image via pixabay

3–2–1 Contract! MA Plans’ Emerging Supplemental Benefits Strategy for Social Determinants

Takeaways from the recent IEN Conference

Patchwise Labs
Aug 30 · 7 min read

This month we had the opportunity to attend Insight Exchange Network’s two day conference on optimizing supplemental benefits in downtown San Diego.

Along with many of our readers, we’ve been eagerly following the latest policy developments shaping how the Medicare Advantage program will allow health plans to spend money to address non-clinical determinants of care.

This proved to be a terrific opportunity to sit in a room full of health plan executives, technology vendors, consultants, ask questions, and listen to experienced benefits veterans of all stripes share their insights on operations and strategy.

A standard repetition of canned talking points this was not: The speakers and panelists rolled up their sleeves and got into the knitty gritty details. Health plan benefits represent the true sausage factory of how insurance works, with technical, clinical, economic, actuarial, and other expertise meshing together like so many gears in the machine.

So at the risk of oversimplifying the discussion, we’ll zoom out and focus on the three key themes that emerged for health plans planning for 2020 and beyond:

  1. Leadership Strategy
  2. Membership Strategy
  3. Partnership Strategy
image via pixabay

Leadership Strategy

This is where it all starts. Buy-in at the C-Suite is essential, as the VPs, Directors, and Managers who make sure the trains run on time take their cues from the top. Some of the specific tactics that emerged from discussions:

  • Carve out Bandwidth to Focus: Developing a multi-year strategy to design, test, improve, re-test, and ultimately scale new benefits is hard enough; doing so in competitive, highly regulated markets with high rate of member churn makes it even more of a challenge. This underscores the sentiment around the industry that 2020 will be a year of listening and learning.
  • Identify the Problem and Define Success: “New supplemental benefits have to have a view of ROI to offset costs with savings to improve outcomes,” one plan leader said. “This is not as easy as it sounds.” Enrollment, satisfaction scores, CMS star ratings, avoided hospitalizations and more are all on the table. Other speakers underscored that new benefits and new forms of engagement (e.g. providing rides or meals) also require new goal setting, to “know what you’re trying to accomplish.” One executive in the audience put it more plainly: “Financials drive what we’re doing. Bang for buck matters.”
  • Cross-Functional Teams To Get in the Weeds: Several health plan leaders spoke to the critical role played by case manager, health economists, actuaries, medical directors, as well as other key stakeholders including sales and marketing, IT, legal, and operations. Input, communication, and trust across these groups is critical, but not easily or quickly accomplished.
  • Integrated Strategy to See the Forest for the Trees: One speaker encouraged fellow health plan leaders: “Don’t just think about your specific line of business or certain segments. You’ve got to think bigger picture if you’re going to make this work: Provider relations, customer service, product people, marketing, legal and compliance.” Another urged the audience not to “build this in a vacuum”- but instead, to look closely at competitor data, market conditions, and the dynamics of people they’re serving.
  • Start Small and Measure Everything: Finally, one executive offered this suggestion: “Don’t over-diversify. There are a lot of cool things out there, but pick your niche and do it well. Resources and ideas need to be honed into what’s practical and useful.” She later continued on the need for “Solid member analytics: You have to identify trends and needs, and ensure effective implementation. Really deep-dive into HEDIS and CAHPS scores. Have a clinical product partner to help drive this — Bucket your members, keep an eye on utilization, execute new benefits really well.”
image via pixabay

Membership Strategy

Member Engagement is always a challenge, and especially so when designing, marketing, delivering, and scaling new benefits. But social determinants of health represent a new ballgame for even seasoned insurance veterans due to the added complexity of designing new products, evolving the engagement strategy, complying with regulations, optimizing enrollment, and more.

  • Clinical Considerations: With CMS removing the uniformity requirement, plans have flexibility to design benefits for any subgroup of members without having to make them available to everyone. This flexibility adds the challenge of where to start selecting the right group of members. The easy answer is to look at costs to determine who might be in need of additional help, but even that is not straightforward. Bruce Chernoff from the SCAN Foundation suggested the use of claims data alone is like looking for your keys under the lamppost. He also explained the cost phenomenon of “persistence versus transience” (left)
  • Business Considerations: Market research is a critical component of designing and deploying new benefits. Survey data, focus groups, as well as past utilization data, competitive analysis, and other factors come into play to determine product/market fit for specific subgroup of
  • Customer Satisfaction: Given the importance of CMS Star Ratings and member satisfaction scores, selecting service partners takes on an extra layer of importance (see below). On the flip side, one plan executive spoke about how some of their MA members have become “walking billboards” who advocate for the plan based on their positive experience with new benefits like gym memberships or acupuncture.
  • Communication: Several leaders also spoke to the perceived challenges of communicating new products and benefits using the outmoded Explanation of Benefits (EOB) document (e.g. is a member sent a new EOB after every single ride they receive from their plan?). Relying on insurance agents or brokers to translate new product offerings carries similar risks about misrepresenting key details or eligibility criteria.
  • Adverse Selection: Plans agreed unanimously that adverse selection remains a concern when introducing new lifestyle benefits into the marketplace, particularly in high-needs populations. “A lot of internal folks are concerned about marketing those ‘condition based benefits’,” one speaker shared. “If we’re not effectively managing this, the numbers can skew pretty quickly.”

Partnership Strategy

Bringing in new partners like social services providers, community-based organizations, volunteers, and other non-credentialed groups to deliver any form of member engagement represents a major challenge. On the one hand, health plans are reluctant to recreate the wheel; on the other they need to set a high bar for partnership when it comes to coordinating social services.

As one VP put it, “Anything that’s going to touch my membership, I’m very cautious with it.” Another speaker echoed this sentiment, underscoring the stakes: “If [the benefit] is not implemented flawlessly, you’ll get complaints, you get CTMs. Supplementals can be a driver of dis-enrollment.”

  • Build versus Buy: When it comes to finding non-clinical partners, “It’s better to buy that than to try to build it,” opined one of the speakers from a mid-sized health plan. “The smaller parts of those relationships are what we tend to keep in house, like managing authorizations to deliver a service.” Another challenge is growth: “With direct services, we’ve seen struggles from our smaller local partners as volume grows. The right vendor brings scaling ability.”
  • Partner Selection: Finding high-quality local partners appeared to be a universal challenge. “Finding the right vendors or providers to deliver these services…has been the key challenge,” shared one executive. “Some of them are established, but there are also a lot of new vendors to the market (with areas like meal delivery), but they’re still in limited services areas.”
  • Oversight: As Mr. Chernoff explained, “If you’re going to send someone into your members’ homes…[there is a lot to figure out] if CMS has not provided any minimum standard.” Several plan representatives readily admitted they did not generally have a good answer for how to credential non-clinical providers. Another cautioned that “Managing multiple vendors can be very challenging…Medicaid versus Medicare vendors are also very different for non-clinical care.”

A special thanks to IEN for inviting us to the show! Check out their upcoming SDOH Action Forum November 13–15 in Miami (use ‘H121PAT’ for a discount)

Patchwise Labs

Stories and analysis of emerging innovations to address the social determinants of health (SDOH)

Patchwise Labs

Written by

We are a creative strategy firm with one simple goal: To make the healthcare system work better for the people who need its help.

Patchwise Labs

Stories and analysis of emerging innovations to address the social determinants of health (SDOH)

Welcome to a place where words matter. On Medium, smart voices and original ideas take center stage - with no ads in sight. Watch
Follow all the topics you care about, and we’ll deliver the best stories for you to your homepage and inbox. Explore
Get unlimited access to the best stories on Medium — and support writers while you’re at it. Just $5/month. Upgrade