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4 best practices to prevent rapid disenrollment for Medicare Advantage plans

4 best practices to prevent rapid disenrollment for Medicare Advantage plans

With the 2022 Annual Election Period (AEP) for Medicare Advantage (MA) plans beginning next month, MA plans are in the final stages of preparing to enroll new members as well as retain returning members to the plan. Soon, the Annual Notice of Change (ANOC) will be in members’ mailboxes, informing them of changes in cost, coverage, and more. This is also the time for MA plans to revisit their member retention strategies to ensure they don’t lose their members during the Open Enrollment Period (OEP) window from January 1–March 31.

Why is this critical? Because MA members have no shortage of options available to them and won’t hesitate to shop around for a better price, better coverage, or most important of all, a better member experience. According to the Kaiser Family Foundation, the average Medicare beneficiary now has access to 33 Medicare Advantage plans, while overall MA enrollment has more than doubled in the past ten years, increasing from 12 million to 26 million total members.

When it comes to preventing disenrollment, first impressions matter—for most members, that means their experience with a plan’s pharmacy benefit, prior authorizations, or transition of coverage. These processes will have a significant influence on their decision to reenroll or disenroll with a particular plan during the OEP.

For returning members, plan changes can result in disenrollment. Which members will be most impacted by formulary changes? Which member cohorts are at highest risk for leaving the plan? Once you have identified these members, reach out and be transparent about the changes. This communication can be delivered with automation, answering benefit questions proactively, redirecting members to the ANOC letter, and reducing call center volumes during this crucial time. It’s critical for MA plans to solidify their strategy for the OEP just as much as the AEP, resolving problems quickly and making rapid adjustments when call volumes and customer complaints tend to increase.

Here are four proven best practices to remember as you build or improve upon your disenrollment prevention strategy.

  1. Proactively identify and engage. Ensure that your returning members are aware of upcoming plan changes. Proactively engage them, send FAQs, and use online resources and automation to reduce frustration and confusion for your members. This supports your members and your call center staff, who are focused on AEP.
  2. Review your first touch with the member. This doesn’t just mean looking at your welcome kit. Review your plan’s pharmacy, care management, and authorization processes and procedures. Work with your member services team by listening to calls, tracking time to resolution, and coaching your agents on customer service and de-escalation skills.
  1. Be an extension of the care team. Members who have a primary care provider have better clinical outcomes. Proactively communicate with your members to ensure they are getting the care they need and identify any issues or changes with your provider network.
  2. Ask for feedback. Every interaction with your members is an opportunity for feedback. Always strive to find out how you can make their experience faster and better. Sponsor disenrollment surveys to best understand why enrollees are leaving the plan and use those surveys to inform what’s next for your plan.

While plans don’t get a second chance to make a positive first impression, a year-round, proactive approach to member engagement can significantly improve member retention and plan growth during the next six months.

By deploying Cotiviti’s Eliza multi-channel member engagement solution, one Medicare Advantage payer achieved:

  • 2x year-over-year member retention rate
  • 65% decrease in complaints during AEP
  • 40% reduction in inbound calls during AEP and Q1
  • 110% of operational cost savings goal achieved through call deflection 

Download our Eliza brochure and learn how to start conversations with your members that improve retention and Star Ratings.

Read the brochure

About the Author

Anne has spent the last 20 years focused on healthcare quality, program development, and evaluation. As Director of Quality Programs and Medicare Strategy, she helps ensure that Cotiviti products support clinical outcomes improvement. Anne has subject matter expertise in the Medicare Advantage market, Star Ratings, HEDIS, and NCQA accreditation standards.

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