Last year, the Centers for Medicare and Medicaid Services (CMS) released their Contract Year 2023 Medicare Advantage and Part D Final Rule — and with it, new provisions for health plan members who are most in need of complex care.
At Belong Health, we anticipate this set of policy changes— geared towards improving consumer protections, managing cost-sharing, and strengthening coordination between healthcare providers and recipients— will yield powerful benefits not only for a broad spectrum of underserved communities, but also for insurers nationwide.
Frankly, we couldn’t be more excited to help chart a path across that new landscape.
As part of CMS’s new rule, Medicare Advantage plans offering Dual Special Needs Plans must establish member advisory committees in each state. By design, these committees— which have historically been successful for Medicaid plans— will serve to gather direct input on enrollee experiences. Maintenance of enrollee advisory committees will ensure that enrollee feedback is heard by the plans to help identify and address barriers to high-quality, coordinated care.
Curated with an eye towards specific demographic and geographic characteristics, the CMS advisory committees are required, by law, to be composed in such a way that reflects the unique makeup of the D-SNP population being served.
Here are five reasons why the development of these culturally specific advisory committees is great news for health insurers:
- Greater enrollee involvement means better quality of care.
Healthcare decisions need not — and should not — amount to a “black box” that alienates the recipient of care from the details of the care they deserve. The existence of an enrollee advisory committee naturally increases the quality of communication between the insurer and the insured — a fact that only strengthens both ends of that ongoing relationship.
By closely involving D-SNP enrollees in healthcare decision-making processes, insurers will gain intimate insights into the needs and preferences of their target populations. How do they get to work? What is their daily diet? Where do they get their news? How do they feel about themselves? With whom do they live?
Once armed with this valuable data, insurers can design and implement stronger and more acutely targeted programs — ones that consider, for example, community-specific needs and social determinants of health, including food insecurity, housing, transportation, and communication barriers.
This socially conscious and targeted approach to healthcare will no doubt strengthen health outcomes for D-SNP members, whose needs and lives are often more complex than most.
- Insurers who demonstrate trust are naturally more trusted.
More often than not, members of the D-SNP population are hampered by low health literacy and by lack of access to trusted health experts. In a culture that renders the nuances of healthcare as unknowable to most Americans, it’s a safe bet D-SNP individuals with complex needs will rush to embrace an insurer that actively involves them in the design and delivery of their own health plans.
According to a 2022 report from Trilliant Health (which drew from Public Opinion Strategies survey data), patients’ trust in doctors and hospitals has steadily declined throughout the COVID-19 pandemic. That same study found insurance companies “consistently rank as the least trustworthy among all healthcare stakeholders” and “consumer’s trust in most healthcare companies eroded between April 2020 and December 2021.”
But as they include members in the care design decisions — lending credibility, candor, and clear communication to a system that too often leaves D-SNP members in the dark — CMS’s new advisory committees may just help the healthcare industry reverse this unfortunate trend.
- Government regulations will now be easier to manage.
The CMS advisory committees don’t just support healthcare recipients as individuals — they aid health plans in meeting the unique needs and preferences of their target populations, guiding each plan to stay comfortably within the bounds of regulatory measures.
By complying with CMS’s new call for the establishment of advisory committees, health insurers can now more easily convey an explicit commitment to regulatory compliance. As anyone working in the Medicare and Medicaid space knows, that commitment is vital for anyone navigating the complexities of D-SNP care.
We predict that, with the support and expertise of advisory committees at the ready, health insurers will now more easily be able to keep their focus on the important, life-changing work at hand, without too much worry on regulatory fines and other penalties.
- More collaboration fosters greater cost savings.
By involving D-SNP enrollees in the design and delivery of their health plans, insurers will naturally gain a deeper understanding of the specific needs and preferences of the diverse populations they serve. Some of this awareness will be born out of the health risk assessments (HRA) questionnaires CMS plans to deploy as screening tools for an individual’s physical, psychosocial, and functional needs.
As insurers experience ground-level, “retail politics” engagement with D-SNP individuals, they’ll gradually gain a clearer picture of risk factors that often impede under-resourced communities from accessing care. Simultaneously, they’ll more easily be able to identify where waste can be reduced, where costs can be lowered, and where operational efficiency can be streamlined and prolonged within their own systems.
That’s all good news for any insurer’s bottom line.
- Stronger relationships mean more targeted, impactful marketing.
As Section 10 of the new CMS rule specifically targets communications requirements for Medicare Advantage and Part D plans, it’s well worth considering the powerful impact savvy marketing can have on the D-SNP population — a community for whom honest and straightforward messaging is deeply valued.
By engaging with D-SNP enrollees through their advisory committees, health insurers can now gain a better understanding of how to reach and engage this varied audience in a way that truly resonates with them. As each advisory committee is naturally made up of members of the unique population being served, a natural geographic and cultural shorthand will soon be more accessible than ever to insurers looking to make a lasting impact.
This more intimate, and more socially astute, avenue of marketing will no doubt aid in the design of outreach strategies that yield important results — namely, increased enrollment and retention among D-SNP enrollees.
The bottom line
Even though CMS hasn’t been prescriptive about meeting frequency, location, format, etc. the benefits are clearly there. We have no doubt that member advisory committees for D-SNP enrollees will be great way for health plans to gain valuable insights to elevate product development, improve care coordination and customer service, and support ALL member needs through the lens of health equity.