Maximizing 2023 Transportation Benefits and AWV Completion
The Opportunity
Today there are 31.5M individuals enrolled in a Medicare Advantage plan.1 Medicare Advantage Organizations (MAOs) rely on the Annual Wellness Visit (AWV) both as a critical preventative care management strategy and as foundational for appropriate risk adjustment, resulting in the allocation of significant resources to encourage members to complete AWVs. Data and experience show that the results of these efforts are quite mixed, at best, and that MAOs often invest resources in a final “sprint” to improve results in the fourth quarter. However, many members still do not complete their AWV. Why do members not complete their AWVs despite costly plan efforts? What can plans do to address this major business and health issue? A deeper dive into the root cause of poor patient adherence shows that social barriers (e.g. transportation) are a critical root cause.
This post discusses the intersections between social needs, including transportation-related barriers to care, and health plan goals related to increasing AWV compliance. It highlights how MAOs can utilize their supplemental benefits, along with a needs-based engagement approach, to remove barriers to completing AWVs.
The Insight
In another post, we wrote about the trends we see with unaddressed aging needs in the Medicare Advantage population. The majority of DUOS enrollees that have not completed an AWV (or similar critical care action) also lack reliable transportation, financial resources and struggle with frailty. Not surprisingly, many older adults suffer from multiple social barriers. 54% of members cite transportation as a barrier to closing their care gaps.
In our conversations with plans, they rightly point out that many of the supplemental benefits they make available to members directly address these issues. In fact, 99% of MA plans now offer an array of supplemental benefit offerings, including transportation, over-the-counter supplies, dental and hearing coverage. Not only do these benefits address many social and care needs, they also differentiate their plan to attract and retain members. Despite the availability of these benefits, both MAOs and members struggle to take full advantage of them. To paraphrase a health plan we recently spoke with: “We have more supplemental benefits than anyone in our market. But, the more benefits we make available the more confused members seem to get.” Therein lies both the challenge and the opportunity.
The Impact
Our experience serving the needs of older adults suggests that there is significant, untapped value in supplemental benefits. When these benefits are aimed squarely at an older adult’s most pressing needs and delivered with a positive experience, members will complete AWVs at a higher rate and be more loyal to their health plan. At DUOS, our virtual-human and member-self service experiences are both powered by a proprietary needs assessment and benefits-matching technology that surfaces and triages aging needs and then provides the most relevant plan benefits and resources. Compared to the experience of self-navigating a complex “Summary of Benefits” document, the DUOS’ needsbased model yields more targeted, higher-satisfaction support. DUOS serves a wide variety of benefits, care-navigation and social needs. Transportation is a category of need that, according to our data, often blocks completion of clinical gaps and AWVs.
DUOS has been extremely successful at closing social and care navigation needs across all our health plan clients. DUOS has demonstrated:
- A 94% success rate at resolving transportation-related barriers for our members
- An 83% conversion rate on gaps in AWV and Healthcare Effectiveness Data and Information Set (HEDIS) gaps for chronically ill noncompliant MA members with at least one SDOH need
Health plans are well-served to have a strong activation and engagement solution for older adult members that increases awareness of supplemental benefits, identifies those members with transportation blockers to care, and effectively connects members with the care they need. Based on our experience working with thousands of older adults, we recommend that health plans:
ACCURATELY CAPTURE NEEDS TO MATCH TO BENEFITS
Understanding an older adult’s unique social barriers is the first step toward identifying if they are at risk for not completing critical care actions like their AWV. Services like DUOS are uniquely able to identify the most pressing barriers to care for an older adult, and then connect the member with readily available supplemental benefits that eliminate common objections and friction points. Older adults feel more supported, and benefits programs are better utilized.
IDENTIFY ROOT CAUSE TRENDS FOR NONCOMPLIANCE
According to one study, a practice saw a 25% cancellation rate on AWVs. An obvious barrier to care may have been a lack of prearranged rides for the patient and their companion or caregiver to and from the visit.4 Appointment cancellations result in missed RAF opportunities and lower gap closure for the plan. Cancellations also cause disruptions in scheduling and negatively impact a provider’s ability to manage their patient population (especially if they are within a risk-based contracting model). While some care-related items can be accomplished via a virtual visit, there are still many items that are best suited to an in-person visit in an effort to build a trusting relationship between patient and provider.
INCREASE AWARENESS OF AWVS AND COST SHARING
Many patients say they have not heard of the AWV and do not understand how it differs from a routine physical or regular office visit.4 Many patients are also confused when copays for services such as lab tests, immunizations, and chronic disease management were added to their “free” visit. Providing members with clear materials and guidance prior to an AWV appointment will increase their understanding of the visit’s value and purpose and prepare them to ask questions of their provider during the visit.
Now that the 2023 benefit year has started, health plans should be looking to promote supplemental benefits - most immediately, around transportation - as a means to drive increased engagement with Annual Wellness Visits.
1 Kaiser Family Foundation, “Medicare Advantage in 2022: Enrollment Update and Key Trends,” 2022
2 American Journal of Public Health , “Transportation Barriers to Health Care in the United States: Findings From the National Health Interview Survey, 1997–2017,” June 2020
3 RAND Corporation, “Going to the Doctor: Rideshare as Nonemergency Medical Transportation,” 2021
4 American Academy of Family Physicians, “Medicare Annual Wellness Visits: How to Get Patients and Physicians on Board,” 2017