A brand new yr will quickly be upon us, bringing a flurry of well being plan actions with it. This contains new member welcome and onboarding, transition of care assist, main care supplier (PCP) task, and usually making a very good first impression to assist guarantee member satisfaction and retention. In a brand new podcast, Anne Davis, Cotiviti director of high quality applications and Medicare technique, joins Jennifer Forster, director of Medicaid technique, to debate:
- The way to assist new members becoming a member of Medicare Benefit and Medicaid plans in 2022
- The way to optimize well being danger evaluation (HRA) completion
- How member retention impacts plans
Anne L. Davis has spent the final 20 years centered on healthcare high quality, program growth, and analysis. As director of high quality applications and Medicare technique, she helps make sure that Cotiviti merchandise assist medical outcomes enchancment. Anne has subject material experience within the Medicare Benefit market, Star Rankings, HEDIS®, and NCQA accreditation requirements.
Jennifer Forster is answerable for growing and implementing Eliza’s Medicaid choices and gross sales technique. She beforehand labored for Tufts Well being Plan the place she served because the product director and operational contact for Tufts’ government-sponsored enterprise. Because the director of public partnerships, she led a group that supported contract administration actions together with compliance, reporting, communications, and negotiations.
Cotiviti’s Eliza member engagement answer is right here to assist drive member engagement and retention. With insights gathered from billions of particular person shopper interactions, we use knowledge and behavioral science to tailor our message to your viewers.
Why is the welcome and onboarding course of so vital?
Anne: I feel theoretically, everyone knows that the primary contact with the well being plan is basically essential as a result of it units up the connection along with your membership for the remainder of the yr, so these first touches make a extremely huge influence in your membership. So issues like your pharmacy prescriptions, ensuring that they are a seamless transition from no matter well being plan the individual had been utilizing earlier than to your new well being plan. It is also a extremely good time to grasp the wants of your inhabitants, so performing a well being danger evaluation, additionally known as an HRA, is a extremely nice alternative at first of the yr. The opposite factor that is particular to Medicare Benefit is that within the first three months of the yr, beneficiaries have a chance to depart the plan that they’ve chosen and select one other plan. In order that motion within the first quarter is another excuse why we wish to make it possible for that first contact is basically impactful and constructive.
Jennifer: For Medicaid it is related in that you simply solely get one alternative to make a very good first impression. Additionally, HRAs are required throughout the first 90 days to be accomplished by the well being plan; it is an awesome alternative and necessities to get that carried out. However what differs with Medicaid from Medicare is that not like with Medicare and that fast enrollment interval throughout the first quarter, Medicaid enrollees are enrolling and enrolling all year long. They’ve decisions simply as they do in Medicare Benefit, however they don’t seem to be locked in to that selection in most states. In some states they’re, however the majority of Medicaid enrollees can vote with their ft and so they can depart at any level through the calendar yr to modify to a different plan. So if that welcome in onboarding course of does not go nicely and so they’re dissatisfied, they’ll choose up and transfer to a different plan inside their service space. And oftentimes there may be one other that they’ll select from, so satisfaction performs a extremely vital position.
There’s additionally the difficulty of simply onboarding folks, giving them an orientation to their new advantages in lots of circumstances. This might be anyone’s first publicity to medical insurance, and so medical insurance literacy is probably not that nice, and it is vital to essentially assist folks perceive the best way to use their advantages and when to make use of them, and the position of a main care clinician or a PCP. A Medicaid enrollee is mechanically assigned a PCP if they do not come on to the plan with one already, and most of them do not. In order that signifies that I feel upwards of 75% of individuals are auto-assigned a health care provider of their space based mostly on various matching standards, together with language and geography. However oftentimes the members do not have a longtime relationship with that PCP. They might have seen one other PCP prior to now that they really feel extra comfy with. And a lot of the calls the start of the month to a Medicaid plan are to ask questions on who this PCP is on their ID card. It is normally anyone they do not know, and one method to drive name quantity down and to assist with member satisfaction is by proactively reaching out to them throughout this orientation interval and inquiring about who their PCP is and if they’ve one which they work nicely with. After which so if it is not anyone they’re already assigned to, getting them as their PCP on document, in order that goes a great distance in constructing belief and satisfaction throughout the membership.
How do you suggest supporting new members coming onto the plan in 2022?
Anne: So I feel I am going to tack on to what Jenn simply spoke of when it comes to new members and when new members come to any well being plan, they should perceive what the advantages are, when to make use of them, the significance of proactively partaking with these members. So I feel that is the identical throughout the board. What’s particular for the Medicare Benefit inhabitants is that older common age are inclined to have extra prescription medicines, are inclined to have extra continual situations that they are managing, so focusing that first contact and that entrance to the well being plan round creating actually constructive care transitions—so if the member wants to vary their prescription medicine or maybe their specialist is not in-network below this new plan, having the well being plan actually deal with these cohorts of members who really want to work together with the plan earlier within the yr and for extra particular causes. Connecting them with care administration or illness administration applications, connecting them with any sturdy medical gear that they may want is basically, actually vital once more throughout that first couple of months of the plan. I feel I am going to additionally echo what Jenn mentioned about ensuring to proactively attain out and have interaction your new members. It is actually vital for Medicare Benefit members, in fact, as a result of CMS requires a welcome to Medicare go to with their doctor, and that has to happen actually rapidly upon enrollment into Medicare Benefit plan. So ensuring that you simply’re reaching out to folks rapidly, like inside two weeks of the start of the yr, is basically important once more to arrange that relationship for future success.
Jennifer: After which from a Medicaid standpoint, I feel 2022 goes to be a singular yr, though not completely distinctive from 2021. However I feel my level is that in 2022 as new members are onboarding, it is going to be vital to essentially it is at all times vital, however it is going to be actually vital to ensure these HRAs, these well being danger assessments are strong and accomplished. And so do not simply ask the usual HRA questions, but it surely’s vital to ask about these social determinants of well being or SDOH, socioeconomic obstacles to care, as a result of a lot has modified in 2021 and 2020 and lots of people approaching to Medicaid are doing so as a result of they might have skilled a COVID associated job loss. Folks could have had COVID themselves and will nonetheless be coping with long-COVID signs. That kind of data is basically vital to grasp.
And simply the character of the final yr and a half in itself, it is vital to ask folks how they’re doing. Are they experiencing elevated anxiousness or despair? Are they socially remoted? Some of these issues are actually vital as a result of they’ve a huge impact in your well being, and well being plans wish to know the way they might help and the place folks want help. And once you’re a brand new member, they do not have claims knowledge to fall again on. So it is actually vital to have these one-on-one conversations with their membership in order that they’ll decide the place they may profit for some additional assist. It is perhaps care administration providers or social care administration or connecting members with assets of their group. After which the opposite factor on Medicaid—that I feel might be vital for Medicare as nicely, however a little bit extra so on the Medicaid facet as a result of that inhabitants tends to be extra transient—particularly once more, given the final yr and a half that we have had with a whole lot of change in folks’s job standing and financial standing is getting updated contact info and ensuring that member is aware of that they should maintain that info updated with each their plan and the state in order that they do not lose protection when it comes time to resume.
Bettering outcomes for Medicare Benefit plans requires motivating senior healthcare shoppers to behave. Discover ways to begin conversations that may assist enhance Star Rankings.
What recommendation do you have got for plans trying to maximize well being danger evaluation (HRA) completion?
Jennifer: I feel most plans wrestle with this. It is tough to get folks to finish a well being danger evaluation, notably when it may be prolonged. However what we actually suggest is taking a multi-channel method. So do not simply ship them a letter within the mail with an enormous survey to finish, strive reaching them the place they’re. So meaning, you realize, catch them on the telephone. Or if you realize that they’re perhaps a youthful inhabitants that is extra text-based, ship them a textual content message with a safe hyperlink for a personalised URL to finish it at their leisure, both on their telephone or their machine or their laptop. Supply it additionally by way of maybe your member portal. We actually suppose that you may’t simply use one dimension matches all. You need to sort of hit them in a few other ways with a view to maximize your completion charges. One other factor that a whole lot of plans use, and it is perhaps extra related for the Medicare inhabitants, though it actually relies on your method, is utilizing incentives. So perhaps you get like a present card or one thing like that in case you full your HRA. After which the opposite factor that we have seen is to tack it on to the welcome outreach. Once we analyzed these, we discovered a 2% to three% increased fee of completion when it was included in a welcome and onboarding outreach. I feel that is most likely since you’re reaching them proper at first of their enrollment, they’re desperate to make it possible for they’re lined, what’s another factor asking them a number of questions or prompting them to finish an HRA on-line. We discover a increased fee of completion once you add it to that welcome outreach.
How does member retention influence well being plans?
Jennifer: Member retention improves well being outcomes, so that you wish to just remember to’re retaining these members that you’ve got put all of that care and energy into over the profit yr. And a part of the reason being due to high quality enchancment and HEDIS, that are high quality enchancment measures, standardized measures that require continuity of protection so as so that you can depend them in your remaining rating. So we spend a whole profit yr working with members and ensuring that they are closing their care gaps and attending to the physician and managing their situations and all of that. But when they’re to disenroll previous to the top of the calendar yr, you do not actually get to take credit score for that. After which your high quality enchancment scores endure.
There’s additionally well being outcomes. These which are repeatedly enrolled in a plan yr over yr present higher well being than these which are bouncing round or in Medicaid. We name that churn, coming out and in of well being protection, and you’ll think about that is as a result of if you do not have protection for a time period and also you’re managing a continual situation otherwise you simply occur to get sick however do not have protection, once you come again on to the plan, you are coming again on sicker or having a better medical danger. So these which are repeatedly enrolled are more healthy, and it is vital that we maintain folks lined in order that they’re getting all of the preventive and continual situation administration care that they want. After which there is a monetary facet as nicely, so more healthy folks value much less to insure. There’s additionally a income implication for well being plans which are experiencing a whole lot of churn or on and off of the membership. We already talked about of the medical expense of sicker members and people who find themselves coping with pent-up demand. After which there’s simply the executive prices of reenrolling members. Those that come off and are available again on must undergo that entire welcome and onboarding course of. Once more, they want a brand new ID playing cards. They must be enrolled into care administration that prices cash as nicely.
Anne: Loads of those self same parts are additionally essential to Medicare Benefit plans and beneficiaries. And the differentiator for MA plans is that they’re sort of rooted in high quality bonus funds for suppliers based mostly on high quality outcomes, and that’s identified within the trade as Medicare Star Rankings. And so Star Rankings are based mostly on these HEDIS outcomes or high quality care hole outcomes, in addition to pharmacy measures and shopper expertise. So once we take into consideration retention in a Medicare Benefit plan, we all know during the last decade or so of expertise that loyal members do shut extra care gaps, so they’re more healthy people. And so they even have stronger relationships with their suppliers and different caregivers all through the care neighborhood. And we additionally know that the extra loyal the members are to a sure well being plan, in order that they’re in the identical plan yr after yr, the extra glad they’re with the plan. So there’s positively a relationship between size of time within the plan and satisfaction with the plan and from a Medicare Star Rankings perspective, shopper expertise is value extra from a weighting perspective in how the rankings are calculated, so everybody is basically centered increasingly once more on making that have one of the best for his or her membership—ranging from the very starting of that welcome and onboarding, however then persevering with to retain these members with constructive advantages, constructive experiences all year long.
What do well being plans want to think about when growing their member retention technique?
Jennifer: Effectively, on the Medicaid facet, it is all about churn. That is sort of on once more, off once more of protection, and that might occur for various causes. It is perhaps that anyone has Medicaid protection, however then their revenue adjustments. Perhaps they get a job and so they have entry to employer-sponsored advantages, or perhaps they make an excessive amount of cash to qualify for Medicaid, or they’ve a seasonal job or one thing like that. So their revenue is fluctuating all year long, which is impacting their capability to take care of their Medicaid protection. So they arrive on and off. Or it might be in Medicaid, you’re required to resume your advantages every year. That is to just remember to’re nonetheless eligible for this system. And oftentimes, folks do not get their renewal discover within the mail, and we already talked about that is actually because folks transfer all year long. And so they do not replace their contact info with their plan or their state, after which they miss that discover that they should renew, and so they fall off of protection; they fall off of care. So we really discovered that 60% of folks that we communicate with do not have their renewal discover in hand. And that is a extremely giant proportion and a extremely huge downside for Medicaid enrollees, for the plans which are serving them, and for the states as nicely, as a result of we already talked in regards to the influence on well being standing and satisfaction and plan income and financial savings. So it is a actually huge deal.
And with a view to forestall churn, there is a bunch of coverage actions that states may take, like steady enrollment standards permitting folks to remain on a plan postpartum, perhaps for 12 months postpartum or six months postpartum. Some states disenroll six to eight weeks after having a child. So there’s various coverage issues that may occur on the state stage.
However there’s additionally issues that plans can do to stop churn. So which may embrace retaining their contact info up to date each time they’ve an interplay with a member confirming their contact info, their mailing deal with, getting consent to outreach to members over textual content message and e-mail in order that they’ll attain them various other ways. Additionally reminding members to maintain their contact info up to date all year long, reminding them proactively about upcoming renewal intervals one thing aside from unsolicited mail, giving them a name or a fast textual content, or reminding them when they should do the redetermination course of and make sure their eligibility to proceed protection on Medicaid. With COVID-19, they put a brief maintain through the public well being emergency. States can put a maintain on redetermination processes with a view to make sure that folks have protection all through this actually turbulent time and ensuring that individuals, are medically lined, however the public well being emergency is because of finish—we predict most likely by the top of the yr and all of these renewals that have been meant to occur from March 2020 by way of 2021 are going to be reprocessed. And so we noticed a whole lot of development within the Medicaid program throughout COVID-19, which is comprehensible. However now we may see the potential for lots extra churn in 2022 after they flip these renewals again on. So plans can actually get forward of that by reaching out to members now and ensuring that they’ve that up to date contact info on file in order that when the state does flip these processes again on, the members will obtain their notices. They need to additionally hopefully get an outreach from their well being plan as nicely. And like I mentioned, use that multichannel method. Name them, textual content them, e-mail them. Do not depend on unsolicited mail.
Anne: I feel a whole lot of these methods are related for the Medicare inhabitants as nicely. I feel most likely crucial factor to think about when growing a retention technique for Medicare Benefit is you really want to know your membership. It is advisable to wrap your arms across the distinctive wants of seniors and to comprehend that these wants change between those that are simply turning 65 versus these which are 85 and older. The second factor is that there have been lots of people delayed in getting care throughout COVID instances, and that was actually seen within the Medicare Benefit inhabitants as nicely. In order you are onboarding new members, it is an awesome alternative as soon as once more with that welcome and onboarding well being danger evaluation to grasp the place are they of their care journey and do they nonetheless have relationships with a main care supplier. Have they seen that care supplier in a time period?
Jenn additionally talked about wanting to make sure that we’ve got the proper contact info on file in order that we are able to work together with folks within the ways in which they wish to work together with us. So it is perhaps mail for some, it is perhaps telephone requires others, it is perhaps texting or on-line portals. So once more having that multichannel method and in addition attending to know what your member’s preferences are across the ways in which they wish to work together with the healthcare system. And I at all times warning plans: do not lump all seniors right into a bucket as a result of there may be a variety of know-how acceptance throughout the senior inhabitants. So positively take note of that as nicely. And naturally, the very last thing that I am going to point out is, particularly for Medicare Benefit: member expertise is every thing. So ensuring that at each touchpoint your members really feel cared for, revered, understood, listened to. In order that first contact is crucial, but additionally customer support coaching proper throughout the board, from member providers to your pharmacy and pharmacists. It actually requires plans to do extra work throughout the healthcare system so that they are speaking throughout totally different silos and capabilities. They’re sharing info for the betterment of the person. In order that when an individual calls in to member providers for instance, member providers sees that holistic view of the member, is aware of after they’ve known as in final, and is aware of in the event that they’re concerned in several care administration applications. So I feel these are actually the important thing items: know your membership, actually interact with them the way in which that they wish to interact with you, and wow them at each flip. Allow them to know that you simply care about them and talk, talk, talk.
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