The following is a guest article by Ashish V. Shah, Co-Founder and CEO at Dina
Payers Lean on Technology to Coordinate New Innovative Supplemental Benefits to Improve Quality, Outcomes, and Costs for Seniors
Non-medical supplemental benefits like in-home support services, meal delivery, home modifications, and transportation have skyrocketed with Medicare Advantage (MA) plans. As care continues to move into the home and community, the trend toward benefits that address health-related social needs (HRSN) will continue.
But activating, coordinating, and measuring the impact of these new benefits remains elusive and difficult.
Traditional care coordination is hampered by time-consuming tasks– phone calls, faxes, multiple emails–to stay on top of which service providers can fulfill certain benefits, and have the necessary capacity to do so in a timely manner. Meanwhile, benefit providers are plagued by persistent staffing shortages at all levels that further exacerbate their ability to be responsive partners to new payer partners.
And the MA market is changing. After years of explosive growth, the market is now at a tipping point, with more than half of all seniors enrolled in an MA plan. Today, most plans are looking to not only use supplemental benefits to grow membership but also leverage them to deliver on cost and quality targets. Furthermore, regulators are now mandating that utilization data and effectiveness be reported back to CMS.
The Medicare Advantage Star Ratings program includes a Health Equity Index (HEI) Reward Factor that will be introduced in 2027 to encourage plans to deliver equitable healthcare. The HEI Reward Factor will assess how well plans serve beneficiaries with social risk factors such as low income, disability, or dual eligibility for Medicaid. Data from measurement years 2024 and 2025 will impact Star ratings in 2027.
The new HEI is part of a broader effort by the federal government to use payment as a mechanism to spur action on closing health equity gaps. For example, a critical, and largely underutilized, resource is leveraging the set of income-based programs available to more than half of Medicare members including both the HEI qualifying programs — Medicaid, Medicare Savings Program, and Low-Income Subsidy — as well as those that support paying for utilities, prescriptions, and food.
I would expect that the new administration will rebrand and/or repackage some or all of these measures in some way in 2025; however, there is largely bipartisan support for addressing the health-related social needs of seniors. Also, I fully anticipate that consumer experience will grow in importance, and accessing benefits will be very critical in that regard.
Poor Access = Bad Outcomes
To thrive under these conditions, we need to get care navigators in situations where they are actually spending more with members to understand their needs versus battling outdated systems to complete basic tasks related to care navigation and coordination. We know that providing timely access to care and services to people following a hospital stay or during an extended illness is critical. In fact, research shows that even a seven-day delay in arranging home health services can lead to:
- 31% increase in Emergency Department (ED) visits
- 40% increase in unnecessary hospital readmissions
- 22% increase in mortality
- $2.289 increase in 90-day average total cost per member
Operationalizing Supplemental Benefits for Members
For payers and providers, the process often involves intricate workflows, multiple IT systems, and continuous communication with multiple benefits providers. To expedite the process, payers are beginning to embrace digital solutions to enable innovative care coordination software for their members.
Reducing this complexity requires a new level of interoperability, integration, and responsiveness. When done right, quality is improved, costs are contained, processes are streamlined, care gaps are closed, and coordinators can serve more members. Ultimately, seniors are happier with the experience.
Here are 7 steps to jumpstart your digital transformation:
Evaluate Your Network of Benefit Providers
Review contracted benefit providers in your network and identify gaps and coordination challenges, particularly with supplemental non-medical services like in-home support services, home modification, meal deliveries, and more.
Share Technology with Key Benefit Providers
Extend your technology to important benefit providers to create a shared digital experience that results in faster and more coordinated benefits. This can reduce the time required to align resources to serve members in a timely manner. You can leverage integration to reduce trivial data entry tasks (e.g., the manual duplication and entry of demographic data across systems).
Maintain a Database of Benefit Provider Capabilities and Capacity
Maintain a database of benefit provider capabilities and capacity with the technology to keep benefit provider data current and organized so they have up-to-date information at their fingertips and can quickly connect people with the right resources at the right time.
Boost Coordinator Productivity with AI
Boost coordinator productivity with AI to drive more efficient processes so coordinators have more time to work with the seniors who need care. For example, the power of generative AI can provide useful summarizations of the plan of care and other information necessary for coordinators to make timely decisions.
Real-Time Data Sharing
Real-time data sharing for service coordinators and in-home service partners to engage, collaborate, and create a great experience for seniors. This can include jointly setting performance goals around care, encouraging partners to validate outcomes with data, and using shared technology to facilitate communication. Be clear about what information is most important and make it easy for your partners to supply it via automation or simple workflow tools.
Evaluate Service Delivery and Performance
Leverage data to determine if partners are meeting commitments on member satisfaction and service delivery. This helps manage the partner network and improve member experience.
Educate Members
Educate members about available benefits and stay connected to determine satisfaction with services.
Improving connectivity between benefit providers is often easier said than done. And as more supplemental benefits are offered, the importance of making sure those benefits are easily accessible will become a measure of quality and Star ratings. When done right, investing in the technology to manage and coordinate supplemental benefits can lead to better outcomes, higher member satisfaction, and, ultimately, lower cost of care.
About Ashish V. Shah
Ashish V. Shah founded Dina in 2015 and leads the team on its mission to make in-home care accessible, reliable, and transparent. Dina provides digital network management and coordination solutions to help health plans and providers improve access to in-home care, long-term services and supports, and supplemental benefits. Today, the company works with top health plans and providers to improve the delivery of home-based benefits and help people live their very best lives.
