Consumer Engagement

Segmented, Personalized Outreach Drives MAO Retention Efforts

Medicare consumers are facing an overwhelming variety of resources and plan choices and are showing signs of increased movement during the Open Enrollment Period (OEP). As a result, effective member engagement during the OEP and throughout the year is becoming increasingly important and can be achieved through using data to segment membership and deliver targeted, personalized messaging to ensure that a member is in the right plan from the start, industry experts advised during the 13th Annual Medicare Market Innovations Forum, hosted by Strategic Solutions Network, LLC (SSN).

After the Medicare Annual Election Period (AEP) that typically runs from Oct. 15 through Dec. 7, the three-month Medicare OEP starts on Jan. 1 and allows beneficiaries who selected a Medicare Advantage plan to make a onetime coverage change. This year was the fourth OEP since it was reinstated by the Trump administration after a hiatus, and seniors’ utilization of the renewed opportunity is growing.

WellCare Kept PDP Enrollees Via ‘Conversational’ Outreach Pilot

A pilot with Drips’ trademarked “conversational texting” platform has helped WellCare significantly lower the percentage of Prescription Drug Plan policies that were being terminated due to nonpayment, according to a case study presented at the 13th Annual Medicare Market Innovations Forum, held May 11 and 12 in Phoenix.

Since WellCare was acquired by Centene Corp. in January 2020, the PDP team has been focused on “optimizing operational execution” and ensuring a positive member experience, said WellCare Senior Director of Prescription Drug Plans Talia Duany, who presented the case study with Drips. “When you’ve got 4.1 million members in an industry that’s shrinking — this year we saw the biggest [decline] in available PDP options, everyone’s moving into [Medicare Advantage] — having a robust member retention strategy” is critical.

Insurers Are Helping Patients, Providers Deal With Medical Debt

Although fewer Americans are dealing with medical-related financial hardships since the coronavirus pandemic began, the percentage is still high and could rise further as Medicaid redeterminations resume, major Affordable Care Act subsidy expansions expire and inflation eats away at people’s incomes and savings. To that end, payers are implementing ways to ease the burden of high out-of-pocket costs for patients and to help providers improve their collections, even as one expert calls the services a “Band-Aid attempt to cover the widening healthcare affordability gap.”

An Urban Institute report published on May 11 found that 16.8% of adults from 18 to 64 years old had medical debt in April 2021, down from 23.6% in March 2019. The Urban Institute cited several potential reasons for the decline, including a reduction in health care utilization, pandemic relief measures and growth in Medicaid enrollment.

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Similar Adherence Is Seen in Digital, Telephonic Offerings

To serve patients wanting the ability to refill specialty prescriptions online rather than telephoning a pharmacy, AllianceRx Walgreens Prime launched its digital service offering in late 2019. A recent study of people with multiple sclerosis (MS) revealed similar rates of adherence — measured by proportion of days covered — between people managing their prescriptions via online tools vs. telephonic engagement.

In addition to offering self-serve refill requests, the company “wanted to ensure patients using the digital clinical assessment received the same level of quality clinical care required for a specialty patient compared with patients supported by the traditional telephonic process,” says Sabeen Hasni, R.Ph., director of pharmacy quality at AllianceRx Walgreens Prime and a lead researcher of the study. After patients log in and select specialty drugs to refill, they answer operational and clinical questions specific to their condition, including their response to therapy, on-hand supply of medication and side effects. Algorithms can identify those patients who need additional support from pharmacists, and patients can request to speak with a pharmacist at any time. In addition, providers are notified when their patients trigger an intervention protocol, and pharmacists can contact them to discuss next steps in care.

With AEP Switching Low, MAOs Must Monitor Member Experience

Medicare beneficiaries have more plan choices than ever before, in addition to a dizzying array of supplemental benefits and increased PPO options, but plan switching has stalled, according to a new study from Deft Research. That leaves Medicare Advantage plans to consider whether low switching is largely due to members feeling satisfied with their current coverage or overwhelmed with the sheer amount of information being presented to them, observed industry experts during a recent webinar hosted by Rebellis Group LLC. As a result, members’ experience during the Annual Election Period may warrant a closer look as plans think about their strategy for the next AEP.

In its 2022 Medicare Shopping and Switching Study, Deft observed an overall switching rate of 11% during the most recent AEP. That’s compared with 12% seen in 2021 and 23% in 2015, reported George Dippel, executive vice president with Deft, during the March 10 webinar, “With more choices than ever, how will your Medicare Advantage plan stand out in 2023?” The annual survey featured responses from 3,389 Medicare enrollees, including 1,846 seniors who were enrolled in a Medicare Advantage plan in 2021 and 1,183 seniors with Medicare Supplemental (MedSupp) coverage. The remaining 360 respondents had Original Medicare only (OMO).

Slim Marketing Guidelines Stress Importance of Reviewing Regs

After nearly four years, CMS has released an updated version of the Medicare Communications and Marketing Guidelines (MCMG) that serve to interpret and provide guidance on the marketing and communication rules for Medicare Advantage and Part D sponsors. Compliance experts tell AIS Health, a division of MMIT, that the long-awaited document is light on additional guidance and clarification except for a few topics, and plans are encouraged to review all related regulations to stay compliant with marketing rules.

Aside from severely whittling down the document — the 2022 MCMG is now a mere 51 pages, down from 84 pages when last released as a full document for the 2019 plan year and 124 pages in the 2018 version — CMS has noticeably consolidated and reorganized sections, moving some subsections into other areas or removing guidance that was codified. The agency reminded plans that the document is to “be used in conjunction with the regulatory requirements to aid plans in understanding and complying with the regulations.”

Payers Can Play a Role in Encouraging Naloxone Coprescribing

To prevent deaths and injuries related to prescription opioid misuse, research has shown that coprescribing the overdose-treatment drug naloxone when patients on chronic pain-management therapy receive high doses of opioids can make a big difference. Yet federal data show that less than 1% of patients who should be prescribed naloxone with their opioid medications obtain a prescription for it — a rate that managed care entities can play a role in changing, according to a new paper from the Academy of Managed Care Pharmacy (AMCP) Addiction Advisory Group.

The AMCP Addiction Advisory Group in 2019 polled AMCP payer members, addiction treatment providers and managed behavioral health organizations, with the goal of understanding and evaluating “trends in treatment, coverage, policies, and needs associated with providing health services to patients with substance use disorders.” One particularly notable finding was that 80% of the managed behavioral health organizations and 47% of AMCP payer members who responded to the survey encouraged naloxone coprescribing in patients at high risk of overdose, but “no organizations required coprescribing.”

FDA Targets Misleading Influencers, Social Media Ads

Under the Biden administration, federal drug regulators have homed in on misleading or imbalanced claims on social media, and early evidence shows those efforts will be a key focus in 2022. According to legal experts, pharmaceutical companies and medical device manufacturers that turn to influencers, celebrities and popular social media channels to promote their products should heed compliance warnings.

The FDA, through its Office of Prescription Drug Promotion (OPDP), issued six enforcement letters — two warning letters and four untitled letters — to pharmaceutical companies in 2021. While drugmakers continue to operate in an era of relatively low-volume enforcement (the FDA also issued six enforcement letters in 2020, down from more than 50 warnings a decade before) the areas of focus are evolving, according to a Jan. 25 webinar hosted by law firm King & Spalding LLP.

2022 Outlook: MA Insurer Execs Plan Investments Supporting Equity, SDOH

For our annual series of forward-looking articles, AIS Health recently featured the perspectives of multiple industry experts on what Medicare Advantage stakeholders will be focusing on in 2022. For a follow-up installment, we asked several health plan leaders to share how their respective organizations will be innovating this year to meet aging members’ needs, advance health equity and address social determinants of health (SDOH) amid the backdrop of the ongoing COVID-19 pandemic.

“The pandemic emphasized how our most daunting challenge — reaching our members in a new remote, digital-first landscape — remains our most compelling opportunity. Delivering home-based care to our nearly 10 million Medicare members and equipping them with the resources they need to age in place are central to our 2022 agenda,” says Jamie Sharp, M.D., vice president and chief medical officer of Aetna Medicare, a CVS Health company.

News Briefs: Dept. of Justice to appeal 340B ruling | January 13, 2022

New drugs are becoming less expensive to bring to market and more profitable at launch, according to a new Deloitte Ltd. white paper. “Cost to bring an asset to market has declined over the past three years, as peak sales forecasts increase,” the report says. “The combined cohort’s average cost to develop an asset was $2,006 million, a decrease of $370 million from 2020....This decrease in 2021 compared to 2020 is due mainly to the overall increase in the number of assets in the late-stage pipeline.” However, the report also notes that this figure is “an increase of $710 million from 2013.” In addition, the cycle time for drug development has increased, especially since the start of the pandemic.

New Hampshire is the latest state to settle its suit against Centene Corp, accepting $21 million from the Medicaid-focused carrier. More than a dozen states have sued the health insurer, accusing Centene of mismanaging their Medicaid programs’ pharmacy benefits. As with the other settlements, in the New Hampshire agreement Centene denied it was liable for any wrongdoing or violations of federal or state statute. The insurer has paid out more than $241 million in settlements with Arkansas, Illinois, Kansas, Mississippi and Ohio out of the $1.25 billion it set aside earlier this year to settle such suits.