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Does Chronic Disease Management in Medicare Advantage Need a ‘Retail’ Makeover?

Adopting consumer strategies from leading retailers can give MA plans an edge in an increasingly competitive market filled with new entities while improving quality, reducing cost, and improving member loyalty.

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If there’s one word that sums up the Medicare Advantage (MA) revolution over the past decade, it’s “consumerism.” The quest to put the patient in the center of their own care has influenced everything about the industry, from zero-premium plans and personalized benefit perks to the widespread use of connected devices, such as continuous glucose monitors (CGMs).

And MA plans aren’t the only ones trying to get in on the trend. Supersized retailers, like Apple, Target, CVS, Amazon, and Best Buy, are using their retail models to change what it means to purchase and engage with care. As these new players start to gain interest from consumers, the first instinct from healthcare stakeholders is to try becoming more like retail.

So far, however, the results have been somewhat disappointing. Ad hoc forays into healthcare from the retail side risk increasing fragmentation of the member journey. Meanwhile, MA plans that only offer hints of retail-style service and value might not be going far enough to secure member loyalty while meeting their quality and performance obligations, which are tightly tied to financial incentives available through the Star Ratings system.

An increasingly sharp regulatory focus on quality, combined with growing diligence in decision-making from consumers and the overall rising costs of care, is putting pressure on MA plans to find new solutions for delivering exceptional services at acceptable costs.

To meet the needs of members, the key to success for MA plans will be to up their game by focusing on the following:

  1. Integrate comprehensive consumer data assets to hyper personalize benefits and overall experiences for members.
  2. Tailor education and coaching to simplify chronic care management for members and improve long-term adherence; and
  3. Create a one-stop shop for healthcare so members build trust and loyalty over time with their MA plan.

Integrating data-driven insights to personalize benefits and experiences

Big retail pioneered the art of collecting consumer data to target the right products to the right personas at high-impact points in the buying process. Even before web cookies allowed for extraordinarily precise online ad targeting, companies like CVS Health were using their loyalty cards to track in-store purchases and serve up coupons designed to match the individual’s buying habits.

Nearly every retailer now uses advanced customer analytics to guide their decision-making around marketing goods to their target audience. But MA plans are still in the early stages of learning how to craft meaningful healthcare consumer personas; generate real-time, consumer-level insights; and apply those insights to improve engagement and create positive member experiences.

These plans will need to refine their skills with a focus on aggregating multisource data, including claims, clinical records, pharmacy and lab data, social determinants of health (SDOH) data, and purchase activity, to understand member activities and get predictive about future needs.

Real-time analytics leveraged during the natural connection points between a member and their MA plan will be key to optimizing personalization — such as reaching out for a check-in when it’s time to reorder diabetes supplies to ensure there are no clinical, administrative, or socioeconomic barriers that need to be addressed.

Tailoring education and coaching to ensure understanding and adherence

When a customer walks into a Best Buy or an Apple Store, they’re not just greeted by a salesperson. They’re also funneled toward the Geek Squad and the Genius Bar, which are available even if the customer isn’t there to make a new purchase. These amped-up help desks let consumers sit down with an expert and learn how to navigate their devices on their own terms.

This is something that healthcare needs to adopt — and fast. Members now have more personal devices than ever, and they need to know how to use them in conjunction with clinical care to successfully manage their own health.

Personalized clinical coaching and education, with an eye toward meeting patients where they are in their health literacy journey, will be essential for ensuring value from connected devices and complementary chronic care management initiatives. MA plans should consider investing in programming and partners to provide onboarding education and ongoing coaching to ensure that members are getting the most out of their digital tools.

Transforming an MA plan into an all-in-one healthcare destination

Target is changing the big-box shopping experience by leaning into their identity as a self-care retreat for busy moms or a fun Saturday afternoon outing for the whole family. Co-locating with other retailers, such as Starbucks, Ulta Beauty, and CVS, means that shoppers can have an entire experience in the store, sipping their lattes while stocking up on essentials — and leaving with a cartful of things they did not know they needed when they walked in.

Medicare Advantage could consider becoming a similar one-stop shop for healthcare needs, especially as consumers continually express frustrations with fragmentation and phone tag.  Members should be able to come to their MA plan to easily find providers, compare prices on services, browse benefit options, and engage with partners providing complementary services, such as dental and vision care, chronic care management coaching, and SDOH-related resources.

When MA plans transform into centralized healthcare hubs that emphasize a holistic experience, they can proactively meet member needs; generate loyalty and consumer satisfaction that is reflected in the Star Ratings system; and create opportunities to collect more data that can then be reintegrated to offer increasingly precise member insights.

Adopting these consumer strategies from leading retailers can give MA plans an edge in an increasingly competitive market filled with new entities while improving quality, reducing cost, and improving member loyalty. By zeroing in on timely, personalized consumer insights, prioritizing person-centered education and coaching, and making it easy for members to engage with a full range of services on-demand, MA plans can deliver exceptional chronic disease management services while creating a consumer experience that exceeds expectations.

Picture: Ligorko, Getty Images

As Chief Executive Officer, Tony Vahedian brings the vision of a tech-enabled future of healthcare to inspire advancement across CCS - a leading provider of clinical programs and home-delivered medical supplies for those living with diabetes or other chronic conditions. Tony has successfully managed healthcare organizations for more than 20 years where he’s fueled accelerated growth and increased market share throughout his career. Now, Tony uses his expertise in integrated healthcare services and technology innovations to enhance the lives of individuals living with chronic conditions while driving growth at CCS.

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