Five Gaps Block Patient Centered Care in Chronic Disease Management
Medicare Advantage (MA) members are looking for more patient-centered care and follow up on their chronic disease management from their health plans.
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- Five gaps prevent Medicare Advantage health plans from engaging in successful patient-centered care for chronic disease management, a HealthMine survey concluded.
"We see that plans have definitely made progress. They are making efforts to be more connected and provide beneficiaries with more options to better manage their chronic conditions,” said Nicole Althaus, chief marketing officer at HealthMine. “But, motivating beneficiaries to be better informed about the right health actions at the right time is important for driving down healthcare costs.”
HealthMine’s research sought to document seniors’ views on their Medicare health plans. The 800 survey participants were 65 years of age or older and suffered from at least one chronic condition. HealthMine fielded the survey in April and May 2019 as a follow up to their 2018-2019 survey.
First, MA plans face a knowledge gap: they do not know their beneficiaries’ condition well enough, according to the respondents. Only 22 percent of respondents said that their plan knows them “very well.” Half of the respondents indicated that their health plans know them “somewhat well.” Nearly 30 percent said that their health plan knew nothing about them or their health.
Respondents had little confidence that their payers knew whether their health condition was positive or not. Only 19 percent said that their plan knows whether their health condition is improving or in decline.
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To address this gap, HealthMine recommended sending timely reminders and rewards to individual members related to their specific health condition.
The survey also identified a trust gap between payers and their MA beneficiaries. The respondents had more trust for their providers, family members and close friends, and pharmacists as health advisors, in that order. However, beneficiaries trusted health plans less than any of these categories. Only 17 percent of participants noted that they trust their health plan to manage their health.
Previous research also concluded that members distrust their health plans and often blame them for surprise medical bills. Lack of information about plan benefits can leave members feeling disconnected and uncertain about their relationship with their payers.
Given the amount of trust that members place in their providers to manage their health, leveraging strong provider-payer partnerships can be one method of establishing stronger trust with beneficiaries.
Offering personalized services can also bolster that relationship. Last year, the Health Care Transformation Task Force released a set of guidelines intended to help health plans implement more personalized, patient-centered care and services.
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The guidelines recommended creating a channel or platform for consumers to offer feedback on their experiences, increasing collaboration with providers and purchasers, communicating strategies that inform and interact with members regarding payment and treatment possibilities, value-based contracting, a balancing the purchaser, payer, provider, and patient needs in the plan’s benefit design, and using patient-centered telehealth and digital solutions.
The connection gap is another hurdle noted by the study, with 23 percent of beneficiaries responding that they do not engage with their health plan online. However, over 50 percent would prefer that their health plan initiate more digital solutions and communication channels.
HealthMine emphasized texting as a positive first step into increased digital communication. Seventy-three percent of the respondents had a smart device and 98 percent had consistent WiFi access.
In a recent interview on the new Xtelligent Healthcare Media podcast “Healthcare Strategies,” Worthe Holt, Jr., MD, vice president and deputy CMO at Humana, explained that payers can use mobile technologies to elevate member engagement, both in timeliness and outcome quality.
“Clearly we see more and more people accessing information through their smart phones,” he confirmed.
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“There are some chronic illnesses like congestive heart failure, chronic obstructive pulmonary disease, or diabetes where the ability to send and receive information through a mobile application on your phone can be tremendously helpful. It facilitates the work that the physician or the other care provider is able to do in a very timely manner, as opposed to waiting for an office visit or the unfortunate case where somebody lands in an emergency room or gets admitted to a hospital. You can do things ahead of time to maintain people’s health and avoid those types of unfortunate events that add expense and in many cases are a source of poor outcomes in and of themselves.”
Chronic condition communication was listed as the fourth gap. All of the respondents had at least one chronic condition, but only eight percent agreed that their plan follows up with them regarding their chronic condition once a month or more often.
The largest percentage of respondents (35 percent) said that their plan never discussed their chronic disease management strategy with them.
Plans most commonly engaged with the respondents regarding their chronic disease management by reminding them to go to a health screening or suggesting actions that would produce better quality outcomes. Just over one in ten respondents said that their health plans sent reminders and recommendations regarding their health condition, which were primarily connected to seasonal or gender-specific conditions and screenings.
Over half of the MA beneficiaries wanted more dialogue with their health plans, particularly dialogue that was personalized and related to health screenings.
HealthMine suggested communicating with members at least once a quarter about their chronic health conditions.
The final gap identified was the health action gap. The survey results pointed to several opportunities for patient engagement that health plans frequently failed to pursue. For example, 48 percent of beneficiaries did not get any feedback or follow up from their health plans after visiting their provider. Almost a quarter only had communication with their health plan when billing was involved.
There’s a disconnect between what motivates members. Over half of the participants said that their health plans offered incentives for positive health steps, but only 12 percent said that they felt motivated by these offerings.
In a similar survey by HealthMine conducted in January 2019, 60 percent of MA members said that their health plans offered no reward for strong health actions, which means that a lot has changed in the past year. However, it is not enough to merely offer incentives if they are ineffective.
HealthMine concluded that health plans should be more vocal about potential risks and respond to every health action that members engage in and reward them.
