The Future is Now: How health plans are revolutionizing care
In a recent Fierce Healthcare webinar, the focus was sharp on how payers are innovating in today’s healthcare landscape to adapt to new technologies, changing regulations, and rising consumer expectations.
The conversation revolved around leveraging the 2024 Star Ratings to drive improvements, embrace technology, and enhance health equity in 2025 and beyond.
Attendees heard from various industry leaders, including:
- Dr. Jodi Smith, RN, MSN, ND, Director of Clinical Quality at Virgin Pulse (now Personify Health)
- Hazem Alsahlani, JD/MPH, Director of Medicare Advantage Business Development and Product Strategy at Johns Hopkins Health Plans
- Erika McCormick, Director of Government Markets Stars at Independence Blue Cross
Here are our top takeaways from the discussion:
Addressing Health Equity with Innovation
An upcoming change in MA Star Ratings hinges on a critical factor: health equity.
We’re talking about the new Health Equity Index (HEI) reward from the Center for Medicare & Medicaid Services (CMS), slated to take place as part of the 2027 Star Ratings.
This change from the CMS reflects a focus on further advancing health equity, expanding coverage, and improving member health outcomes. Requiring plans to think differently about how they eliminate health disparities—especially for their most vulnerable populations.
Introducing the HEI will motivate plans to address the social risk factors of the Health Equity Initiative populations who are often harder to reach or not easily identified by providers: those who are disabled, dual eligible, or low-income members.
- Reader note: This definition is somewhat narrower than broader public discussions about health equity, which often include considerations of racial disparities, maternal mortality, socio-economic status, and other social determinants of health.
The HEI aims to improve Star Ratings by factoring in the performance of health plans in serving these high-risk populations.
This change means plans will need to prioritize interventions and strategies that specifically target the needs of the HEI populations to maintain or improve their Star Ratings. Plans are being encouraged and motivated to identify and address the barriers these populations face now, including issues related to accessibility, affordability, and provider awareness of these members’ unique needs.
To respond to the challenges and opportunities presented by the HEI, Erika McCormick shared how plans are adopting several strategies, including:
- Educating internal departments and providers: All stakeholders within a plan must understand CMS’s specific definition of health equity and the significance of their HEI populations. This also involves educating providers on identifying these members and understanding their unique healthcare needs and challenges.
- Improving identification of HEI populations: Plans are working on better methods to identify members who fall into the HEI categories, especially since providers may not have direct access to indicators like dual eligibility or low-income subsidy status in their systems.
- Enhancing provider engagement and support: By assisting providers in recognizing and addressing barriers to care, plans can improve care delivery and outcomes. This includes addressing issues like transportation and cost barriers to ensure screenings and preventive care are accessible.
Leveraging Data & Technology to Drive Health Outcomes
The panelists unanimously agreed on the pivotal role of data and technology in improving healthcare quality and outcomes.
Hazem discussed the impact of data to influence healthcare strategy, including trends and utilization. By collecting and analyzing member data, including claims and consumer data, plans can better understand utilization patterns and member needs, enabling tailored interventions and informed benefits design.
- Pro tip! Data-driven strategies can help you develop your program. For example, data can help identify prevalent conditions within a member population and craft benefits to meet those specific needs. Take targeted programs for diabetes management, as an example.
Erika shared examples of how plans can collect member data and insights through off-cycle CAHPS surveys. They leverage the data through advanced regression models to identify and address member needs for post-acute care. This proactive approach to member experience has led to decreased readmission rates and improved satisfaction, highlighting the importance of member (and data) focused strategies.
Technology and data go hand in hand. And as society ages, comfort with technology increases, opening new avenues for healthcare delivery.
Devices like tablets for monitoring chronic conditions (e.g., congestive heart failure) and wearables for emergency alerts (e.g., fall detection) are a few examples of how technology is improving member care.
Technology is also helping health plans create unique touchpoints through texting, email, apps, social channels, etc., offering plans a variety of ways to reach and interact with members.
- Pro tip! Taking a multi-channel approach is how innovative plans are providing personalized support as it allows plans to meet members where they are while catering to their preferences and needs.
The conversation progressed towards the importance of personalized health engagement platforms, described by Dr. Jodi Smith as not just a nice to have but a must have.
Personalized health engagement platforms serve as curators and aggregators, offering a personalized approach to the member experience through a diverse ecosystem of solutions and vendors.
By leveraging the data collected through tech-enabled platforms, health plans can better stratify the member population to identify those at higher risk or with specific needs. This facilitates the development of multi-channel, targeted interventions that address these needs directly, whether through technological solutions or care management strategies.
Providing members with easy access to health information and personalized communication through their preferred channel significantly enhances their experience.
Proactively Addressing Health Disparities and SDOH
The panelists explored additional strategies for health plans to proactively address health disparities and Social Determinants of Health (SDOH) to ensure equitable care while improving Star Ratings.
This involves identifying and addressing barriers to care by connecting members with community programs and resources. The immediate connection of members to these resources ensures they are aware and able to utilize the services they are eligible for.
Addressing SDOHs through benefit design significantly reduces barriers to healthcare, and it enhances health equity by directly targeting the non-medical factors that influence health outcomes, which make up the majority of our personal health status. This approach involves creating benefits that cater to the specific needs of populations, such as transportation services, nutritional support, and housing assistance, removing obstacles that prevent individuals from accessing care and adhering to treatment plans.
By focusing on the root causes of health disparities, these tailored benefits help level the playing field, ensuring that all members, regardless of their socio-economic status, can achieve better health outcomes.
The Future of Technology in Member Engagement
In the next 5-10 years, technology’s role in member engagement is poised for significant transformation, particularly with an aging Medicare population that’s increasingly tech-savvy. The discussion among the panelists highlighted a few key predictions and expectations for the future.
- Dr. Smith noted how advancements in AI, health information exchanges, and predictive analytics will be crucial in personalizing care plans and streamlining communication between providers and plans. This tailoring of healthcare experiences is expected to meet members where they are, offering support closely aligned with their health needs and preferences.
- Hazem shared the role he believes AI will play in care management and streamlining processes. Care plans would be instantly created based on individual needs, possibly through AI analysis of responses to health surveys. Additionally, technology could simplify complex processes like prior authorizations, reducing administrative burdens for members and providers and making healthcare access more straightforward.
- Erika shared how she anticipates that with increased technological literacy among Medicare members, plans are expected to leverage various channels (e.g., mobile apps, remote monitoring, and personalized health engagement platforms) more effectively. These tools will facilitate better health monitoring and management and enhance the directness and relevance of communication with members.
Reflecting on the broader implications of technology in healthcare, the panelists also touched on the importance of integrating SDOH into member engagement strategies. By using data to identify and address the non-medical needs of members, health plans can remove barriers to care and significantly improve health outcomes, underscoring a shift towards more holistic approaches to health equity.
Overall, the panelists envision a future where technology bridges gaps in healthcare accessibility, enhances the personalization of care, and fosters a more engaged and informed Medicare member population. This future hinges on the innovative use of data and technology to predict and meet health needs and empower members through more accessible, efficient, and tailored healthcare experiences.
Key Takeaways for the Future
The discussion concluded with a forward-looking perspective, emphasizing the need for health plans to center their goals around the member, leveraging multiple channels to meet and exceed their needs.
Integrating technology in healthcare is not just about innovation for its own sake but about improving member outcomes, enhancing quality ratings, and providing better benefits.
And as the healthcare landscape evolves, focusing on health equity, the strategic use of technology, and a personalized approach to healthcare delivery will be crucial for success.
Looking to gain an edge? We’ve made it easy for you to revisit the Fierce Healthcare webinar on-demand:Break from the Crowd: How Visionary Medicare Advantage Health Plans are Driving Transformative Outcomes in Healthcare Management.