COVID-19 has made member engagement more important than ever before. In this article, RISE talks to three of the facilitators of RISE West’s upcoming preconference workshop that tackles the need for Medicare Advantage (MA) plans to double down on member engagement in the second half of 2020.

The virtual three-hour workshop will take place at 1 p.m. EST on Wednesday, Sept. 9, the day before the two-day live-streamed main conference. To learn more about this growing focus area, RISE interviewed the three preconference workshop leaders about why member engagement is an organization-wide effort, the impact of COVID-19, challenges and opportunities, and what attendees can expect to learn at the virtual session.

Member engagement: Why MA plans must address it now

COVID or no COVID, the industry is moving closer toward valuing member engagement more and more, says Shannon Decker, M.Ed., MBA, Ph.D., vice president, clinical performance, Brown & Toland Physicians, who will lead the workshop alongside Prominence Health Plan’s Dominic Henriques, vice president of performance improvement, and Johanna Martinez, director of quality improvement.

“COVID exacerbated the need—if anything it advanced the opportunity that was coming, only much more slowly pre-COVID,” says Decker, pictured right. “The larger goal of our work and all these programs is managing health care. We can only get to that end by involving the patient. The way we used to practice, screenings once a year, etc., has had its time—it’s not enough to keep up with patients and providers and managing how they interact with the health care system and make a difference if they are not both engaged and see the system as being useful and themselves as competent users.”

If that isn’t enough to propel the movement forward, the Centers for Medicare & Medicaid Services (CMS) continues to ratchet up the importance of member experience in the Stars rating program, according to Henriques. As MA continues to become more competitive, it is more important than ever for plans to have membership retention strategies, he says. “The cost and challenges that go into new membership are great, so membership retention through engagement/satisfaction is a winning strategy.”

Martinez agrees. “CMS continues paving the future of Stars by giving more weight to member experience and that is why it is imperative to invest in member engagement and retention. “Investing in engagement can definitely influence the outcome of other aspects of the Star rating: Members that are engaged with the plan are more likely to participate in our preventive programs, be more compliant with their screenings, reach out when something goes wrong, and be more aware of the benefits we offer,” she explains.  

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Forget silos: Member engagement is an organization-wide effort

Not one department is responsible for engaging members and improving their experience. Everyone in the organization has a role in member engagement, says Henriques, pictured.Just as quality is not the job of just a quality department, member experience/engagement is not just the job of a single department. Recognition of the fact that the member is the customer, and the customer is king should promote cross-organizational attention,” he says.

Consider every process within your health plan that directly or indirectly touches a member, suggests Martinez. It goes beyond the call center. “Think about the effect on member experience of your utilization management team processing authorizations, your claims department paying provider claims, or your communications team creating a piece of marketing. Each team has a responsibility to assure that member experience is priority #1,” she says.

Decker agrees, noting that organizations must consider the larger goal of health care of providing the right care in the right time in the right way. “I tell my organization that we are all investing in the quadruple aim of health care and we can only get there if all of us keep that goal in sight and move toward that end,” she says.

The impact of COVID-19

MA members are looking to health care providers and plans for guidance. It’s an opportunity for plans to shine and be a true resource and advocate for the member,” says Henriques.  “We have their attention now more than ever.

Indeed, Martinez, pictured right, has noticed that members are more open to better understanding their options and explore benefits, such as mail-order pharmacy or telehealth, that they wouldn’t have used if the pandemic didn’t hit.

Decker says COVID-19 has had a polarizing effect on members. “For some patients, it has provided opportunities to those who may not have accessed health care appropriately, if at all, in the past to be redirected, she says. “For others, it has ostracized them.”

Top challenges and opportunities

Decker sees challenges involving the need to engage more patients, physicians, and their office staff and diminish the polarization that many have experienced during the pandemic. It means organizations must get the right messaging out in a way that will encourage a desired action.

“The opportunities are the opposite---give these groups the opportunity to interact in a way that is more authentic and hence, more likely to have the effects we desire. We can diminish the polarizing effects,” she says.

Martinez and Henriques also see challenges and opportunities with technology. Although organizations have made efforts over the years to combat many barriers to access, most have centered around physical access to care, according to Henriques. Now it’s time to address disparities in access to technology.

“We see that the access to basic internet varies not only across age groups but age/ethnicity, income, education, living arrangements (i.e. living in a multigenerational home) have an important effect on whether or not a member can access technology,” says Martinez.

Preconference takeaways

The workshop is intended to be an exchange of ideas where attendees can share their experiences to gain new perspectives and better enhance member engagement. Henriques said he and his co-facilitators will explore the challenges that health plans and management services organizations (MSOs) face and provide real-world, practical examples of how two types of managed care organizations have responded to the shifting tides and addressed member engagement. Best of all, Martinez said attendees will walk away with tips and strategies for member engagement that they can implement in their organizations.

RISE West 2020 will take place Sept. 9-11. This year’s virtual event will bring together leaders, senior managers and directors from Medicare Advantage health plans, commercial marketplace sponsors, Part D health plans, provider groups, and pharmacy benefit managers. Preconference workshops on member engagement, HCC coding, and risk adjustment will take place on Sept. 9.  Click here for more information about the full agenda, special virtual pricing, and registration.