Educating Medicare Advantage Consumers Through the Healthcare Continuum: Why Health Plan Literacy Is Key to Improving CAHPS

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Medicare Advantage plans face many challenges when trying to increase their Star Ratings. Health literacy—more specifically, poor health plan literacy—is one of the top complicating factors.

Low health plan literacy limits an individual’s ability to navigate the healthcare continuum. Many consumers don’t fully understand what benefits and services are available to them within the healthcare delivery system. The problem is especially acute among Dual-Eligible Special Needs Plans (D-SNPs). This vulnerable subgroup is made up of low-income seniors with high rates of multiple chronic conditions, physical or cognitive disabilities and social determinants of health (SDOH) issues that can interfere with their ability to comprehend or access their benefits.

Health plan literacy challenges may explain, in part, why D-SNPs have historically under-performed on Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, given the annual survey’s focus on consumers’ ability to access needed care. Data shows that in contract year 2018, D-SNPs performed 5.8 percent worse for CAHPS measures compared to non-D-SNP plans.

In contract year 2021, CAHPS performance will have the ability to make or break each plan’s Medicare Advantage Star Ratings. CAHPS measures will be quadruple-weighted in contract year 2021, meaning that CAHPS performance will represent almost one-third of the entire MA Star Ratings calculation. Given this change, educating MA consumers throughout the healthcare continuum should now be a top priority for health plans—especially D-SNPs, because they are at highest risk of falling short of the four-star threshold necessary to qualify for Quality Bonus Payments (QBPs).

When health plan literacy improves, the entire healthcare ecosystem benefits: Consumers have more positive experiences and tend to utilize more of their available benefits, which leads to better outcomes, increased medication adherence and, ultimately, lower healthcare costs. To promote health plan literacy, it is essential to first understand the gaps in your current communication with consumers and acquire the right tools to overcome any hurdles.

Most Medicare Beneficiaries Don’t Understand Their Coverage

According to a Medicare Advantage 2020 literacy study of 1,000 consumers, 70 percent don’t understand their coverage. Without clarity on plan coverage, consumers may not be using the most important preventive services or maximizing their prescription coverage.

Much of this misunderstanding comes from a lack of health plan literacy around terms such as deductible, coinsurance and premium. Recently, consumers have experienced confusion around COVID-19 and what’s covered in light of the pandemic. Resources from Centers for Medicare and Medicaid Services (CMS) contain all the specifics, but those resources aren’t personalized—and they’re not always written in language that’s accessible for a consumer with low health literacy.

When consumers feel a disconnect with their health plans, they may be less likely to use their benefits. Further, they may not be aware of their options when it comes to plan benefits, such as pharmacy home delivery options. This unawareness can impact continuity of care, particularly in the context of COVID-19, which has exacerbated SDOH issues and medication adherence challenges for underserved populations. Statistics show that almost 90 percent of those who are hospitalized with the virus have underlying conditions, and a majority are over the age of 50. By proactively targeting and educating high-risk populations, MA plans can keep more consumers adherent and healthy and help them reduce their risk of becoming seriously ill from the virus.

Now more than ever, it’s clear that supporting health plan literacy should be a priority. But do you know how it affects your consumers? Do you currently have plans in place that identify and help improve your consumers’ health literacy? Most health plans need a strategy to improve their consumers’ health plan literacy.

Create Accessible Resources to Improve Health Plan Literacy

It’s no secret that the website is often confusing and full of jargon that isn’t accessible to the average consumer. It’s up to each health plan to provide consumers with an easy-to-read website that offers digestible information they can use.

The U.S. Department of Health and Human Services (HHS) developed a guide for health literacy online that provides best practices for organizations on how to create an easy-to-use website for consumers, including those with low health literacy. The guide outlines usability principles and examples of web elements that can overwhelm consumers, plus ways to create actionable, clear content that’s consumer friendly.

Offering more approachable health plan content is important, but content alone can’t bridge the gaps in health literacy. The best way to improve health plan literacy is to ensure every interaction your clinical team has with a consumer includes a conversation about their SDOH challenges and other hurdles that may prevent them from accessing needed care.

Asking personalized questions related to SDOH can be sensitive, so it’s essential to have a clinical workflow that guides clinicians through motivational interviewing tactics to uncover such issues as food insecurity or mobility challenges. The Adhere Platform™ Resolve™ solution even takes things a step further, providing embedded health plan benefits and integrated tools to connect consumers with available community resources, such as Meals on Wheels, to resolve their unique issues.


Consumer Literacy in the Healthcare Continuum Has Real Consequences

When consumers are more aware of their care benefits and have consistent, proactive and personalized interactions with their health plan, they will be more likely to report positive experiences. This is critical to the CAHPS survey measures—which make up 32 percent of overall Medicare Advantage Star Ratings beginning in contract year 2021.

Plans that don’t make it a priority to engage consumers on health plan literacy effectively rely on consumers to educate themselves. Instead, focus on building a proactive strategy to address your consumers’ literacy throughout the healthcare continuum.

Consumer health literacy supports better medication adherence and leads to better management of chronic conditions and higher quality of life. This is particularly important as the nation experiences a second surge in COVID-19, given consumers with underlying conditions who are at heightened risk due to COVID-19 are also at risk of nonadherence. Medication adherence not only will help consumers remain healthy amidst the crisis, but it also reduces costs across the entire healthcare system. What’s more, medication-related measures still make up 52 percent of MA Star Ratings.

Because medication adherence and CAHPS dominate MA Star Ratings for contract year 2021, focusing on these two areas will put your plan at a strong advantage for the $11.6 billion QBP pool. Succeeding in these areas will also make your plan more likely to retain consumers because they will recognize the efforts you make at every touchpoint to deliver clear and concise, proactive and personalized information. Consumers and health plans both win when awareness and information are a priority.

How Do You Make Consumer Health Plan Literacy a Priority?

Whether you need to revise an existing plan or develop a new one, addressing consumers’ health plan literacy is a complex process. The key is reaching the right consumers at the right time and using a customer relationship management (CRM) tool to engage your consumers over time in a holistic way that leverages every touchpoint with consumers. Intelligent clinical workflow software powered by consumer-specific analytics can help with this effort.

Use a data-driven tool to target consumers with gaps in care or medication adherence, and make health plan literacy—and overall health literacy—a priority in every conversation. When you begin to personalize touchpoints based on specific consumers’ challenges instead of using impersonal or disconnected communication plans, you have a better chance of enhancing consumer literacy and access to care.

Resolve empowers health plans to target consumers for more successful engagement over time. It’s a powerful, customer-centric, analytics-driven tool that addresses 80.5 percent of MA Star Rating weightings, including CAHPS and medication-related measures.

To maximize MA Star Ratings performance, plans must focus on improving CAHPS and medication adherence. Leverage Resolve as a proactive tool to enhance and improve your consumer engagement and ensure you reach the right consumers at the right time. Resolve analyzes data from dozens of sources (including CAHPS, HOS, pharmacy and medical claims, HEDIS, eligibility and hospital discharge data) to identify at-risk consumers and facilitate SDOH-focused outreach. Resolve is available as a software-as-a-service (SaaS) application or as a tech-enabled clinical service.

With MA Star Rating changes, it is urgent to develop more advanced outreach programs to improve your consumer experience. See how Resolve can help by scheduling a demo.