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How Medicare Advantage plans can begin closing coverage gaps through better communication

Personalized communications and robust analytics capabilities can help MA plans avoid some of the pitfalls of coverage gaps.

Jeff Lagasse, Associate Editor

Now that the year is more than halfway to the finish line, Medicare Advantage plans may notice that they have coverage gaps. It's not an ideal situation to be in, and there are many reasons why such gaps may occur, but the good news is that there are ways to close them, given the right processes and strategies.

There are a few ways by which coverage gaps may occur. According to Katie Kopansky, health optimization economist at consumer-facing health technology company Welltok, gaps can form when Medicare Advantage plans don't have close relationships with provider groups and health systems. That can mean missed opportunities to partner with the care delivery team to ensure gaps don't occur in the first place.

Another factor may be plans' inadequate relationships with their members. If those relationships aren't strong, plans won't have the ability to communicate with their members in a meaningful and helpful way.

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Communication, and effective messaging, are the cornerstones of ensuring adequate coverage. Failure to meet certain standards can have negative financial implications for the plan itself.

"Not closing gaps in care will affect your star rating," said Kopansky. "A big part of the star rating is achieving gap closure; you will be negatively impacted because those ratings directly correlate to the reimbursement dollars you can receive from (the Centers for Medicare and Medicaid Services) and the federal government.

"That also impacts their ability to market to members," she said. "If someone drops out of a five star-rated plan, they lose their ability to market year-round."

To avoid this fate, there are a few steps Medicare Advantage plans can take.


Like most first steps, this one is simple: Plans should identify the areas in which they'd like to make progress.

That means deciding upon the areas where the plan can have the most impact, determining where the competition is, and then using that yardstick to identify gaps in care and assessment. This allows the plan to determine which steps are required to move in the right direction, and to focus communications around the population that is likely to help the plan inch closer to its goal.

"If choosing a mammogram to close a gap in care, and that's your gap in focus, the obvious step is to focus on females in your communications," said Kopansky. "Look at who's likely to be receptive if you give them a nudge. Identify what your barriers are.

"The other way you can go down the road to more personalized communication with your members is by initially focusing on the measures you need to make movement," she said. "Especially later in the year, it's important to say which measure you'd like to have an impact on."

Many plans are proactively using consumer data to understand patients better and predict who's likely to close the gap and who needs a nudge. The next step for a plan is to settle on the best method with which to communicate. Personalization on that kind of mass level simply isn't possible without robust data, so it's important to make sure there are advanced algorithms in place that can compute and identify a list of individuals a plan should reach out to.

"A lot of players might use one or the other: text or rewards," said Kopansky. "You're only going to reach a portion of the population with either one of those. The way to get ahead is to use multiple of those, and orchestrating which members you engage on each technology. You don't need to text someone twice if they've already responded to your email. There's nothing more abrasive and frustrating than telling someone to do something they've already done."


With analytics becoming more advanced and complex, even analysts themselves can't keep up with the amount of data and information that's now available on a population. It's virtually impossible to build a team large enough to process call center data, provider data, satisfaction data, and any other survey data. Without the right analytics, it can't be turned into something useful and actionable.

This is where machine learning can play a huge role. With such adaptable technology, it's much more feasible for plans to update their scripts, refine their messaging, and update their member targeting and personalization efforts in a more scalable way.

Interactive voice response messaging, or IVR, is another important technological component of sound communication strategy. The trick here is to deliver an IVR message that's personalized, starting with the basics, such as the patient's name and any basic supporting information that can be gleaned from the available data.

Even the little things matter, like what the gender of the voice is delivering the message.

"The only way to really continue to be personalized is to collect information back," said Kopansky. "Ask the questions: When are you planning on closing your gap? Do you have any barriers? Do you need help scheduling visits? Are you concerned about the cost? In that way, you can reach people in a way where they're more receptive. The language, the gender of the voice, the accent -- you've asked them where they're at.

"And now, if you need to provide an intervention to get them a provider, or need to explain to them that something is preventative and there are no costs, you have the info to follow up with then and there. Or you can call them back in a day or two and say, 'Hey, thanks for letting us know what support you need, we'd like to help you with transportation.' You're not engaging in a personalized communication with your member, but you've done it in a scalable way."

Of course, live reminders and follow-ups are an important part of the process as well, and to be maximally effective, they'll need to be tailored to the individual, whether it's a text message, follow-up call, email or other method. The thing to keep in mind, said Kopansky, is to now what to follow up on, and to have the information available at the fingertips so the plan can act on it.

"Gap enclosure does not stop at a nudge," she said. "Gap enclosure stops when the gap is closed. The only way to do that is with interactive dialogue."

Twitter: @JELagasse

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