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Medicare Advantage (MA) health plans are being held to increasingly high standards of quality, cost and member experiences via the powerful Star Ratings system. With their consumer reputation and billions of dollars in incentives on the line, plans must do everything they can to ensure they’re serving their members to the best of their ability.
And they certainly can’t do it alone. Access to reliable, comprehensive and coordinated providers is essential to success in an extremely competitive marketplace.
Unfortunately, many providers are struggling right now to make sense of a post-COVID world where workforce shortages are the norm, emotional and professional burnout is widespread and finances are uncertain. They may feel disconnected from their mission as they strive to do more with less, and are likely to be actively considering leaving the profession for a less stressful career path.
This isn’t just a crisis for health system leaders. It’s a pressing concern for health plans, as well. A disaffected and overwhelmed workforce is less able to provide accessible, proactive, holistic care to members, potentially leaving MA plans with lower CAHPS scores, gaps in preventive care measures, and higher costs when poorly managed clinical issues snowball into acute events.
MA plans can support their clinicians to break through the burnout with tools, technologies and collaborative support that assist providers with delivering high-quality, holistic care. This includes providing clinicians with data-driven insights into member populations, enabling improved risk stratification, outreach prioritization and comprehensive management.
Leveraging data analytics to address the fourth pillar of the Quintuple Aim—Improving Clinician Experience
The Quintuple Aim of healthcare is an expanded version of the well-known Triple Aim. In addition to promoting better health outcomes, lower medical costs
and better healthcare experiences for patients, the Quintuple Aim addresses a fourth guiding principle—better clinician experiences—and a fifth pillar, health equity, to truly round out the shared goals of the care continuum.
All these goals are interconnected, with the last two having a major impact on achieving the three core tenets. A clinician who is optimally equipped to perform at their highest level (and has the cognitive and emotional bandwidth to do so) will be more likely to make positive care decisions, pursue the most cost-effective options, develop strong relationships with patients, and strive to go above and beyond when solving for socioeconomic barriers.
The challenge for health plans working with their own in-house clinicians is identifying how to best offer the right resources at the right time to members of the care team. This can include everyone from physicians, nurses, nurse practitioners and physician assistants, to social workers, behavioral health workers, pharmacists and more.
Timely and accurate data, delivered through an intuitive and workflow-friendly interface, is a high-impact way to approach the problem. For example, MA plans can share clinical risk stratification data, enriched with socioeconomic vulnerability indices, to give provider staff a targeted approach to conducting outreach activities. When the workspace includes additional features, such as the ability to rank relevant risk factors, or community resources embedded into the workflow for resolving socioeconomic barriers to care, providers can take action with more information, fewer clicks and less frustration.
This can also result in improved member adherence to care plans, medications and preventive care recommendations, which can translate into better Star Ratings performance and more opportunities for the MA plan to earn financial incentives—all by zeroing in on the clinician experience.
Best practices for using data analytics to improve clinician experiences
To jumpstart an improved clinician experience, MA plans need to evaluate their existing technology infrastructure and consider making investments in provider-facing tools that elevate the experience of their clinicians.
Empower outreach efforts with a robust data analytics platform for the right team members
Member outreach can take many forms and originate from several different points within the care team. Plans need to be aware of how outreach is being conducted and which team members need access to platforms that offer insights tailored to their role and goals.
Clinicians, including nurses and advanced practice providers, may need more information about medical diagnoses, procedures, transitions of care and social determinants of health. Meanwhile, pharmacists need additional insight into factors tied to prescription claims, such as the gaps in treatment and medication adherence that can occur, for example, when an ICD-10 diagnostic code doesn’t match up with a corresponding pharmacy claim NDC code.
Making sure dashboards and analytics capabilities are robust and supports the needs of different clinical personas is key to fostering better experiences for all end users.
Improve efficiency and reduce frustration with ease of use
No matter who is using the tool for what purpose, user interfaces must be intuitively designed to remove the burdens of administrative tasks. In the modern health IT environment, clinicians expect the ability to access the information to complete their tasks in a workflow that requires a minimum of clicks, tabs and windows.
Technology should assist with the care process by surfacing “nudges” to users about upcoming tasks that help plan members achieve and maintain their best health and allow the plan to achieve adherence and improved Stars measure performance. This can include completing preventive care treatments, or improving adherence to medications that allow for success with more longitudinal health behaviors. This is most effective when offered in a simplified user interface that highlights critical information in an integrated and accessible manner.
Align medical and pharmacy data for deeper clinical insight
Combining medical and pharmacy data maximizes a provider’s ability to stay one step ahead of medication adherence issues, which can have an outsized effect on Stars performance for health plans.
Platforms that leverage both data types on a daily or weekly basis help health plans identify the broadest possible set of drug therapy problems (DTPs) that can contribute to avoidable emergency department use, unplanned readmissions, and poor control of chronic conditions—all of which can pile up to drag down a plan’s Star Ratings. These analytics enable pharmacy staff to conduct medication reviews more quickly, while being more confident they are addressing the member’s whole health profile.
The alignment of medical and pharmacy claims provides a richer set of data that supports pharmacists and clinicians in the efficiency of CMR outreach to maximize closure of DTPs. Not only does this help reduce frustration and burnout for the clinician—it also helps the MA plan reduce medical spending through improved health outcomes and avoidance of future medical issues—a win-win.
Choose the right options for your plan and providers
Partnership with the right healthcare technology can help your health plan positively impact provider experiences with the right data analytics tools. And a partner that’s available either as a Software-as-a-Service (SaaS) platform, or as technology-enabled clinical services, can provide augmentation at times when in-house clinicians are still unable to handle the demands of a high-needs member population all on their own.
This is especially true in geographic regions hardest hit by clinician shortages, including rural areas and underserved urban regions that are home to some of the highest risk communities with high socioeconomic burdens. When even the best clinicians simply don’t have the resources to meet the enormity of need, plans need to find creative solutions for bridging the gaps.
Enlisting a technology partner with the experience and clinical capacity (if needed) to conduct outreach on the plan’s behalf can boost existing resources and significantly relieve burdens on contracted provider groups, improving experiences and outcomes across the board.
With all of the Quintuple Aim riding on ensuring that provider networks are empowered, informed and equipped with meaningful data, MA plans should lean into the adoption of easy-to-use platforms that offer a variety of critical capabilities aligned with Star Ratings goals.
If your Medicare Advantage plan is in need of a robust, data analytics platform or clinical services supported by data-driven technology, contact AdhereHealth to learn more. Our programs help MA plans improve medication and treatment adherence with the right data and insights to support patients and populations. Request a consultation today!
Authored by:
Levi Sanderson, PharmD.
Clinical Solutions Specialist at AdhereHealth
