Dawn of the Virtual Medicare Advantage Plan from Alignment Health

August 11, 2020 - As part of its product and footprint expansion in 2021, Alignment Healthcare (“Alignment”) plans to launch a virtual Medicare Advantage plan, the payer announced on August 6.

“Lack of care coordination and lack of personalized care threaten the health of seniors in our country every day,” John Kao, founder and chief executive officer of Alignment Healthcare, said in the press release.

“Alignment has succeeded because we solve these critical gaps for our growing member base nationwide with our concierge-like care and service model and our powerful data engine.”

The payer is pushing into new markets in California, Nevada, and North Carolina, with a few new products in tow. Alignment is introducing health maintenance organization (HMO) dual eligible, special needs plans as well as HMO point-of-service plans.

In addition to these, Alignment will make its virtual plan available to eligible consumers, a plan which emphasizes digital, concierge-style solutions for primary care and specialty care services, Dawn Maroney, president of consumer and markets at Alignment, confirmed to HealthPayerIntelligence.

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The Medicare Advantage plan seeks to incentivize members to employ digital solutions through its virtualization platform by offering rich benefits.

“The design of the program will be centered around primary care services and specialty services—not just on demand services, but primary care through a concierge platform,” Maroney explained.

Although the plan promotes virtual care, members will not be restricted to the virtual platform if that is not the most effective channel for treatment. For patient interactions that require face-to-face engagement with a provider, the virtual plan will cover in-person visits.

Employing concierge-style care and service

Alignment is already familiar with offering concierge-style service. The virtual plan builds on the payer’s ACCESS On-Demand Concierge platform.

Two-way consumer engagement is key to successful concierge services in a health plan, according to Maroney. The concierge team needs to be prepared to take calls and requests at any time, but also needs to be actively reaching out to members as appropriate.

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For example, as the nation shut down due to the coronavirus pandemic, Alignment started receiving requests from consumers for help with food security. As Alignment addressed these concerns, the health plan’s concierge team also called members who may be at risk of limited food access.

Concierge care and services require frequent and personal member engagement. As the health plan expands into a new market of nearly 6 million Medicare Advantage beneficiaries, it may face the challenge of scaling this personal level of care to a broader consumer base.

To compensate for the larger number of beneficiaries relying on Alignment’s concierge care and services, the payer will ensure multiple channels of communication: through clinicians, concierge representatives, and technologies, particularly self-service platforms, texting, and chats.

“Even if we had to hire many more individuals working for the organization, it's worth it because it does prevent issues that can arise,” Maroney emphasized. “If somebody doesn't get the care or service that's needed, such as not having food in the home, bad things will happen.”

Furthermore, she argued that giving Medicare Advantage members access to concierge service allows them to maintain that level of control and independence.

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“This consumer takes a lot of pride in making sure that ‘I'm not dependent on a family member. I want to still do this,’” she said.

The health plan intends to set up a concierge team dedicated specifically to the members who enroll in the virtual Medicare Advantage plan.

Maroney added that for health-related needs outside of health insurance’s traditional scope, the plan gives members a credit card—similar to the Cigna Care Card—with which they can purchase healthcare items from retailers.

Helping members, clinicians leverage technology, data

Clearly, member access to technology is a core element of this plan’s design. However, it is not a pre-requisite. If a member does not have access to the technology needed for this virtual plan, Alignment will provide them with the tools necessary.

While self-selection may lead to more technologically adept enrollees, the health plan would offer technical support to members struggling with the virtual platforms or would recommend an in-person visit.

Maroney shared that member education would be key for the virtual plan. Every new enrollee would go through a high-touch onboarding process. The onboarding process itself would not rely solely on technology, but would assign an assistant to each enrollee who can ensure that enrollees understand how to use their benefits.

The technological backbone of this program is Alignment’s proprietary system called Alignment’s Virtual Application (AVA). An internally developed platform, AVA pulls data from across a member's journey of care to develop what Alignment calls “patient 360”—a full view of the member’s medical treatments, prescriptions, and more accessible in real-time.

Maroney asserted that the ability to access a holistic view of the patient’s journey of care in real-time is a unique aspect of Alignment’s virtual health plan.

“Even working with other platforms as well as other organizations, it is interesting that the on-demand services is there, but the on-demand patient 360 is not there,” Maroney noted.

When a member goes to the emergency room or picks up a prescription that may result in an adverse drug event, Alignment is alerted immediately through AVA. Alignment will then contact the provider in charge of the member’s care so that the provider can gain access to the patient’s data through AVA.

“When you give that update to a clinician, they will have more information and provide better care instead of giving different types of care or running tests or procedures that are inappropriate,” Maroney explained.

The virtual plan will have to receive CMS approval before Alignment can offer it to members. Members in five different markets will have access to this product.

“Just as important as our geographic expansion is the work we put into expanding our plan options to cater to clinical and social needs of seniors during the pandemic and beyond,” Maroney said in the press release.

The telehealth waivers that CMS implemented for the duration of the public health emergency successfully increased Medicare Advantage member access to telehealth and virtual care solutions, a study found.

While there is still a long way to go in ensuring that seniors can effectively use virtual care benefits, payers continue to innovate new ways of engaging with members and conducting virtual care.