Case study: Engaging members to apply for the Low-Income Subsidy (LIS)

As Medicare Advantage (MA) plans prepare for the introduction of the Health Equity Index (HEI) in Star Rating year 2027, it’s clear that addressing social risk factors (SRFs) such as disability, dual eligibility (DE), and enrollment in the Low-Income Subsidy (LIS) will be critical for success.

One key factor driving this shift is the need to ensure Medicare beneficiaries have access to the care and medications they need without financial barriers. One large MA payer is already taking steps to engage its members and connect them with the support they require, especially when it comes to supplemental benefits like LIS.

Background: The Low-Income Subsidy program

The LIS provides financial assistance to Medicare beneficiaries to help cover prescription drug costs under Part D. However, as many as 3 million beneficiaries who qualify for LIS remain unenrolled. By leveraging the LIS program, MA plans can not only help members reduce their out-of-pocket drug expenses, but also improve medication adherence and compliance, which directly influences Star Ratings and overall health outcomes.

With the HEI replacing the reward factor—an incentive that many plans have traditionally relied on to boost their overall ratings above the four-star threshold required for quality bonus payments—the importance of enrolling eligible members in the LIS has grown significantly. MA plans must take proactive steps to identify eligible members and guide them through the enrollment process to maintain high performance and achieve bonus eligibility.

Identifying LIS-eligible members

To maximize the impact of the LIS, plans must first identify the members who are likely eligible. While claims data provides an essential starting point, it’s crucial to look beyond traditional data sources. Socioeconomic data, geospatial information, and insights from health screenings or social needs assessments can offer a fuller picture of a member’s eligibility. By combining predictive analytics with targeted outreach, payers can stratify populations based on their likelihood of engaging with programs like LIS and their clinical needs.

In addition to addressing current members, MA payers can look at their commercial or individual plan members who are approaching Medicare eligibility and their Medicaid members who may become dual-eligible to ensure those who will soon qualify for LIS are prepared.

Case study: Delivering personalized outreach and support

Effective outreach is key to engaging LIS-eligible members. Many beneficiaries are unaware of the program and its benefits, so clear and personalized education is vital. One large payer is already making strides in this area by engaging members who need help with their LIS applications. The plan has partnered with Cotiviti to create a multichannel outreach campaign that provides personalized support to members needing to reapply for the subsidy each year.

Driven by Eliza, the program uses a combination of interactive voice response (IVR), text messaging, direct mail, and live agents to engage members 90, 60, 30, and 15 days before their reapplication deadline for the LIS program. By offering a warm transfer to the Social Security Administration, the outreach ensures members can seamlessly complete their reapplications, preventing any lapse in their prescription drug coverage.

Achieving results that drive impact

In 2023, this targeted outreach was highly successful, with 81% of the 27,000 targeted members being reachable via IVR and 93% through text. Live agents connected with 25% of members, helping 56% of these members complete their applications by guiding them through the often-complex process. Ultimately, this led to a significant increase in the number of members receiving no-cost prescription drug benefits, a crucial step in addressing health disparities among low-income populations. The plan will execute this program again to an even larger population at the end of 2024 to help members ensure their LIS coverage does not lapse.

Looking ahead

As we approach the rollout of the HEI, the importance of programs like LIS will continue to grow. Engaging vulnerable populations and helping them access critical benefits is essential not only for improving individual health outcomes, but also for driving better Star Ratings performance. By leveraging data while delivering personalized outreach and proactive support, MA plans can ensure that their members receive the care they need while positioning themselves for success in the years to come.