change the trajectory of their health. Recent research indicates that social determinants of health have a key impact on health; furthermore, these factors change more rapidly than core health status.

For example, a member’s spouse might undergo a significant illness, leading to a prolonged hospitalization or need to be placed in residential care. For the member, this could lead to:

  • Greater economic instability, as the funds necessary to cover the costs of this treatment are not readily available
  • Greater social isolation, triggering a higher risk of depression
  • Loss of transportation, if the spouse is the primary or sole driver in the family
  • Greater risk of falls, increased risk of medication non-compliance and subsequent complications of both

These factors are rarely tracked. In the best circumstances, members are surveyed at enrollment about their living conditions. However, even once a year isn’t frequently enough to assess the impact of changing social conditions. Assessing and engaging the member quickly and on a regular basis, provides support in a way that helps them overcome unexpected changes and is the difference between healthy longevity and a rapidly deteriorating situation.

Ongoing and regular contact with members is an intimidating proposition for most Medicare Advantage plans because the typical options to deal with this scenario are either expensive or ineffective.

On the one hand, assigning every patient to a chronic care management nurse for a monthly check-in is very expensive. While this frequency of interaction would catch the member’s changing social determinants of health in a reasonable amount of time, it requires enormous overhead and staffing.

On the other hand, population health analytics have been helpful in targeting interventions but do not track any of the information necessary to predict changing social or economic conditions. Even if they did, they would likely be ineffective because the challenge of unpredictable events is just that—they can’t be predicted.

Member engagement: where the rubber hits the road

The best approach is to leverage the trust garnered through educational programs and create a low-cost, member-initiated interaction framework. This consists of a member regularly checking in with a plan-sponsored engagement program, via phone, text or mobile app. These check-ins vary, focusing heavily on health status and medication adherence on some days (particularly for those patients who have chronic conditions that require some level of maintenance or monitoring), then evaluating self-care on other days. Self-care includes measuring activities of daily living, how well they are able to manage at home by themselves or with a caregiver, and regularly conducting a depression screening and assessment of emerging fall risk.

On a slightly less frequent basis, members can be screened for changes in their social determinants of health. These include housing and income stability, safety and social isolation. Members can also receive cognitive assessments on a regular basis to determine their need for other services or to augment their primary care with additional help or therapy. The icing on the cake is that by building these assessments into daily life, members learn habits that reinforce the education received in the first phase, leading to healthier behaviors and healthier activities overall.

These are the building blocks of member engagement programs that work, they align with building better health for members to ensure that members will choose to renew their current Medicare Advantage plan when open enrollment comes around.

Interested in building a program like this for your MA plan members? We’ll show you the math and the path to improved economics and better health for your members. Contact us at info@pharosinnovations.com.

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