Postcard from Dallas: What’s Setting Medicare Advantage Plans Apart

HealthEdgeMarch 04, 2020
The Edge Report

Changing CMS regulations, benefits and challenges of narrowing provider networks, tapping front-line staff to share the pulse on Medicare Advantage membership, and innovative consumer-focused benefit plan design top the list of key insights shared at the recent Health Plan Alliance Medicare Advantage Product and Implementation Fly-In. As an HPA business partner and silver sponsor of this event, HealthEdge, along with several member plans, shared insights and best practices drawn from the successful implementation and support of health plans leveraging the HealthRules solution suite for MA lines of business.

While a wide range of topics were discussed during the two-day event, below are the most compelling takeaways we’re actively talking about with health plans:

CMS loosening allowable provider marketing regulations. Plans can now co-brand materials with their provider networks and this is making inroads.  Tapping these new regulations contributed to one plan’s Medicare Advantage business growing by 37 percent last year. Providers can now conduct sales activities, distribute materials, answer questions on plans – including cost sharing and benefit information – and can refer patients to other sources of information, including marketing representatives. Additionally, marketing materials may be distributed and displayed in all areas of the health care setting. In the Fall, Medicare Advantage enrollment windows will compete with a plethora of political messaging in this election year. This will be particularly true if a publicly floated Medicare For All option gains momentum and lands on a political party’s platform.  As a result, loosened marketing rules will mean health plans will work harder and experience a longer duration by which to ensure they are capturing the attention span of people from Labor Day to Election Day, which directly competes with their open enrollment window.

Pros and cons of narrowing or expanding provider networks continues to be debated.  Some data indicates provider networks are indeed narrowing; however, only anecdotal data surrounds this hypothesis. While the average consumer may not fully understand the intricacies of a provider network, health plans with a Medicare Advantage line of business wrestle with the perception that a narrower network may mean longer wait times, less access, and less consumer choice. Some health plans believe a narrower provider network may create cost savings through tighter coding controls, improve quality improvements, and reduce system leakage by pushing providers to use designated facilities. The data suggests most five-star Medicare Advantage plans have narrower provider networks. 

Medicare Advantage health plans continue to conceptualize and operationalize innovate, supplement plan design. Involving a cross-functional approach to plan design, health plans are looking to all for input into member pain points. Coders offer insight into how one benefit may seem to be a “sell” only to share it could offset another code, thus being a detriment. Operations and configurations staff are critical in benefit design. Call center representatives and the data points they collect are instrumental. Some plans utilize a member consumer advisory board but struggle with a lack of governance. Others are using a member and provider council with membership strategically selected across demographics and satisfaction levels. Listen to HealthEdge’s webinar, SDoH: A Payer’s Strategic Advantage on-demand to learn about some existing operationalize programs.

Local and regional plans are building relationships with community-based agencies so they can link members to services. Social service coordinating agencies are there to create linkages and yet many health plans are not fully capitalizing on these to create a more positive customer experience. One health plan is considering the Disney Fast-Pass® experience by giving expedited appointments to in-network providers. Health plans are reaching deep into the community to leverage these relationships. Training and education of the customer service call center representatives empowers them to solve problems directly, which correlates to satisfaction levels – the greater the ability to do this, the happier the beneficiary.

Looking for additional Medicare Advantage resources? Check out our 2019 Voice of the Market Survey: Health Plans are Riding the Wave of Medicare Advantage Plans, a survey of over 200 health plan executives working in the Medicare or Medicare Advantage and found insurers are focused on growing those lines of business faster than traditional Medicare.

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