H2C PERSPECTIVE
 

What’s Your Digital Strategy for

Medicare Advantage?

 

For providers and payers alike, a robust digital care and engagement strategy, in parallel

to primary care, is critical to staying competitive in a disruptive market.

March 2022

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With a growing older adult population and provider staffing constraints, there is a significant need for digital tools among Medicare and Medicare Advantage populations. This presents a critical opportunity for health systems and health plans alike to bolster digital engagement capabilities to attract and retain members while simultaneously helping improve members’ health outcomes.

Medicare Advantage is the fastest-growing health insurance category (1), and it’s highly lucrative, generating higher monthly margins per member than other health plan offerings (2). It is also a highly competitive market, with the average Medicare beneficiary having access to 33 Medicare Advantage plans, the highest number of plans available in the past decade (3) in the country.

Retaining Medicare Advantage members is no easy feat: One in four stayed in a Medicare Advantage plan in 2021 but changed health plan providers (4). Meanwhile, spending per Medicare Advantage enrollee is growing at a faster rate per member than for beneficiaries in traditional Medicare ($321 per person annually in 2019) (5).

Investment in digital tools and capabilities presents strong potential to attract and retain Medicare Advantage members while simultaneously reducing costs and likely improving outcomes by way of greater engagement, adherence, and care coordination.

The Average Medicare Beneficiary Has Access to 39 MA Plans in 2022

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Note: MA Plan Enrollment Numbers for 2022 are not yet available.

(1) Excludes SNPs, EGHPs, HCPPs, PACE, and MMPs.

(2) Includes cost plans as well as Medicare Advantage plans.

Source: "Medicare Advantage 2022 Spotlight: First Look," Kaiser Family Foundation, Nov. 2, 2022

https://bit.ly/3qtU5p9

Engaging a More Tech-Savvy Population

Seniors’ tech literacy increased during the pandemic, with 61 percent of seniors (6) saying they relied more heavily on technology. Among Medicare Advantage members, a Kaiser Family Foundation survey found one out of four members (7) used telehealth during the pandemic, including 45 percent of those whose usual provider offers telehealth services. Meanwhile, 42 percent of younger seniors—those ages 65 to 75—use wearable technologies to monitor their health, a Deloitte survey (8) found.

Digital tools present tremendous opportunity to improve chronic care management under value-based care models, enhancing health outcomes while reducing care costs. Older adults, for example, record higher rates of engagement (9) with digital coaching technologies than younger populations—a sign that digital coaching could improve outcomes for high-risk, high-cost conditions. A recent study shows digital tools also could make a marked difference in medication adherence among seniors, with one study demonstrating a 14 percent improvement in adherence (10) by using text-based alerts. That’s critical, given that failure to take medications as prescribed results in $100 billion per year (11) in avoidable hospitalizations.

As a result, leading Medicare Advantage plans are ramping up investment in digital health and digital communications capabilities for members:

  • Anthem designed a digital-first strategy (12) that enhances member convenience and access to care. It’s a strategy that Anthem credits with helping to secure strong ratings for many of its Medicare Advantage plans. Today, 72 percent of Medicare Advantage consumers enrolled in Anthem’s affiliated health plans are in plans rated four stars or higher.

  • Alignment Healthcare offers a virtual-first health plan (13) with built-in supports to help Medicare Advantage members schedule their first appointment. To encourage members to use these services, Alignment Healthcare provides a $100 incentive that members can use to pay for WiFi coverage or broadband access or purchase an iPad or Apple Watch for use in accessing services or monitoring health.

  • Humana established a center for digital health and analytics (14) that will drive more personalized, member- centric experiences for Medicare Advantage members. The health plan also pairs members with virtual access to care navigators (15) who can help address members’ unique needs. One metric demonstrating success: Medicare Advantage members who accessed wellness information online demonstrated an 83% increase in rate of closed gaps in care, according to a Humana study (16).

Payer and Provider Investments in Digital Health Are Rising

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Note: Number of investor transactions refers to the sum of all investments made by each investor.

A single deal may have multiple disclosed investors, which would amount to multiple investor transactions.

Source:"2020 Market Insights Report: Chasing a New Equilibrium," Rock Health, Jan. 11, 2021

https://rockhealth.com/insights/2020-market-insights-report-chasing-a new-equilibrium/

In this environment, newer, more tech-enabled Medicare Advantage plans also are partnering with providers, retailers, and even competing health plans to offer competitive options for hybrid care—part in-person, part digital. Providers that are skilled in using digital technologies to engage patients and successfully manage population health do and will stand out from the pack, strengthening their ability to partner with Medicare Advantage plans under value- based contracts.

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Digital Health Ecosystems Can Benefit Both Payers and Providers

Source: "Digital Health Ecosystems: A Payer Perspective," McKinsey & Company7, Aug. 2, 2019,

https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/digital-health-ecosystems-a-payer-perspective

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

  •  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.

  • 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

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.

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.

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.

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.

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Note: These sectors are among eight sectors for venture-backed women + digital health identified by Rock Health. These sectors highlighted above meet the ends of women age 65 +

Source: "Building Comprehensive Women + Digital Health: Eight Sectors Serving Women + Needs," Rock Health, Sept. 27, 2021 https://rockhealth.com/insights/building-comprehensive-women-digital-health-eight-sectors-serving-women-needs/.

Digital Innovations in Women’s Health Could Appeal to Seniors

No. 4: Tailor strategies to distinct Medicare Advantage cohorts, including younger and older members. Today, four out of 10 Medicare Advantage members say they have little to no interaction with their health plan, according to a JD Power study (29). There are two distinct Medicare Advantage cohorts: younger members (those ages 65-75) and older members (76 and older). Among Medicare Advantage members, younger members are more likely to rely on digital tools (30). As a result, leading health plans are tailoring digital service offerings and communications to younger and older Medicare Advantage cohorts (31) to attract younger Baby Boomers and retain older seniors.

No. 5: Double down on at-home options for exercise and musculoskeletal care. Spending on musculoskeletal care has doubled in recent years (32), without a corresponding improvement in patient outcomes. Among seniors, 40 to 60 percent (33) face persistent musculoskeletal pain—and it carries significant economic and social cost (34). Startups such as Kaia Health, Vori Health, Hinge Health, and Kinetxx tackle musculoskeletal pain with innovations in digital tech. For example, Kaia Health designed a customized mobile app (35) that helps seniors and otherpopulations more effectively reduce pain levels by tracking members’ movement, leading them through exercises, and offering suggestions on ways to improve their posture. Similar technology is being used in physical monitoring and protocol checks to improve seniors’ safety. Programs that assist Medicare Advantage members with physical rehabilitation and a regular exercise regimen are very important to this population and will be key to satisfaction, engagement, and the ability to reduce or control healthcare costs. Other options to consider include virtual “SilverSneakers” programs and programs that present virtual and in-person options for musculoskeletal care—an area of investment for Intermountain Health and Ascension (36).

No. 6: Look for opportunities for partnership between health plans and providers in developing a digital Medicare Advantage strategy. For providers and health plans, a crucial consideration in a rapidly evolving and increasingly competitive environment is whether they can provide all the services a Medicare Advantage population needs on their own—especially as well-funded disruptors chip away at profitable service lines (37). Providers and health plans should carefully evaluate opportunities to accelerate digital transformation that enhances competitiveness and value for Medicare Advantage in partnership with one another. They should also objectively determine whether an acquisition of a digital asset or the formation of a joint venture or partnership will better enable them to reach their goal: creating better care and more memorable experiences for a prized population.

Footnotes:

  1. “Medicare Advantage Is a Fast-Growing, Lucrative Marketplace. But Is It Benefiting Patients Or Insurers More?” Kaiser Health News, Feb. 21, 2020, https://khn.org/morning-breakout/medicare-advantage-is-a-fast- growing-lucrative-marketplace-but-is-it-benefiting-patients-or-insurers-more/.

  2. “More Plans, Less Money: Why Many Seniors Are Choosing Medicare Advantage,” Dallas News, Nov. 9, 2021, https://www.dallasnews.com/business/health-care/2021/11/09/more-plans-less-money-why-many- seniors-are-choosing-medicare-advantage/.

  3. “Medicare Advantage in 2021: Enrollment Update and Key Trends,” Kaiser Family Foundation, June 21, 2021, https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-enrollment-update-and-key- trends/.

  4. Lagasse, J., “A Quarter of Medicare Advantage Subscribers Changed Providers in 2021, Poll Finds,” Healthcare Finance News, Jan. 28, 2021, https://www.healthcarefinancenews.com/news/quarter-medicare- advantage-subscribers-changed-providers-2021-poll-finds.

  5. Biniek, J.F., et al., “Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare's Solvency and Affordability Challenges,” Kaiser Family Foundation, Aug. 17, 2021, https://www.kff.org/medicare/issue-brief/higher-and-faster-growing-spending-per-medicare-advantage- enrollee-adds-to-medicares-solvency-and-affordability-challenges/.

  6. Fox, J., “COVID-19 Boosted Senior Tech Literacy. Here’s How that Affects Medicare Advantage,” MedCity News, Feb. 4, 2021, https://medcitynews.com/2021/02/covid-19-boosted-senior-tech-literacy-heres-how- that-affects-medicare-advantage/.

  7. Koma, W., et al., “Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future,” Kaiser Family Foundation, May 19, 2021, https://www.kff.org/medicare/issue- brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/.

  8. Gamboa, A.R., and Read, L., “Understanding Differences Among Baby Boomers Could Help MA Plans Attract and Retain Enrollees,” Deloitte, July 16, 2020, https://www2.deloitte.com/us/en/blog/health-care- blog/2020/understanding-differences-among-baby-boomers-could-help-ma-plans-attract-and-retain- enrollees.html.

  9. Graham, S.A., et al., “Older Adults Engage with Personalized Digital Coaching Programs at Rates That Exceed Those of Younger Adults,” Frontiers in Digital Health, Aug. 6, 2021, https://www.frontiersin.org/articles/10.3389/fdgth.2021.642818/full.

  10. Heath, S., “Digital Tools Useful for Medication Adherence in Older Patients,” https://patientengagementhit.com/news/digital-tools-useful-for-medication-adherence-in-older-patients.

  11. “Medication Non-Adherence: A $290 Billion Unnecessary Expenditure,” Triple Tree, April 7, 2015, https://www.triple-tree.com/strategicinsights/2015/april/medication-non-adherence-a-$290-billionunnecessa/.

  12. “Nearly Three-Quarters of Consumers in Anthem, Inc.-Affiliated 2022 Medicare Advantage Plans Will Be Enrolled in Plans That Are Highly Rated by CMS,” Press Release, Oct. 8, 2021, https://www.businesswire.com/news/home/20211008005491/en/Nearly-Three-Quarters-of-Consumers-in- Anthem-Inc.-Affiliated-2022-Medicare-Advantage-Plans-Will-Be-Enrolled-in-Plans-That-Are-Highly-Rated- by-CMS.

  13. “How Payers Can Launch a Virtual-First Health Plan,” HealthPayer Intelligence, Aug. 23, 2021, https://healthpayerintelligence.com/features/how-payers-can-launch-a-virtual-first-health-plan.

  14. Whyte, S., “Humana’s Blueprint for Creating Whole-Person Digital Health Experiences,” ClearData, https://www.cleardata.com/humana-digital-health-experiences/.

  15. Humana Value-Based Care Report, Humana, 2020, https://humana.gcsweb.com/staticfiles/39bb066ebca545ff-aab2-827fe03c92c1.

  16. Ibid.

  17. “Fewer Medicare Advantage Plan Members Actively Managed Their Health during Pandemic, J.D. Power Finds,” Press Release, JD Power, June 17, 2021, https://www.jdpower.com/business/press-releases/2021- us-medicare-advantage-study.

  18. Patel, N., “Modernizing Medicare Coverage Pathways for Prescription Digital Therapeutics,” Health Affairs, May 13, 2021, https://www.healthaffairs.org/do/10.1377/forefront.20210510.303135/full/.

  19. Tozzi, J., “Walmart’s Next Foray Is Medicare Plan with Startup Clover,” Bloomberg, Oct. 1, 2020, https://www.bloomberg.com/news/articles/2020-10-01/walmart-s-next-health-foray-is-medicare-plan-with-startup-clover.

  20. Minemyer, P., “Humana teams with Signify Health, AACN to tackle social determinants in San Antonio, Fierce Healthcare, June 30, 2021, https://www.fiercehealthcare.com/payer/humana-teams-signify-health-aacn-to-tackle-social-determinants-san-antonio.

  21. “Rising to Meet Challenges Head On,” Fortune, 2021, https://brandstudio.fortune.com/centene/rising-to-meet-challenges-head-on/?prx_t=hbkGAAAAAAoPEQA.

  22. Lagasse, J., “Centene growing Medicare Advantage footprint by 26% in 2022,” Healthcare Finance News, Oct. 5, 2021, https://www.healthcarefinancenews.com/news/centene-growing-medicare-advantage-footprint-26-2022.

  23. Muchmore, S., “Evernorth Drives Cigna's Q2 Revenue Growth Despite More Return to Care than Expected,” Healthcare Dive, Aug. 5, 2021, https://www.healthcaredive.com/news/evernorth-drives-cignas-q2-revenue-growth-despite-more-return-to-care-than/604478/.

  24. Ibid.

  25. Tepper, N., “Pharmacy Services, Medicare Advantage Bump Cigna's Revenue Up 6.5% is Year Over Year,” Modern Healthcare, May 7, 2021, https://www.modernhealthcare.com/insurance/pharmacy-services- medicare-advantage-bump-cignas-revenue-up-65-year-over-year.

  26. Karysbaev, J., “Healthcare IT: Actionable Trends In 2021 for Digital Transformation,” Forbes, Oct. 29, 2020, https://www.forbes.com/sites/forbestechcouncil/2020/10/29/healthcare-it-actionable-trends-in-2021-for- digital-transformation/?sh=7637dc147566.

  27. “Medicare Advantage: Overcoming Barriers to Good Health,” AHIP, March 29, 2021, https://www.ahip.org/resources/medicare-advantage-overcoming-barriers-to-good-health.

  28. “Investments Abound in Strong Year For Women’s Digital Health Startups,” The Healthcare Technology Report, Oct. 20, 2021, https://thehealthcaretechnologyreport.com/investments-abound-in-strong-year-for- womens-digital-health-startups/. 

  29. Minemyer, P., “J.D. Power: Medicare Advantage Plans Still Struggle with Member Engagement,” Fierce Healthcare, June 18, 2021, https://www.fiercehealthcare.com/payer/j-d-power-medicare-advantage-plans- still-struggle-member-engagement.

  30. Ibid.

  31. Read, L., et al., “Leveraging Digital Solutions to Engage, Attract and Retain Medicare Advantage Members,”The Deloitte Center for Health Solutions, 2020, https://www2.deloitte.com/content/dam/insights/us/articles/6883_CHS-Digital-in-MA/DI_CHS-Digital-in-MA.pdf.

  32. Wooldridge, S., “Musculoskeletal Care Spending Up 65%; More Preventive Care Needed to Reduce Costs,” BenefitsPro, March 17, 2021, https://www.benefitspro.com/2021/03/17/musculoskeletal-care-spending-up-65-more-preventive-care-needed-to-reduce-costs/.

  33. Welsh, T., et al., “Musculoskeletal Pain in Older Adults: A Clinical Review,” Medical Clinics of North America, September 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034863/#R9.

  34. “Chronic Back Pain,” Georgetown University Health Policy Institute, https://hpi.georgetown.edu/backpain/.

  35. Reuter, E., “Digital Health Startup Kaia Hopes to Win Over Insurers with Results of Back Pain Study, ”MedCity News, July 21, 2020, https://medcitynews.com/2020/07/digital-health-startup-kaia-hopes-to-win-over-insurers-with-results-of-back-pain-study/.

  36. “Vori Health Raises Additional Capital from Strategic Partners Intermountain Healthcare, Ascension Ventures, and Echo Health Ventures,” Press Release, July 7, 2021, https://www.prnewswire.com/news- releases/vori-health-raises-additional-capital-from-strategic-partners-intermountain-healthcare-ascension- ventures-and-echo-health-ventures-301326406.html.

  37. “Market Integration & Strategic Coordination: Trends That Will Shape 2022 & Beyond,” Citi, Health Management Academy Presentation, Nov. 5, 2021.

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About the Author

Kaustubh Wahal is a Managing Director for H2C. Contact Kaustubh at kwahal@h2c.com.