What's Happening?
Dual-eligible members, a growing segment in Medicare Advantage, present challenges in engagement and retention for health plans. Darin Buxbaum, CEO of Wider Circle, discusses the shortcomings of traditional enrollment approaches and emphasizes the importance
of trust. Fragmented enrollment processes and misaligned incentives can negatively impact member experience and plan performance. Buxbaum advocates for community-powered engagement models that leverage social connections and peer advocates to improve outcomes. These models, supported by research, aim to reduce churn, close care gaps, and enhance member trust, ultimately benefiting both members and health plans.
Why It's Important?
The focus on community-powered models addresses critical issues in healthcare, particularly for dual-eligible members who often face complex healthcare needs. By fostering trust and engagement, these models can lead to better health outcomes and more stable enrollment, which are essential for the sustainability of health plans. The shift towards community-based approaches reflects a broader trend in healthcare towards personalized and patient-centered care. Successfully implementing these models could transform how health plans interact with members, leading to improved satisfaction and reduced costs.
What's Next?
As the Centers for Medicare & Medicaid Services (CMS) moves towards exclusively aligned enrollment, health plans must adapt to these changes to remain competitive. This may involve expanding community engagement efforts and investing in peer advocate programs. Health plans that delay action risk falling behind in a rapidly evolving market. The continued development and refinement of community-powered models will be crucial in meeting the needs of dual-eligible members and achieving long-term success in the Medicare Advantage space.
Beyond the Headlines
The emphasis on trust and community engagement in healthcare highlights the importance of addressing social determinants of health. By integrating social support networks into healthcare delivery, plans can better address the holistic needs of members. This approach also underscores the potential for healthcare systems to play a role in community development and social cohesion, extending their impact beyond traditional medical care.
