a person posing for the camera
Jasmine Crenshaw, MPH
Content Marketing Strategist
For Medicare Advantage (MA) members with chronic conditions, plan satisfaction has several meanings.

Potential members are looking for a plan that (1) accommodates their budget, (2) adapts to their current health status, and (3) anticipates any condition-related complication. But for patients with diabetes, being satisfied with their MA plan can come at a more complex price.1  When it’s time to identify a plan for this patient population, they have to consider additional external circumstances faced daily while managing their condition, including uncontrolled insulin pricing 2, lack of social support 3, and food insecurity 4, among a plethora of other barriers.5

Although Medicare Advantage offers a variety of choices for patients with diabetes, the plans can fall short when put into action. One 2020 study showed that 16% of members surveyed noted that their Medicare plan, traditional or not, did not adequately support their condition-specific needs.3 For example, the Medicare Diabetes Prevention Program (MDPP), one of the main programs offered to Medicare members with diabetes, has yet to gain ground with its intended population due to two reasons: lack of visibility with many beneficiaries and program costs not fully covered by health plans.6,7 But for all MA plans, the Star measures act as a great equalizer, providing beneficiaries with additional details to make the best decision for themselves.8

16% of MA members feel that their plan did not meet their needs (3)

For health plans, there is no better time than now to focus on how patients across conditions, but particularly those with diabetes, impact Star measures.

Studies have shown that Medicare Advantage plans with higher Star ratings can have a profound effect on patients’ health outcomes 9 and yearly enrollment. 10 Further, starting with the 2023 Star measures, ratings associated with member engagement and experience are now considered a higher priority than before. 11 Another major change to Star ratings is the decreased influence and impact felt by the COVID-19 pandemic. 12 With these considerable changes to Star measures and patients becoming more knowledgeable about their health 13, it’s crucial for plans to start taking action.

It's no secret that patient engagement is a great way forward.

Digital solutions, such as telehealth or chronic condition management, sprung to prominence during the COVID-19 pandemic because of their ability to provide patients additional tools and support to navigate managing their health all from the comfort of home. And while we seem to be on the downshift of the pandemic, plans shouldn’t take digital options to support patients out of consideration.

An innovative, accessible digital patient engagement strategy can be the differentiator needed for health plans to complement current offerings and increase brand visibility to potential MA members, particularly those with diabetes who represents 32% of the population.14  That’s why we’re covering three strategies that you can implement to engage members with diabetes: outbound support for plan assistance, addressing social determinants of health, and preventative programming. 

3 Patient Engagement Strategies to Implement

Outbound support for plan assistance  

Sometimes selecting a plan is only half the challenge for many Medicare Advantage members with diabetes. After finding a plan that fulfills health needs and addresses external circumstances, some members may experience difficulty understanding the plan itself or how to access benefits. Unlike traditional Medicare, some Medicare Advantage plans can provide additional benefits for patients with chronic conditions, particularly diabetes, such as prescription discounts, gym memberships, and specialized care coordination with Special Needs Plans (SNP). 13 In fact, according to a Commonwealth Fund study, more than half of SNP enrollees have a diabetes diagnosis. 13 With this many resources available for this population, there still remains one large problem for health plans: When members are not aware of all their plan’s benefits, their plan is not being used to its full advantage. Some members may not feel that the plan is worth it. Worse, some members may even revert back to a traditional Medicare plan.15 The risks for churn are higher than ever.  

3 Patient Engagement Strategies to Implement

Outbound support for plan assistance

A dedicated strategy making it as easy as possible for potential beneficiaries to learn about your plan and all it has to offer.

Addressing social determinants of health

Using a digital strategy to address members’ barriers and issues accessing necessary care.

Preventative programming

Processes, education, and services that can help your members to manage and prevent comorbid conditions.  

Think of it this way: first impressions matter. For health plans, making it as easy as possible for potential beneficiaries to learn about your plan and all it has to offer is really the first step at getting (and keeping) them in the door. Not only would this strategy help members to feel encouraged and supported by your plan but this has the potential to help with increasing Star measures focused on member experiences, such as quality of health plan and rate of health care quality. 8,11   

Also, it’s important to ensure that members receive accessible programming and content due to varying levels of health insurance literacy. Studies have shown that health insurance literacy plays a role in how members select their Medicare Advantage plans. In fact, a Journal of the American Medical Association (JAMA) study concluded that Medicare members with a high health insurance literacy were more likely to select Medicare Advantage as their plan of choice.16 Here, implementing a variety of strategies will be key. Understand that while some members are okay with an email, a PDF, or a survey, others will want to have a conversation with a real person.17 In whichever avenue a member may choose, it’s important to make sure that this communication is timely, consistent, and accessible.  

"When patients are working around their barriers because they’re unaware of plan resources to help take them on, plan satisfaction is likely to take a hit."

Addressing social determinants of health

Even after selecting their plan, Medicare Advantage members may still deal with issues accessing necessary care. Barriers, such as costly medications and lack of transportation to doctors’ visits, can prevent members from utilizing their plan and its benefits wholly. For example, it has been found recently that 1 in 5 Americans have started to ration their insulin due to cost and that can even occur with premium insurance coverage, such as a MA plan.18,19 When patients are working around their barriers because they’re unaware of plan resources to help take them on, plan satisfaction is likely to take a hit.

Using a digital strategy to address members’ social determinants of health (SDOH) as a strategy would play an essential role in improving patient experience.  Better yet, plans new to this approach won’t be alone in adopting this strategy.20 One report found that over 800 Medicare Advantage plans offer some form of supplemental benefits that directly address SDOH in 2021 and this number will only increase in the years to come. 21 With this many competitors adopting this strategy, yours will have to stand out with unique SDOH programming that truly speaks to what your patient population needs.

In building your strategy, you might wonder how to identify the priority needs of your beneficiaries. SDOH strategies have been crafted after listening sessions and surveying members using Consumer Assessment of Healthcare Providers (CAPHS)-related questions.22 After identifying member barriers and truly understanding them, it’s best to find previous strategies that work, such as medication adherence interventions 23 and medically-tailored meal delivery 24, and customize them to what your member base needs.10 For example, one American Diabetes Association study investigated the feasibility of one medically-tailored meal delivery program for members with type 2 diabetes for a 28-day period and found that significant changes occurred with glucose monitoring within that timeframe.25

There are a select Star Measures that explicitly focuses on the experience of members with diabetes, such as D12- Medication Adherence and C11-Eye Exam and are now weighted more heavily.11

Correlating to these specific measures would include preventative screenings for comorbid conditions, such as chronic kidney disease, and condition-specific education, such as educational resources about properly managing blood glucose.28

Preventative programming.

Medicare Advantage members with diabetes have to deal with more challenges and obstacles in managing their care more than other MA members, including controlling any condition-related complication and preventing other comorbidities, such as hypertension or chronic kidney disease.26 Plans can alleviate these challenges by developing a strategy that can help your members to manage and prevent comorbid conditions.  

Within this strategy, the programming should be easy to follow and accessible to patients. Otherwise, it may feel harder than it’s worth to integrate into their daily routine. The great news is that digital engagement makes this easier than ever by putting the power of choice into your members’ hands. They are no longer tied down to solely guidance from the healthcare provider; they can adapt what they have learned into their care plan for the condition in whichever way they prefer. Plus, plans can make this type of intervention even stickier for their overall goals by directly aligning engagement to diabetes-related Star measures. 

Putting All Three Strategies Into Practice

Implementing all three strategies in conjunction provides a greater opportunity to create an effective and harmonious experience for the Medicare Advantage member base (plus, it’s likely more cost-effective to find one solution provider to do it all).  

Imagine this.

One of your newest plan members begins to use Medicare Advantage. Within the first month of starting, she is sent materials via mail about what’s available with her plan, how to access each of her benefits, and where to find help if she has questions about her plan. It’s a pretty long document, so she skims it over, but is a little overwhelmed. She sees a call out towards the beginning that her plan offers one-to-one coaching with a Health Advisor that not only keeps her healthy, but helps her keep up with all the benefits offered by her plan. Better yet, she can sign up right now on her phone. This is great!, she thinks. 

She starts meeting weekly with her Health Advisor, who finds out she isn’t engaging in weekly exercise because a gym membership is out of her price point. No worries! Her Health Advisor lets her know that her plan offers gym discounts. A few weeks later, her Advisor sends her a reminder to set up her quarterly visit with her doctor so she can get her foot and eye test done: she’s overdue! Whew, she thinks, I almost forgot. At her visit, her physician runs a few tests and sees that she may need an adjustment to her medication plan. It’s a good thing you came in when you did!, he says.  With this timely visit to her physician, her treatment plan was adjusted to match the advanced severity of her condition to compare with hierarchical condition category (HCC) risk scoring27 After returning from her visit, she finds a mailed satisfaction survey that aims to gauge her experience so far with the plan. She is told in the mailer that this survey will be sent every 6 months.  

"When your patient engagement approaches are developed with the patient in mind, they will use it to the best of their ability. "

How do you think she’s going to respond? 

This sample member story utilizes all three approaches to illustrate how health plans can use them in tandem to provide patient engagement for members with diabetes. We know it can be a lot to take on, but patient engagement platforms, such as Pack Health, a Quest Diagnostics company, can act as a partner in implementing these types of strategies for your member base. Without a doubt, this kind of member experience is truly possible for every patient with diabetes. 

All three strategies used in collaboration can effectively help Medicare Advantage members with diabetes manage their condition, keep them fully engaged, and keeps their satisfaction with their plan high. Further, one study investigated how impactful a telephone-based diabetes management program is for Medicare Advantage members in reducing hospitalizations and healthcare spending costs. Within the program, members who received the intervention received frequent educational materials about their condition via mail, consistent phone call assessments with their care managers, and care coordination between the nurses and physicians. Ultimately, it was found that hospital readmissions were reduced slightly more than in the control group. 29 When your patient engagement approaches are developed with the patient in mind, they will use it to the best of their ability. 

Adapting new strategies are never easy, but when it comes to this specific member population, these new approaches will help ease the challenges they faced while managing their condition. Just remember: When your members are successful and satisfied with your plan. your health plan will succeed and rise in the ranks.  

Article updated 10/27/2023

Check out Pack Health and the American Diabetes Association’s discussion on how life sciences, health plans, and health systems can use patient engagement to improve patient support for individuals living with diabetes. Watch it below: 

References

  1. National Committee for Quality Assurance (NCQA). Comprehensive diabetes care (CDC). HEDIS Measures and Technical Resources. Accessed September 29, 2022. https://www.ncqa.org/hedis/measures/comprehensive-diabetes-care/  
  2. Rabin RC. Medical care alone won’t halt the spread of diabetes, scientists say. New York Times. October 5, 2022. Accessed November 9, 2022. https://www.nytimes.com/2022/10/05/health/diabetes-prevention-diet.html?searchResultPosition=4  
  3. GoHealth. Report: Medicare Beneficiaries with Diabetes Struggle to Receive Adequate Support and Care. November 18, 2020. Accessed November 9, 2022. https://www.gohealth.com/report-medicare-beneficiaries-with-diabetes-struggle-to-receive-adequate-support-and-care/  
  4. The Pack Health Team. Why “diet improvement” doesn’t help food insecure individuals manage their chronic conditions. July 13, 2020. Accessed November 9, 2022. https://packhealth.com/news-food-insecurity-chronic-conditions/  
  5. Kirwan JP, Sacks J, Nieuwoudt S. The essential role of exercise in the management of type 2 diabetes. Cleve Clin J Med. 2017;84(7 Suppl 1):S15-S21. doi:10.3949/ccjm.84.s1.03 
  6. Meyer H. Medicare diabetes prevention: Enrollment short of projections. Health Affairs 40(11):1682-1687. https://doi.org/10.1377/hlthaff.2021.01292  
  7. Gruß I, Firemark A, Papajorgji-Taylor D, Fitzpatrick SL. Challenges with implementing the Diabetes Prevention Program for Medicare beneficiaries in an integrated health system. Am J Manag Care. 2021;27(11):e400-e403. Published 2021 Nov 1. doi:10.37765/ajmc.2021.88784 
  8. Center for Medicare and Medicaid Services (CMS). CMS Releases 2022 Medicare Advantage and Part D Star Ratings to Help Medicare Beneficiaries Compare Plans. October 8, 2021. CMS Newsroom. Accessed September 29, 2022. https://www.cms.gov/newsroom/press-releases/cms-releases-2022-medicare-advantage-and-part-d-star-ratings-help-medicare-beneficiaries-compare   
  9. Meyers DJ, Trivedi AN, Wilson IB, Mor V, Rahman M. Higher Medicare Advantage Star ratings are associated with improvements in health outcomes. Health Affairs 40(2): 243-250. https://doi.org/10.1377/hlthaff.2020.00845 
  10. Carlton S, Malfara D, Neher K, Repasky C. New Stars ratings for Medicare Advantage prioritize customer experiences. McKinsey. October 15, 2020. Accessed October 3, 2022. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/new-stars-ratings-for-medicare-advantage-prioritize-customer-experiences 
  11. Center for Medicare and Medicaid Services (CMS). 2023 Medicare Advantage and Part D Star Ratings. October 6, 2022. CMS Newsroom. Accessed September 29, 2022. https://www.cms.gov/newsroom/fact-sheets/2023-medicare-advantage-and-part-d-star-ratings  
  12. King R. Medicare Advantage star ratings show steep declines for 2023 as pandemic flexibilities go away. Fierce Healthcare. October 6, 2022. Accessed October 13, 2022. https://www.fiercehealthcare.com/payers/medicare-advantage-star-ratings-show-steep-declines-2023-pandemic-flexibilities-go-away  
  13. Jacobson G, Cicchiello A, Sutton JP, Shah A. Medicare Advantage vs. Traditional Medicare: How do beneficiaries’ characteristics and experiences differ? (Commonwealth Fund, Oct. 2021). Accessed October 12, 2022. https://doi.org/10.26099/yxq0-1w42 
  14. Andes LJ, Li Y, Srinivasan M, Benoit SR, Gregg E, Rolka DB. Diabetes Prevalence and Incidence Among Medicare Beneficiaries — United States, 2001–2015. MMWR Morb Mortal Wkly Rep 2019;68:961–966. DOI: http://dx.doi.org/10.15585/mmwr.mm6843a2 
  15. Meyers DJ, Belanger E, Joyce N, McHugh J, Rahman M, Mor V. Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries. JAMA Intern Med. 2019;179(4):524–532. doi:10.1001/jamainternmed.2018.7639 – https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2725083  
  16. Park S, Langellier BA, Meyers DJ. Association of Health Insurance Literacy With Enrollment in Traditional Medicare, Medicare Advantage, and Plan Characteristics Within Medicare Advantage. JAMA Netw Open. 2022;5(2):e2146792. doi:10.1001/jamanetworkopen.2021.46792  
  17. Sokol E. 5 strategies for 5 stars: Cigna’s approach to CMS Star ratings. HealthPayerIntelligence. August 16, 2019. Accessed October 10, 2022. https://healthpayerintelligence.com/features/5-strategies-for-5-stars-from-cigna  
  18. Lovelace Jr. B. Nearly 1 in 5 U.S. adults with diabetes ration insulin to save money, study finds. NBC News. October 17, 2022. Accessed November 3, 2022. https://www.nbcnews.com/health/health-news/insulin-prices-many-adults-diabetes-ration-insulin-study-finds-rcna52287  
  19. Aggarwal R, Gondi S, Wadhera RK. Comparison of Medicare Advantage vs Traditional Medicare for Health Care Access, Affordability, and Use of Preventive Services Among Adults With Low Income. JAMA Netw Open. 2022;5(6):e2215227. doi:10.1001/jamanetworkopen.2022.15227 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793106 
  20. King R. BMA: Number of MA plans offering social determinants of health benefits increased threefold in 2021. Fierce Healthcare. August 5, 2021. Accessed October 12, 2022. https://www.fiercehealthcare.com/payer/bma-ma-plans-offering-social-determinants-health-benefits-increased-three-fold-2021 
  21. Better Medicare Alliance. NORC at the University of Chicago. Case study report: Innovative approaches to addressing social determinants of health for Medicare Advantage beneficiaries. January 2022. Accessed October 12, 2022. https://bettermedicarealliance.org/wp-content/uploads/2022/01/SDOH-Case-Studies-NORC-Report-Jan-2022.pdf 
  22. Healthmine. How to capture actionable data to inform end-of-year CAHPS improvements. Accessed October 17, 2022. https://www.healthmine.com/resources/end-of-year-cahps-improvements  
  23. Hong M, Esse T, Vadhariya A, et al. Evaluating success factors of a medication adherence tracker pilot program in improving Part D medication adherence metrics in a Medicare Advantage plan: Importance of provider engagement. J Manag Care Spec Pharm, 2020 May;26(5):662-667. doi/10.18553/jmcp.2020.26.5.662 — https://www.jmcp.org/doi/10.18553/jmcp.2020.26.5.662 
  24. Berkowitz SA, Terranova J, Hill C, et al. Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries. Health Aff (Millwood). 2018;37(4):535-542. doi:10.1377/hlthaff.2017.0999  https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0999 
  25. Clark CN, Hart BB, McNeil CK, Duerr JM, Weller GB. Improved Time in Range During 28 Days of Meal Delivery for People With Type 2 Diabetes. Diabetes Spectr. 2022;35(3):358-366. doi:10.2337/ds21-0093 
  26. Hasche J, Ward C, Schluterman N. Diabetes occurrence, costs, and access to care among Medicare beneficiaries aged 65 years and over. Medicare Current Beneficiary Survey. September 2017. Accessed November 8, 2022. https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Downloads/Diabetes_DataBrief_2017.pdf  
  27. Berg C. Diabetic HCCs: Documenting and capturing complications. 3M Inside Angle blog. October 13, 2021. Accessed November 16, 2022. https://insideangle.3m.com/his/blog-post/diabetic-hccs-documenting-and-capturing-complications/ 
  28. Anderson SL, Marrs JC, Chachas CR, et al. Evaluation of a pharmacist-led intervention to improve statin use in persons with diabetes. J Manag Care Spec Pharm, 2020 Jul;26(7):910-917.https://doi.org/10.18553/jmcp.2020.26.7.910 
  29. Rosenzweig JL, Taitel MS, Norman GK, Moore TJ, Turenne W, Tang P. Diabetes disease management in Medicare Advantage reduces hospitalizations and costs. Am J Manag Care. 2010;16(7):e157-e162. Published 2010 Jul 1. 

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Copyright © 2023 Pack Health, A Quest Diagnostics Company. All rights reserved.

Pack Health is not intended to be a substitute for medical advice provided by a person’s treating healthcare provider and is not intended to practice medicine. Pack Health is intended to be an aid for people to gain insights into ways to help improve their general health and well-being. 

Only a person’s healthcare provider should diagnose and treat their patients based on the provider’s clinical assessment, education, and training. This service should not be used as a substitute for a person’s healthcare provider.