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Top five items that can make or break your benefit strategy in 2021

Co-Author: Debra Devereaux MBA, RPh

Although we’re almost to the plan benefit package (PBP) and bid filing deadline (it’s the final countdown!), there are a few items that we believe all Medicare Advantage Organizations (MAOs) should “check” before submitting the final bid on June 1st .

1. Special Supplemental Benefits for the Chronically Ill Subset (SSBCI)

CMS allowed SSBCI for the first time in 2020 which has fundamentally changed the playing field (click here for more information). Identifying those benefits that will address the needs of your membership with chronic conditions and demonstrate positive outcomes (e.g. reduced MLR), as well as those benefits that will position your Organization well in your market is key.

2. Supplemental Benefit Strategy

Over the past few years, the industry has seen an influx of supplemental benefits such as OTC, transportation and home delivered meals. These benefits are now the new norm or “table stakes” benefits in many markets. It is critically important to understand your local market landscape and the “likely” strategy of your competitors around supplemental benefits in order to create benefit packages that will win. Now is the time to think outside the box on your supplemental benefit strategy. No time like the present to set yourself apart!

3. Telehealth

With the current COVID-19 pandemic coupled with CMS’ allowance to implement mid-year benefit enhancements, a strong telehealth benefit for 2021 (and 2020) is key to ensure that members are accessing care. Telehealth strategy goes far beyond enrollment numbers as member health engagement also has direct impact on items such as risk adjustment, STARs ratings and avoidable hospital admissions/readmissions.

4. Formulary Changes

Ensure that your Organization has done a comprehensive review of membership makeup so that medications, tiers and co-pays will not adversely affect treatment goals and access. Which members will be impacted by formulary changes and will those changes cause membership loss that may impact enrollment goals? In addition, it is critical to understand how your formulary is positioned in your local market, and how formulary content and negative changes may impact the ability to attract (and retain) membership.

5. Rewards and Incentives

Rewards and Incentive programs have always been an important part of member engagement strategy. Now with routine care utilization being greatly reduced due to the COVID-19 pandemic, rewards and incentives are more critical than ever before in order to ensure that members are actively engaged in their health care, again providing another opportunity to reduce avoidable hospital admissions/readmissions and positively impact risk adjustment and STARs measures.

Sales and Marketing Strategy

Given the challenging times we are currently in, it is extremely important to re-evaluate your 2021 sales and marketing strategy. Were you heavy in “kitchen table” sales during the last AEP? Is your website and online enrollment process inefficient and lackluster? These are indications that it may be time to coordinate with partner entities, such as FMOs or other third parties that provide platforms for online enrollment and have implemented a video sales strategy to ensure that your organization is prepared for the change in climate for the 2021 selling season.

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