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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
MA plans must educate members about participation in their health
- MEMBERS ARE:
- SMART & PICKY Baby boomers are info junkies who like to shop around
- A FAST-GROWING GROUP Each day there are 7,000 new Medicare entrollees4
- FACING CHRONIC CONDITIONS 83% of Medicare beneficiaries have at least one chronic condition and 23% have five or more chronic conditions5
- 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
- keeps members connected and allows them to actively manage their care
- engages members regularly outside a healthcare facility
- educates members and gives the care team near real-time info
- empowers members to self-manage their health
- 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).
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