Large health plans that have a strong investment in the Medicare Advantage (MA) market may be in the best position to capitalize on this booming business, according to a Health Affairs blog post.
With MA market projected to grow over the next 10 to 15 years, and with rate cuts easing, plans should invest in designing new benefit structures. This will improve customer experience and, in turn, help plans earn higher quality ratings and claim beneficiaries from weaker plans that can no longer compete in the market.
Here are two key focal points for successful Medicare Advantage plans, according to the blog post:
Reinvent how members receive care. The most successful health plans focus on an entire health issue as opposed to just an individual procedure. This prompts plans to collaborate more directly with smaller providers who help identify ways to avoid unnecessary care and reduce costs. For this to happen, plans must align incentives and pinpoint the providers best up for the task. Additionally, plans should adopt "whole-person care models" for individuals with complex diseases. Under this model, plans work with an entire team of collaborators--such as long-term care facilities, government agencies and the patient's family--in addition to physicians.
Don't be afraid of analytics. Successful plans use analytics as a way to interact with their beneficiaries. For instance, Independence Blue Cross uses data to create predictive models on a variety of factors, such as who in a particular population is likely to be hospitalized in the next 90 days, which diabetes patients are likely to develop the most complex and expensive comorbidities and who is least likely to adhere to a medication regimen. There are endless ways to reach beneficiaries, noted the blog post, including mobile apps, email alerts and personal care coordinators. What's more, MA plans can best determine which channels and which messages are most effective for their beneficiaries.
- here's the blog post