Measures Look Fine. Members Are Still Falling Through.
Medicare Advantage plans are scored by measure, but members need to be engaged as a whole. This resource shows how to coordinate outreach around the member.
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Key Takeaways
- Outreach indexed by campaign hides overlap, competing priorities, and stalled handoffs that only become visible when you index by member ID.
- When a member mentions a transportation barrier or a cost concern in one conversation, that should change what every other program does next.
- Most plans can tell you how many AWVs were scheduled last quarter. Fewer can tell you how many were completed. The difference between those two numbers is where performance erodes.
The Coordination Problem
Most Medicare Advantage plans can defend the outreach decisions they make. The HRA, AWV, and medication adherence program are all right. The problem is that no one owns the prioritization of which of those decisions needs to reach the member first, and the member could experience all of them at once.
This framework lays out the consequences of that disconnect and gives plan teams a 90-day, member-level review they can run.
What You'll Learn
- Why program-level metrics can look strongwhile member-level follow-through breaks down.
- Three consequences of outreach that iscoordinated by measure instead of by member.
- What a regional health plan achieved whenoutreach was coordinated around member action: 2-4x goal performance, 17Kpreventive visits completed, and 2,100+ care gaps closed.
Who This Is For
Medicare Advantage plan teams responsible for Stars performance, quality, care management, pharmacy, and member engagement. Also useful for operations leaders evaluating whether their outreach coordination matches how members experience it.