Top 5 Tips for Medicare Advantage Plans Looking to Incorporate Digital Specialty Care...and How to Do it at No Cost!
The Opportunity for MA As Medicare Advantage (MA) plans continue to focus on improving member outcomes while controlling costs, digital specialty care solutions have emerged as a powerful tool for enhancing access to high-quality care. However, successfully integrating these technologies into MA plans requires a strategic approach to maximize their impact on both clinical outcomes and financial performance. Here are the top five ways to effectively incorporate digital specialty care into your Medicare Advantage plan...
1. Prioritize Solutions with Easy-to-Use and Broadly Accessible Technology
Accessibility and ease of use are critical when selecting digital specialty care platforms for a Medicare Advantage population. Many MA members may not be comfortable with complex digital interfaces, and some may reside in areas with limited broadband internet connectivity. Solutions should be intuitive, broadly accessible, and function effectively even in low-bandwidth environments. Look for platforms that:
- Offer a simple user interface accessible to all age groups.
- Require minimal training for members and providers.
- Provide staff support and ability to engage family members to facilitate ease of use.
- Function on standard smartphones and cellular networks without requiring broadband or additional gadgets.
By choosing solutions designed for simplicity and accessibility, you can reduce barriers to care and promote broader member engagement.
2. Contract with Digital Solutions as In-Network Providers
One of the most effective ways to streamline the adoption of digital specialty care is by treating these services as in-network providers. This ensures that both members and partner provider organizations can easily access and utilize the digital solution without facing out-of-network restrictions or additional costs. Benefits of this approach include:
- Simplified billing and claims processing for the plan.
- Encouraging collaboration between digital solutions and existing care networks.
- Integration of fees with existing claims/medical expense infrastructure.
- Improve medical loss ratio (MLR) by including these in-network fees as medical expenses as opposed to administrative expenses required in most vendor digital solutions
By formalizing these relationships, MA plans can ensure a seamless experience for both members and providers while maintaining cost efficiency.
3. Choose Solutions with a Validated Track Record for Clinical and Cost Savings
When incorporating digital specialty care into your MA plan, it is essential to choose solutions that have been rigorously validated for both clinical efficacy and cost savings. Evidence-backed platforms can drive better outcomes and help justify investment in these technologies. Look for solutions that:
- Have published studies and data demonstrating improved health outcomes in Medicare-aged populations.
- Show measurable cost reductions through claims analysis and risk stratification.
- Align with CMS quality metrics and star rating improvements.
- Demonstrate robust clinical outcomes through transparent reporting of patient reported outcome measures (PROMs) across multiple health domains
By selecting solutions with proven results, MA plans can minimize risk and optimize both quality of care and financial performance.
4. Choose Solutions That Integrate Seamlessly Into Existing Benefits and Offerings
To maximize the value of digital specialty care, the solutions must integrate smoothly into your current benefits structure and care management pathways. Seamless integration ensures that digital care complements existing services without creating redundancy or confusion for members and providers. Look for platforms that:
- Align with existing chronic care management and care coordination programs.
- Allow data sharing with existing EHR systems and care analytics tools.
- Offer co-branded member education resources tailored to your MA population.
- Serve as a platform to covered benefits and preferred provider networks
By embedding digital specialty care into your existing infrastructure, you can create a cohesive care ecosystem that enhances member satisfaction and optimizes health outcomes.
5. Choose Solutions That Integrate Seamlessly with Health Plan Operations
To maximize the value of digital specialty care, the solutions must integrate smoothly into your health plan operations, especially when it comes to enrollment into the digital health program. Look for platforms that:
- Can clearly identify inclusion criteria present in existing health plan workflows (such as health risk assessment, care management, and claims reporting).
- Able to serve as an upstream utilization management solution.
- Provide their own capabilities for proactive member outreach and streamlined enrollment processes.
By embedding digital specialty care into your existing infrastructure, you can create a cohesive care ecosystem that enhances member satisfaction and optimizes health outcomes.
Conclusion
Integrating digital specialty care into Medicare Advantage plans offers significant opportunities to improve care quality, expand access, and reduce costs. By prioritizing user-friendly and accessible technology, contracting digital platforms as in-network providers, selecting validated solutions, and integrating with health plan operations for streamlined enrollment and outreach, MA plans can position themselves for success in an increasingly digital healthcare landscape.
What if you could implement a digital health program at no cost?
It may seem too good to be true, but there is a way to incorporate high-value digital health programs at no cost through plan-friendly in-network contracting, effectively replacing low-value care with high-value care. If you are interested, our team at Protera Health is ready to help in any of the following ways:
☞ Schedule a demo to learn about the power of in-network contracting and how it benefits your members.
☞ Download our quarterly magazine with insights on the latest trends in value-based digital health.
