Value-Based Care Should Drive Competitive Differentiation

Posted by Alicia MacLeod on Mar 6, 2019 3:16:27 PM

iStock-497392002-webValue-based care offers Medicare Advantage Plans a Path to More Market Share.

Value-based care offers Medicare Advantage (MA) programs an important opportunity to capture market share. Ranging from cost savings from the reduction of medical errors, to providing benefits, such as transportation, it's clear why health plans are innovating on these options. Consumers though, still don’t know which plans are making investments to create better healthcare options for them. Their perception is that, aside from cost, most MA plans don’t differ, which is an opportunity for plans to differentiate themselves from their competitors.

Because MA programs compete both with one another and with traditional Medicare, their existence depends on capturing market share. Doing that successfully requires two key components: care quality that generates high patient satisfaction and communication that educates patients about the options available.

Value-based care addresses both of these components. By incentivizing providers to focus on improving patient engagement and outcomes across the continuum of care, value-based care offers a reward for offering the improvements that are most likely to matter to patients, and doing so efficiently. MA programs get paid per member, per month, so any savings they generate through greater efficiency or care innovations go straight to the bottom line.

MA plans also receive financial incentives for achieving quality scores based on the Star Ratings program. That provides MA programs a useful way to measure their progress and focus their innovative energies. On the patient education side, quality metrics provide an easily understood, apples-to-apples metric that demonstrates a program’s effectiveness.

By focusing on developing and providing innovative care for specific patient populations, MA programs have a potential opportunity to increase their lead on the competition. Their smaller, more nimble footprint than traditional Medicare providers allows MA programs to pilot and identify evidence-based best practices that move the needle on patient outcomes and quality scores. The better they become at generating efficient, high-quality care practices, the better their outcomes—and the more attractive they become to patients with similar conditions who desire similar outcomes. That creates a positive feedback loop benefiting all stakeholders.

What’s more, CMS has recognized this potential. The CMS Innovation Center recently announced plans to expand the MA model, increasing the flexibility plans have to offer telehealth and hospice care. The Value-Based Insurance Design model (VBID) that rolls out in nationwide 2020 will offer MA programs even more flexibility to differentiate their offerings.

Now that this incentive is in place, MA plans are focused on creating the right communication strategy that will impact a member's understanding of these important plan distinctions. The strategy should focus on 3 key components: member education, assessment on the ability to access and use these services, and a call to action to activate the member into these new benefits. Crafting a personalized message to a member that captures these 3 components will increase member satisfaction, grab and retain more market share, and positively impact STARS and other quality ratings. 

Alicia MacLeod

Written by Alicia MacLeod

Alicia MacLeod is Regional Vice President at Citra. Alicia has 20 years of experience working with payers and population health organizations. She specializes in health plans on population health and member engagement strategies for Commercial, Medicare, and Medicaid in the national and regional health plan markets.

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