Nineteen percent of Medicare Advantage beneficiaries said that they forget to take prescribed medications; of those, 24 percent said they forget at least once per week.
Fifteen percent of respondents noted that a reminder system would help them with adherence. The survey results are based on a 2018 survey of 781 Medicare Advantage beneficiaries with at least one chronic condition conducted by Health Action as a Service company, HealthMine.
For Medicare Advantage plans, drug adherence is a key factor in Star ratings. Star Ratings have been created to measure the performance of Medicare plans. These ratings include three measures of drug adherence targeting chronic disease: 1) Medication Adherence for Diabetes Medications, 2) Medication Adherence for Hypertension, 3) Medication Adherence for Cholesterol. This is indicated in the CMS, Medicare 2019 Part C & D Star Ratings Technical Notes, updated 11/08/2018, page 100. Those measures are given triple weight among all Star Ratings measures.
The results are in line with a 2014 study of 586 Medicare beneficiaries entitled: Medication adherence behaviors of Medicare beneficiaries. It was conducted with the approval of the Institutional Review Board of the University of the Pacific. The study revealed 30 percent were non-adherent. The following reasons were provided: 73 percent, forgetfulness; 11 percent, side effects; 10 percent, the medication was not needed. Lower adherence rates were also associated with difficulty paying for medication, presence of a medication-related problem, and certain symptomatic chronic conditions.
Medicare Advantage (MA) plans are not doing enough to motivate their members to improve their personal health, according to a new survey from HealthMine.
Sixty percent of members participating in the poll said that their MA plans do not offer any incentives for engaging with healthcare providers or making lifestyle improvements, leaving individuals on their own to meet their wellness goals. All of the beneficiaries participating in the survey have at least one chronic disease. Yet respondents feel as if their MA health plans are not taking steps to make it easier to manage their conditions.
Three-quarters stated that instead of sending personalized recommendations, their plans will offer generalized advice, such as suggesting a flu shot during the winter. Just fifteen percent have received messaging specific to their diagnosed chronic disease. Thirty-five percent said that they have never received a reminder of any kind from their MA plan.
Medicare Advantage enrollment is skyrocketing as more beneficiaries enter the over-65 age bracket. From plan year 2018 to plan year 2019, enrollment in MA plans increased by 12 percent, according to a recent report from Mark Farrah Associates. Since 2015, MA membership has seen a 125 percent increase.
With 21 million total members, MA plans represent a large segment of the overall insurance market – and a highly lucrative opportunity for payers who can attract and retain beneficiaries.
Personalization is likely to play an important role in generating consumer loyalty. Tailoring communication strategies to meet the preferences of each member is an important place to start. Generalizing, older Medicare Advantage beneficiaries may prefer phone communication, or email, while those between the ages of 65 to 70 years might gravitate more to texting and digital communications.
More than three-quarters of Medicare Advantage members are using Internet of Things devices, such as blood pressure monitors, fitness wearables, blood sugar monitors, and cardiac monitors, to keep track of their personal health and chronic diseases.
But only 8 percent said their health plan can harness this data to make suggestions about chronic disease management or connect them with resources that could help improve their quality of life. Almost half of respondents said they rarely or never get answers to their questions. Thirty-one percent said they don’t have access to connected care services that could reduce their spending and improve their health.
Bridging the divide between member preferences and MA plan capabilities will be essential for generating sustained engagement, equipping members with actionable tools, and, ultimately, lowering the costs of care. MA plans that wish to succeed in an increasingly competitive environment will need to take a more proactive stance towards communicating with members how and when they desire it to ensure that beneficiaries feel motivated to complete important chronic disease management tasks.
Model would reflect the number of conditions and add categories for mental health, substance use disorder, and chronic kidney disease.
The Centers for Medicare and Medicaid Services is proposing to phase-in changes to the way it calculates risk adjustment payment to Medicare Advantage plans. Starting in 2020, CMS will calculate payments using a blend of 50 percent of the risk adjustment model first used for payment in 2017 and 50 percent of the new risk adjustment model proposed, but not finalized, in the 2019 rate announcement.
The new model adds variables that count the number of conditions a beneficiary may have. It includes additional condition categories for mental health, substance use disorder, and chronic kidney disease. Building on the model being used for 2019, it includes technical updates such as calibrating the model with more recent data and selecting diagnoses with the same method used for encounter data.
WHY THIS MATTERS
The advance notice issued is Part I of the 2020 advance notice of methodological changes for Medicare Advantage capitation rates and Part D payment policies.Risk scores determine payment. The model is designed to reduce incentives for payers to enroll healthier members, by giving them reimbursement for higher-risk and costlier beneficiaries.
The 21st Century Cures Act requires CMS to make adjustments to the risk adjustment model to take into account the number of conditions an individual beneficiary may have, in addition to other factors in the existing model. Further, the 21st Century Cures Act requires that CMS fully phase in the required changes to the risk adjustment model by 2022.
CMS calculates risk scores using diagnoses submitted by Medicare fee-for-service providers and by Medicare Advantage organizations. Historically, CMS used diagnoses submitted by Medicare Advantage organizations.
In recent years, CMS began collecting encounter data from Medicare Advantage organizations.
In 2016, CMS began using diagnoses from encounter data to calculate risk scores, by blending 10 percent of the encounter data-based risk scores with 90 percent of the risk-adjustment processing system, or RAPS-based risk scores.
In 2017, CMS continued to use a blend to calculate risk scores, by calculating risk scores with 25 percent encounter data and 75 percent RAPS. In 2018, it used 15 percent encounter data and 85 percent RAPS; and in 2019, 25 percent encounter data and 75 percent RAPS. The new model will determine risk scores by adding 50 percent of the score calculated from diagnoses from encounter data, RAPS inpatient diagnoses and fee-for-service diagnoses, with 50 percent of the risk score calculated with diagnoses from RAPS and fee-for-service diagnoses.