Proactive member engagement strategies to close gaps in Medicare Advantage

With the Medicare Advantage Annual Election Period (AEP) underway, running now through December 7, health plans are intensifying efforts to close member gaps. The Annual Notice of Change (ANOC) highlights critical updates in cost and coverage, prompting plans to refine their engagement strategies, especially as over half of Medicare members are expected to enroll in MA plans by the end of 2024.

A proactive, multichannel approach can significantly improve gap closure, member satisfaction, retention, and plan growth. In the remaining months of 2024 and into 2025, ensuring that your communication and outreach strategies are aligned with these goals will be key to success. Here, we provide strategies to identify members needing outreach, deploy omnichannel communication for optimal engagement, and drive member satisfaction as we prepare for the next open enrollment period.

Effective communication strategies for Medicare Advantage members and D-SNP members

Now is the time to ensure that your member communications are effective. A recent study revealed that only 48% of Medicare beneficiaries carefully read mail from their health plans, with many finding the information difficult to understand. This highlights the need for clear, concise, and culturally competent communication.

Dual Special Needs Plans (D-SNPs), designed for individuals eligible for both Medicare and Medicaid, are increasingly popular, with over 6.6 million beneficiaries enrolled in 2024—more than double since 2019. These plans offer lower costs and enhanced benefits like dental and vision care, transportation, and financial support for groceries through flex cards. However, many members are unaware of these benefits: approximately 3 million seniors could benefit from the Low Income Subsidy (LIS) program but are not enrolled. During the AEP, health plans must focus on educating D-SNP members about their options and addressing social determinants of health (SDoH) to improve outcomes for this vulnerable population.

One case study from a large regional health plan demonstrated the value of addressing SDoH through digital outreach. The health plan deployed Eliza’s Secure Digital solution to conduct a multichannel campaign, including interactive voice response (IVR) calls, to survey member needs and capture SDoH data. Over 12 months, the campaign initiated 190,000 calls, with a remarkable 91% of targeted members reached. This initiative allowed the plan to collect critical data on demographics, housing, transportation, and financial situations, which empowered care managers to extend personalized support. As a result, over 12,000 visits to essential services websites were logged, linking members with resources to address their SDoH needs. Such proactive strategies demonstrate the impact of data-driven, personalized outreach in improving both member engagement and outcomes.

Here are some best practices for improving member engagement through communication:

1. Just-in-time outreach: Timing is crucial. With ANOC letters sent out, followed by the Annual Election Period and then open enrollment, ensure that your follow-up outreach is timely and relevant. Don’t forget the new Centers for Medicare & Medicaid Services (CMS) requirement for mid-year notifications if members haven’t used their supplemental benefits.
2. Omnichannel communication: Use a variety of communication methods—mail, email, phone calls, text, and even multimedia messages. Short, engaging texts and visual content like pictures or videos tend to resonate more with members. Including culturally competent messaging ensures that you’re reaching your diverse population effectively.
3. Leverage digital tools: As Medicare and Medicaid members become more tech-savvy, digital-first strategies are more critical. In addition to using multimedia to capture attention, send digital appointment reminders to help keep members engaged with their health plan.
4. Prepare your call centers: Call centers will be busy, so it’s essential to have extra hands available or use technology like IVR systems to streamline communications. IVR can help triage calls, ensuring members get connected with the right services quickly and addressing their needs more efficiently.

Preparing for CMS changes and the future of Medicare Advantage

Looking ahead, CMS is introducing the Health Equity Index (HEI) to the 2027 Star Ratings program, which will reward Medicare Advantage plans that provide high-quality care to underserved populations, including those with low income, dual eligibility, and disabilities. The HEI aims to shift how plans receive performance bonuses, potentially leading to some gaining or losing up to half a star, and is expected to save $5.12 billion over 10 years. To succeed, plans should focus on identifying and engaging members with social risk factors (SRFs) by utilizing claims, socioeconomic, and geospatial data.

In addition, CMS is placing greater emphasis on culturally competent care by requiring interpreter services and multilingual materials. By integrating communication strategies with care coordination, addressing social determinants of health, and enhancing outreach efforts, plans can close care gaps, improve Star Ratings, and support their most vulnerable populations. Acting now will help plans drive better outcomes and prepare for the HEI’s impact on future ratings.