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

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.

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. 

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.  

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.  

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

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. 

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 scoring. ²⁷ 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.  

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: