REMOTE CARE MANAGEMENT PROGRAMS MAY IMPROVE RATINGS AND SUCCESS IN MA PLANS

Enrollment in Medicare Advantage (MA) plans is projected to reach 15 million by 2013. While the Affordable Care Act lowers payments to MA plans by more than $140 billion over the next decade, bonus payments based on high ratings in the Five-Star Quality Rating System can help make up for those lost dollars. Here are ways remote care management programs help enable MA health plans to reduce costs while achieving the 4-star and 5-star ratings needed to compete and win in this changing environment.

STELLER STAR RATING IS IMPERATIVE FOR LONG-TERM SUCCESS

IMPROVED RATINGS BOOST

BONUS PAYMENTS

Plans have compelling financial incentives to achieve stellar star ratings:

CMS 5-Star Rating

$3.1 BILLION

in total bonus payments in 20121

Today, 30% of bonus payments are awarded to above average (4-star) or excellent (5-star) rated plans

Yet in the next couple of years, higher rated plans will gain a significant advantage over the competition as bonus payments established from the health reform law increase in percentage for plans rated 4 stars or higher.2

  • 1.5% in 2012
  • 3.0% in 2013
  • 5.0% in 2014

MORE MONEY FROM

AN INCREASED NUMBER OF ENROLLEES

High marks give MA plans a competitive edge in marketing to and enrolling new members.

28%

20113

MA entrollees in 4- or 5-star plans

37%

20123

MEMBER BEHAVIOR GREATLY IMPACTS THE RATING SYSTEM

ATTAINING HIGH SCORES

IS GETTING HARDER

improving or maintaining physical health

improving or maintaining mental health

idiabetes care: blood sugar controlled

diabetes care: cholesteraol controlled

blood pressure controlled

The lower the domain, the more that measure is weighted in the star rating assessment.

MA plans must educate members about participation in their health

  1. MEMBERS ARE:
  2. SMART & PICKY Baby boomers are info junkies who like to shop around
  3. A FAST-GROWING GROUP Each day there are 7,000 new Medicare entrollees4
  4. FACING CHRONIC CONDITIONS 83% of Medicare beneficiaries have at least one chronic condition and 23% have five or more chronic conditions5
  5. LIVING LONGER Act as the primary caregivers for their health in their homes

IN ORDER TO IMPROVE RATINGS

MA PLANS MUST:

DECREASE - READMISSION

DECREASE - CARE COSTS

INCREASE + MEMBER TOUCHES

INCREASE + MEMBER TREATMENT COMPLIANCE

INCREASE + CHANGE BEHAVIOR

INCREASE + FACILITATE TIMELY INTERVENTIONS

Remote Care Management is a valuable strategy for MA health plans in this changing environment:

REMOTE CARE MANAGEMENT MAY REDUCE COSTS & IMPROVE RATINGS

CONNECTED, SELF-MANAGED MEMBER

actively engaged in their treatment plan, connected to their care team and MA Plan, and self-managing their conditions

REMOTE CARE MANAGEMENT

  1. keeps members connected and allows them to actively manage their care
  2. engages members regularly outside a healthcare facility
  3. educates members and gives the care team near real-time info
  4. empowers members to self-manage their health
  5. facilitates timely intervention if condition worsens

CONNECTING THE MEMBER

AND THEIR CARE TEAM

CARE TEAM

receiving near real-time data to make the best decision in terms of patient care

Positive outcomes of Remote Care Management programs include

reduction in hospital readmission rates by up to 75%6

savings of $197 billion over the next 25 years7

medication adherence increased by up to 78%8

members increasingly engaged in their care plan

THE BOTTOM LINE:

Remote care management programs help enable MA health plans to reduce costs while achieving the 4-star and 5-star ratings needed to compete and win in this changing environment.

1Kaiser Family Foundation analysis, November 2011

2Data Brief - Medicare Advantage Plan Star Ratings & Bonus Payments in 2012

3http://www.hhs.gov/news/press/2012pres/10/20121012a.html

4http://www.aarp.org/personal-growth/transitions/boomers_65/

5"Medicare and Chronic Conditions," New England Journal of Medicine, Gerald F. Anderson, p. 305 (July 21, 2005).

6Case Study, St. Vincent's Hospital Reduces Readmissions by 75 percent with a Remote Patient Monitoring-Enabled Program, 2012

7Robert Litan, "Vital Signs via Broadband: Remote Monitoring Technologies Transmit Savings," Better Health Care Together Coalition, October 24, 2008, p. 1.

8The Advisory Board. Patients With Access to Physician Notes More Engaged in Their Care