Consumer Engagement

Medicare Advantage insurers can’t share the juicy details of their new plan offerings until Oct. 1, but they are taking steps to prime the market and help boost enrollment during the 2024 Annual Election Period (AEP) with “preheat” strategies. Such efforts are often used to create or reinforce brand awareness in the month or two leading up to the AEP, and some insurers are shifting more dollars to this channel as consumer switching is expected to rise again this year, marketing experts tell AIS Health, a division of MMIT. (Warning: The following article contains an abnormal amount of marketing lingo.)

“Before AEP starts, ‘market warming’ with mail and DRTV [direct response television] continues to pay off. In fact, many say that if a plan misses pre-AEP market outreach, they’ve missed most of the available leads for the period. For some plans, these early leads represent over half of all AEP volume,” says Lindsay Resnick, executive vice president with Wunderman Thompson Health. However, such efforts are successful only if the plans’ “sales funnel” and call center are prepared to handle high call volumes and if they have a “lead nurturing” process in place to optimize the value of these leads, he advises. For example, “responder non-converters” (i.e., those who have responded in the past but did not become members) tend to convert at higher rates, he notes.

A survey of people enrolled in Affordable Care Act marketplace plans in California found that 28% had difficulty paying their premiums in 2021, according to a study published last month in Health Affairs. While that is an improvement from 40% in a similar sample of enrollees in 2017, Vicki Fung, Ph.D., the study’s lead author, tells AIS Health that more could be done to help people choose affordable coverage and determine whether they are eligible for cost-sharing subsidies.

Fung notes that health insurers could help people with consumers’ decisions, including coordinating with agents and brokers that insurers work with and steering people who are eligible for generous subsidies toward purchasing a similar plan via the ACA exchange rather than off-marketplace.

A federal panel of medical experts on Aug. 22 recommended that pre-exposure prophylaxis be prescribed to people at increased risk of HIV infection, and included long-lasting, physician-administered injectable forms of PrEP in its guidance. However, a leading vaccine expert says the decision by the U.S. Preventive Services Task Force (USPSTF) is unlikely to increase access to PrEP, especially given an ongoing conservative-led legal battle that threatens to overturn the preventive services mandate included in the Affordable Care Act.

USPSTF granted PrEP an “A” grade, its highest rating. In the rating, USPSTF experts “recommend[ed] that healthcare professionals prescribe PrEP to people at increased risk for HIV to help prevent HIV.” Notably, the new rating mentions injectable PrEP, Apretude (cabotegravir extended-release injectable suspension), which had not been included in USPSTF PrEP recommendations before. In a 2019 PrEP endorsement, the task force only mentioned oral PrEP.

As Medicaid managed care organizations look to assist states with ensuring enrollees maintain coverage throughout the redetermination process, text messaging is often seen an effective way to reach members whose only method of communication may be a smartphone. During an Aug. 9 webinar hosted by Medicaid Health Plans of America, mPulse Mobile Chief Marketing Officer Brendan McClure said the technology company has reached out to more than 7 million members this year on behalf of its Medicaid plan clients.

The engagement solutions provider divides its phone-based outreach efforts into two main categories:

Effective April 1, states were allowed to begin disenrolling people from Medicaid who no longer qualify after a multiyear pause during the COVID-19 public health emergency (PHE). Yet data from the federal government suggests many people are losing coverage for procedural reasons, and surveys show a concerning lack of awareness regarding the redetermination process. Medicaid managed care organizations say they are working to supplement outreach efforts from state and federal agencies and are trying a variety of tactics to activate impacted members, including text messaging and notifications at the pharmacy. Since the start of redeterminations, CMS has clarified that states may rely on MCOs to assist enrollees with completing and submitting renewal forms and even pay them for this type of work.

KFF estimates that at least 4.77 million Medicaid beneficiaries have been disenrolled as of Aug. 15, with three quarters of disenrollments occurring for procedural reasons. HHS had previously estimated that 8.2 million people will no longer qualify for Medicaid once redeterminations resumed and find other coverage, while 6.8 million Medicaid enrollees could lose coverage despite still being eligible.

Since implementing diabetes-related programs in 2021, Capital Blue Cross said it has saved its members and their employers nearly $6 million in health care costs. Meanwhile, Humana Inc. has launched a diabetes self-management education and support (DSMES) program through its CenterWell Home Health subsidiary that has seen an uptick in usage among health plans. The initiatives are part of a growing trend among payers that recognize the health burden and huge costs associated with diabetes.

Kelly Brennan, Capital Blue Cross’s senior director of Health Promotion and Wellness, tells AIS Health that the insurer’s beneficiaries with diabetes often have other chronic conditions, “which can be expensive to manage, both for our members and for business leaders who rely upon us to provide strategic solutions that curb health care spending and ensure their employees can be their healthiest.”

For the past couple of years, payers have been focusing more attention on health inequities related to race, income and other factors by hiring staff and investing money in programs to improve access to care and lower costs. More recently, they have adopted similar strategies to address inequities in the pharmacy side of their businesses, according to health plan executives who spoke at a conference last month at the University of Pittsburgh.

The push among payers is known as “pharmacoequity,” a term popularized by Utibe Essien, M.D., an internal medicine physician and assistant professor at UCLA. Essien, who moderated the panel with the payer executives, defines pharmacoequity as “equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions.”

In an effort to improve Medicare Advantage and Part D sponsors’ timeliness in processing Parts C and D coverage requests, CMS several years ago launched the Timeliness Monitoring Project (TMP) and began issuing fines to Part D plans with excessively high rates of “auto-forwarding” to the Independent Review Entity (IRE). And while CMS historically deducted one star from the appeals measure-level ratings based on IRE data integrity issues, the TMP also resulted in a scaled reduction intended to reflect the severity of the plan’s failures. Now, CMS is relieving MA organizations of that penalty by suspending the collection of Part C Organization Determinations, Appeals and Grievances (ODAG) universes for non-audited organizations that impacted the appeals measures.

Parts C and D sponsors are required to notify enrollees within specific time frames of their decisions on a coverage determination or redetermination. When plans miss that window, it’s considered an adverse decision, and sponsors are expected to automatically forward the case to the IRE within 24 hours. There are two Part C Star Ratings appeals measures that rely on data submitted to the IRE:

For the past couple of years, payers have been focusing more attention on health inequities related to race, income and other factors by hiring staff and investing money in programs to improve access to care and lower costs. More recently, they have adopted similar strategies to address inequities in the pharmacy side of their businesses, according to health plan executives who spoke at a conference last month at the University of Pittsburgh.

The push among payers is known as “pharmacoequity,” a term popularized by Utibe Essien, M.D., an internal medicine physician and assistant professor at UCLA. Essien, who moderated the panel with the payer executives, defines pharmacoequity as “equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions.”

So as not to penalize Medicare Advantage plans serving a large proportion of enrollees with social risk factors (SRFs) that impact care quality, CMS has previously taken steps to adjust for within-contract disparities in Star Ratings performance among MA and Part D contracts. But beginning in 2027, insurers will be rewarded for their efforts to assess SRFs and address disparities in certain quality measures with the new health equity index (HEI). MA and Part D organizations must act now to assess disparities within their contracts' current performance and begin to pinpoint where their efforts can make the biggest impact in the two years of data leading up to the reward, according to industry experts who spoke at AHIP’s 2023 conference.