Six Tips for Health Plans to Succeed in the Future of Medicare Advantage
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Tomorrow Health
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As the Medicare Advantage (MA) landscape evolves, health plans face the challenge of maintaining high Star Ratings while addressing member needs and controlling costs. McKinsey’s “The Future of Medicare Advantage” report provides strategies for navigating these complexities and achieving positive outcomes. Here's Tomorrow Health checklist to guide your plan toward success:
1. Elevate HEDIS Performance and Prioritize Health Equity
Key Changes: The Centers for Medicare & Medicaid Services (CMS) has introduced new clinical measures and the Health Equity Index (HEI), which will be critical in upcoming Star Ratings. The HEI, set to be implemented in the rating year 2027 (RY2027), will focus on reducing health disparities, especially for low-income and dual-eligible populations.
How Tomorrow Health Can Help:
- Invest in Predictive Analytics: Identify and proactively address care gaps, especially for underserved populations, using advanced analytics.
- Strengthen Provider Partnerships: Enhance data accuracy and care coordination through collaborations with providers.
- Address Health Disparities: Implement targeted programs to align with CMS’s focus on health equity.
Result: Tomorrow Health’s platform ensures ~97% of patients start care on time, compared with an industry average of ~50%, significantly boosting HEDIS performance and health equity.
2. Engage Low-Income Subsidy (LIS) Members Effectively
Key Changes: With the HEI focusing on LIS-eligible members, effectively engaging this segment will be crucial for improving Star Ratings.
How Tomorrow Health Can Help:
- Leverage Comprehensive Data: Utilize claims data and social determinants of health (SDOH) to tailor interventions for LIS members.
- Personalize Outreach: Customize communications to meet the specific needs of low-income seniors, enhancing engagement.
- Enhance Care Coordination: Implement care management programs that address challenges specific to LIS members, leading to better outcomes.
Result: Improved health outcomes and higher Star Ratings for LIS populations.
3. Innovate Benefit Designs and Overcome Geographic Barriers
Key Changes: The CMS's push towards Value-Based Insurance Design (VBID) and the inclusion of benefits addressing social determinants of health are becoming increasingly important. Geographic disparities, especially in rural areas, are also under greater scrutiny.
How Tomorrow Health Can Help:
- Adopt VBID: Reduce cost-sharing for high-value services to increase member satisfaction.
- Expand Benefits: Include services such as mental health, transportation, and nutrition to provide holistic care.
- Address Geographic Disparities: Utilize mobile health units and telehealth to improve access in underserved areas.
Result: Enhanced member satisfaction and improved access to care, particularly in geographically challenged areas.
4. Enhance Member Experience with Digital Tools
Key Changes: Although the weighting for member experience measures will be reduced in future Star Ratings, it remains a critical component. Digital engagement is important for improving member satisfaction and maintaining high Star Ratings.
How Tomorrow Health Can Help:
- Utilize AI-Driven Member Support: Offer 24/7 support and personalized responses through AI tools.
- Streamline Prior Authorizations: Automate the process to reduce administrative burden and improve member satisfaction.
Result: Tomorrow Health’s automated prior authorization system delivers 3-5% payor savings while enhancing both operational efficiency and member satisfaction.
5. Balance Clinical Excellence with Member Experience
Key Changes: The Star Ratings program is shifting focus toward clinical measures, making it essential to balance clinical outcomes with a positive member experience.
How Tomorrow Health Can Help:
- Integrate Care Management Systems: Combine clinical and member experience data for a comprehensive approach to care.
- Leverage Technology: Use advanced tools to manage Durable Medical Equipment (DME) orders and streamline care coordination.
Result: Tomorrow Health’s platform optimizes coding and payment policies in real-time, resulting in 3%+ savings for payors and improved health outcomes.
6. Mitigate Rising Costs with Efficiency Measures
Key Changes: With rising costs and declining margins, efficiency is more important than ever. The McKinsey report highlights the need for digital transformation to offset these challenges.
How Tomorrow Health Can Help:
- Drive Digital Transformation: Streamline administrative processes with digital tools to reduce costs.
- Implement Proactive Cost Management: Develop strategies to manage rising medical costs, including negotiating provider rates and emphasizing preventive care.
Result: Tomorrow Health delivers 15%+ cost savings for payors through its approach to care coordination and cost management.
Key Benefits of Partnering with Tomorrow Health:
- Achieve up to 4x ROI ($3.97 Average PMPM Savings)
- 96% member satisfaction with an average supplier rating of 4+ stars
- Save 300,000+ hours annually in administrative tasks for care managers and network prescribers
- 99% of prescribers adopt Tomorrow Health after their first order
By focusing on innovation, technology, and a member-centric strategy, health plans can successfully navigate the evolving MA landscape. Partnering with Tomorrow Health can further strengthen these efforts, helping health plans achieve and maintain high Star Ratings while optimizing costs and member satisfaction.
Ready to elevate your MA plan's performance?
Contact Tomorrow Health today to learn how our innovative solutions can help you succeed in the competitive Medicare Advantage market.
