Yet research shows that a significant number of Medicare Advantage plans continue to struggle with member engagement, including digitally. A JD Power study found that while overall satisfaction with Medicare Advantage plans has increased, just 55 percent of Medicare Advantage plan members actively managed their care in 2020, down from 64 percent in 2019 (17). Plans also received low marks when it comes to member communication.

 

Further, there remains a need for health plans and providers to add capabilities to diversify their digital offerings for the Medicare Advantage population—including digital therapeutics (18)—or risk losing market share to tech-enabled healthcare disruptors. Even before the pandemic, the number of well-capitalized healthcare startups entering the Medicare Advantage playing field had begun to rise, backed by companies like Alphabet, the parent company of Google, and Walmart, which partnered with startup Clover Health (19) to offer two products for seniors in Georgia. Today, disruptors in the Medicare Advantage market include

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•  Signify Health, whose proprietary technology platform identifies members’ unmet medical and social health needs—from food insecurity to loneliness—and pairs members with live support to meet these needs. A recent partnership with Humana Medicare Advantage in San Antonio demonstrated an 8.6% decrease in “Unhealthy Days” (20) through use of this platform.

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• Centene, which leverages artificial intelligence and data analytics to lower healthcare costs for vulnerable populations (21)—including underserved communities and racial and ethnic groups—through reduced utilization of care and administrative expense. In 2022, Centene will expand its Medicare Advantage footprint by 22 percent (22), with 48 million beneficiaries across 26 states.

 

• Cigna, whose investment in end-to-end virtual health offerings for Medicare Advantage members—including those that address social determinants of health—led to a 10 percent year-over-year increase in revenue (23) through Q2 2020. While use of virtual behavioral health services increased 40 percent (24), Cigna expects its digital investments to reduce costs by helping members more effectively manage chronic conditions, eliminating unnecessary diagnostic procedures, and steering members toward lower-cost sites of care (25).

 

Unless health plans and providers invest in the digital capabilities and infrastructure to meet Medicare Advantage members’ expectations and need for a tech-enabled experience, they could lose members to competitors with a shinier digital value proposition.

 

Keeping Pace with Digital Innovation for Medicare Advantage

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It’s clear that momentum around Medicare Advantage has fueled innovation in digital services for this population. For health plans and providers to compete with disruptors and start-ups effectively and to successfully manage the member experience, leaders should consider the following strategies.

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No. 1: Reimagine digital engagement as a longitudinal approach to care. At the last HLTH conference, innovators in telehealth predicted the move toward using virtual care technologies to create better member experiences and outcomes across the continuum of care. By empowering physicians to leverage digitally delivered care to connect with members in their home—“You can use the surrounding digital tools to create a far bigger bear hug and a more intimate, continuous longitudinal relationship and experience,” one expert shared during the HLTH panel “Forecasting Telehealth’s Trajectory.” “That’s the type of thing that only technology can unlock at scale [access to care]. We’re really only scratching the surface there—and the potential is enormous.” One way to establish a path for virtual longitudinal care is to explore partnerships with telehealth platform providers to seamlessly integrate virtual services across the continuum of care, from specialty providers to behavioral health to rehabilitation and home care.

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No. 2: Bolster digital engagement and services for primary care. The rapid expansion of virtual care infrastructure and digital capabilities sets the stage for a unique “remote mentoring” approach to primary care (26) that leverages the trust seniors have in their physicians to proactively encourage changes in behavior that improve health. By investing in this type of model for primary care, organically or inorganically—and by seeking ways to remove the administrative burden from physicians so they can spend more time connecting with members—providers and health plans can work together to drive success under value-based payment models. It’s a decision that also supports better member experiences and higher retention rates. Organizations also should seek ways to broaden entry points for virtual primary care.

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No. 3: Diversify digital service offerings for Medicare Advantage. Such a strategy should include digital offerings designed specifically for women’s health—critical given that 57% of Medicare Advantage enrollees are women (27)— and behavioral health. Consider that digital startups focused on women’s health attracted $1.3 billion in funding across 26 transactions through August 2021 (28), double the amount raised in 2020. For older women, the types of women’s health offerings that could be prioritized include female-specific primary care services, solutions that target chronic care management for women, and women-centered behavioral health services.