MACRA Patient Engagement Bonus: Medicare Advantage

Participating in the Medicare Advantage program has quickly become a key part of the Medicare-based population health strategy for many large healthcare provider organizations. In Medicare Advantage, the program provider (either an insurance company or a healthcare provider organization) enrolls specific Medicare beneficiaries. The provider is then financially responsible for each person's care, receiving a fixed payment from Medicare and additional payments as necessary from the patient.

Medicare Advantage is growing in patient popularity, with enrollment expected to climb from 16.8 million in 2015 to 30 million in 2025, according to The Advisory Board Company. For providers, it’s an attractive alternative to the Medicare Shared Savings Program because it offers more control over contract elements and opportunity to operationalize those contracts. Providers also have greater control over patient network choices, giving them more ability to manage and contain costs.

There are 2 fundamental reasons why patient engagement is critical for success as a Medicare Advantage provider:

1. Delivering value-based care is critical. Medicare Advantage is the most fully capitated payment model currently in use. As a result, it presents the greatest possible rewards for provider organizations who can deliver quality care economically.

2. Patient attraction and retention. Each year, patients individually select whether or not to enroll with or stay with a given Medicare Advantage provider. Therefore, maintaining customer satisfaction is essential to keeping enrollment numbers high. Efficiencies of scale mean that the more patients enrolled, the more revenue-positive the program is likely to be.

Patient engagement for value-based care delivery

In support of the first goal, delivering the best care value possible, patient engagement technology and programs offer myriad cost-effective ways to enlist patients in their own care.

It only makes sense to first focus any patient engagement efforts on the most costly patients, those with chronic conditions. Sometimes these patients may be unsuitable for technological engagement due to physical or mental challenges, but the same patient engagement supports can be delivered to their caregivers and reap the same benefits. Providing tools and technologies for these individuals to care for themselves can easily prevent very expensive care episodes. Examples include:

● Reminders to take and refill critical medications to improve medication adherence.

● Home devices to track key health indicators such as blood pressure, blood glucose and weight between appointments. This data can be processed by an analytical engine to generate alerts to the patient, a home caregiver, or a healthcare professional if either readings are missed or readings are outside of a prescribed range.

The next logical cohort to target is those who are experiencing an acute episode requiring pre- and post-episode involvement on the part of the patient. For example, patients who undergo an orthopedic procedure, such as a knee or hip replacement. These patients can be given online tools to learn about and prepare for their operation and recovery. During the recovery period, they can be given tools to help them adhere to medication, physical therapy instructions and other necessary postoperative routines. This can reduce the risk of complications and provide the best chance for a full and successful recovery.

Finally, generally healthy patients can be given tools and information to maintain their health to a certain degree. From automated reminders about preventive services such as flu shots to tips on staying active, a variety of services can be delivered technologically for almost no cost.

Patient attraction and retention

In support of the second goal, increasing patient satisfaction to maximize current patient retention and word-of-mouth enrollment, improving outcomes as described above is a great start. Additionally, patient engagement programs offer numerous ways to cultivate a positive, ongoing relationship with patients rather than only interacting with them episodically. Putting branded valuable tools in patients' hands that they can access and benefit from on a daily basis can generate a patient-organization relationship. Typically, patients will only think about their relationship with their individual doctors without realizing the vast network of support on which those doctors rely. By technologically engaging them as the organization, you have an opportunity to begin to change that. If the tools, education or services you provide as part of your patient engagement efforts are valuable and/or engaging enough, some patients will tell their peers and then become ambassadors for your organization.

Conclusion

Participating in Medicare Advantage is becoming more attractive and important to healthcare provider organizations as a means of adjusting to pay-for-performance pressures. Including an adaptable patient-engagement strategy that can deliver different solutions to different cohorts while improving both care value and patient loyalty can have a substantial impact on the success of a Medicare Advantage program. Therefore, organizations that aren't currently delivering a Medicare Advantage program and utilizing advanced patient engagement technologies would be well served to consider how they could benefit from them.