Consumer Engagement

In the first year of the COVID-19 pandemic, when many people were having trouble accessing basic personal protective equipment, Highmark Blue Cross Blue Shield began sending out care kits including PPE and other items to support seniors at home. The response from Medicare Advantage members was so positive that what started out as a feel-good gesture has become a full-blown supplemental benefit, and the insurer continues to refine the kits to meet members’ evolving needs and ensure continued satisfaction with the plan.

Starting with plan year 2022, eligible Highmark members were given the option to receive one of 17 condition care kits. Commonly referred to as the “big blue box,” each kit is filled with a variety of items tailored to a specific condition, with a focus on member choice and high quality, speakers from Highmark and its strategic partner RR Donnelley explained during the 14th Annual Medicare Market Innovations Forum, held on March 28 and 29 in Orlando. RR Donnelley, a firm that provides marketing and business communications, commercial printing, and related services, has assisted CVS Health Corp.'s Aetna and Humana Inc. with similar initiatives.

As CMS takes multiple steps to steer managed care organizations and states toward advancing health equity across government programs, the agency’s Office of Minority Health recently put out its annual report illustrating persistent disparities in Medicare Advantage. Released for National Minority Health Month and produced in collaboration with The RAND Corp., the 2023 Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex report showed some modest improvements on clinical care measures for a few groups, but a substantial proportion of clinical care scores continued to fall below the national average for American Indian/Alaska Native (AI/AN), Black and Hispanic MA enrollees.

Compared with the traditional, fee-for-service Medicare program, the MA program serves a larger proportion of minority enrollees. The April report compared care for six groups across 44 measures: (1) seven patient experience measures based on responses to the 2022 Consumer Assessment of Healthcare Providers and Systems (CAHPS), which was conducted between March and May of last year and asked respondents about care received in the six months prior to the survey, and (2) 37 clinical care measures based on the Healthcare Effectiveness Data and Information Set (HEDIS) that is collected from medical records and administrative data and reflects care received in 2021.

Family caregivers have long been regarded as an important part of care teams for high-needs Medicare beneficiaries, especially those enrolled in Dual Eligible Special Needs Plans (D-SNPs). But there are strong cases for Medicare Advantage insurers to support caregivers as part of their broader care management strategy, as they can help improve outcomes, reduce costs and enhance member experience, according to speakers at a session of the AHIP 2023 Medicare, Medicaid, Duals & Commercial Markets Forum, held March 14-16 in Washington, D.C.

Although there is “concurrent public policy and private solution[s] and investment going on in the caregiver space,” multiple challenges exist with activating them, from identifying potential caregivers to supporting them with the training they need to identify issues such as a change in condition, observed John Mach, M.D., founder and general manager of Mach Health Care Strategies, LLC, during the panel discussion, “Achieving the Triple Aim for Medicare Members by Activating Family Caregivers.”

As marketing experts from regional Medicare Advantage plans and their strategic partners shared success stories from the recent Medicare Annual Election Period and their year-round member engagement campaigns at the 14th Annual Medicare Market Innovations Forum, there was one commonly recurring theme: Today’s MA beneficiaries are increasingly embracing technology for everything from conducting AEP research to maintaining a healthy lifestyle.

In his experience working with digital marketing agency Amsive, Dan Paladino noted that Medicare consumers are relying on digital tools to research their coverage options “early and often” and that clients have experienced a surge in digital use “across many channels” this past AEP.

Since the conclusion of the 2023 Medicare Annual Election Period (AEP), several common threads have emerged from industry reports, Medicare Advantage insurers and marketing experts. These include a slow start to the AEP, a higher rate of switching among MA enrollees, increased use of digital channels, and member confusion or frustration with certain benefits. These observations and other data may help MA insurers and their marketing partners predict future member movement and influence strategy when it comes to both marketing and benefit design.

While the midterm elections certainly created a distraction, inflation and economic concerns may have created a drag in signups, suggested Dan Paladino, vice president of healthcare client experience with Amsive, while speaking at the 14th Annual Medicare Market Innovations Forum, held March 27-29 in Orlando. At the same time, the digital marketing agency observed more people using digital tools to conduct their research about coverage, such as online educational videos and Google search. “When that happens, they’re not picking up the phone and calling as early as we would probably like and I think some of our clients would like,” said Paladino, during a panel discussion moderated by AIS Health.

Uber Technologies, Inc. announced late last month that it would embed same-day prescription delivery on its Uber Health app, expanding the offerings available to its health care provider and payer customers. Although the feature could help patients adhere to their medications and save costs for employers, PBMs and health plans, Uber faces numerous competitors in a crowded field and could have challenges getting the delivery feature covered, according to health care experts who spoke with AIS Health.

Uber Health, which launched in 2018, is primarily used for coordinating non-emergency medical transportation of patients to and from hospitals and other health care facilities. The company entered the prescription delivery business in August 2020 through a partnership with NimbleRx in Seattle and Dallas. And two years ago, the company formed a partnership with ScriptDrop to make Uber the default delivery app for a network of grocery stores and independent pharmacies in 37 states. Those stores and pharmacies already had deals with ScriptDrop, a health care information technology company founded in 2016, so they gained access to Uber’s network of drivers.

As of last year, more than 80% of physicians had inconsistent addresses and specialty information across major health insurance companies’ provider directories, according to a recent JAMA research letter. Neel M. Butala, one of the study’s authors, tells AIS Health the discrepancies can have major implications for patients and payers, including reduced access to care, delayed care and inability to accurately assess physician networks. Regulators also have a difficult time determining whether health insurers meet network adequacy requirements.

Butala adds that he and his coauthors were interested in evaluating provider directories because the No Surprises Act (NSA) includes provisions related to the subject and require insurers to maintain, verify and update their directories. Previously, CMS conducted three rounds of reviews of Medicare Advantage online provider directories, with the last one spanning November 2017 to July 2018 and finding that 48.74% of the provider directory locations listed had at least one inaccuracy. And CMS’s Center for Consumer Information and Insurance Oversight reported similar findings when it compared provider information obtained through secret-shopper calls to machine-readable provider directories in Affordable Care Act marketplace plans for plan years 2017 to 2021.

The return of Medicaid redeterminations and the resulting changes in the risk pool could mean a more expensive-to-cover mix of members for managed care organizations, according to a recent webinar convened by the American Academy of Actuaries. Experts say that Medicaid managed care organizations will likely lose healthy, employed members, but retain sicker members — and could face artificially inflated costs related to unnecessary disenrollments.

States can resume Medicaid eligibility redeterminations starting April 1, which means that private Medicaid health plans will see heavy turnover as all of their members are checked for eligibility by state Medicaid agencies. In exchange for a higher Federal Medical Assistance Percentage (FMAP) authorized by Congress as a pandemic relief measure, states agreed to stop income checks for the duration of the COVID-19 pandemic public health emergency (PHE).

Point32Health, the nonprofit health care company that was formed two years ago through the merger of Harvard Pilgrim Health Care and Tufts Health Plan, earlier this year launched a partnership with Included Health to better serve LBGTQ+ health plan members and their families.

Starting on Jan. 1, Tufts Health Plan’s fully insured commercial beneficiaries began gaining free access to Included Health’s LBGTQ+ Health product through which they can connect with care coordinators who can answer questions and refer them to services such as in-network gender-affirming care providers. Harvard Pilgrim’s fully insured commercial members will gain access to the product later this year.

Many Medicaid agencies’ “frontline eligibility” divisions and call centers are understaffed, according to the Kaiser Family Foundation’s (KFF) just-released annual survey of state Medicaid officials, which was fielded in January. That could complicate income checks and other parts of the eligibility redetermination process, which will resume on April 1 after a yearslong pause due to the COVID-19 pandemic.

State Medicaid programs are ultimately responsible for determining whether a Medicaid enrollee is in fact eligible for enrollment in the program, but Medicaid managed care organizations (MCOs) also have a hand in managing disenrollments — and have strong incentives to keep as many members enrolled as possible. Indeed, the survey found that 41 states are relying on Medicaid MCOs to “conduct outreach and assist members” as they navigate the disenrollment process; 33 states provided MCOs with “advance lists of members up for renewal,” and 26 states have sent out “advance lists of members who may be disenrolled because they have not responded to requests for information.”