Why Your Medicare Advantage Members Aren’t Engaged and How to Solve It

Think about the best customer experience you’ve ever had — an interaction where you, the customer, felt truly heard, appreciated, and, most important, received genuine value. 

Medicare Advantage members are no different from other customers in that they want to feel they have their health plan’s attention. While the exchanges may be more complex and the outcomes life-changing, at the core, feeling heard and appreciated is what creates a happy customer. A happy customer becomes a fan and engages with the service or product in a deeper, more meaningful way. 

But how can you get your members to love your brand and engage with you? What makes a great customer experience for Medicare Advantage (MA) members? 

Members want to be heard

Medicare Advantage seniors represent a unique segment, with needs that range from those just entering the program at age 65 to those in their 80s and beyond. According to Center for Medicare Services (CMS) enrollment data, Medicare Advantage plans have a higher percentage of enrollees aged 75 and older (39%) compared with traditional Medicare (36%). Across this wide age range, all seniors want their concerns acknowledged and addressed, which for health plans may mean offering multiple channels of communication and engagement. 

But what can you do when personalization poses a cost challenge? Health plans now can implement independent healthcare navigation, a two-way communication solution that is easy to access and adapts to each member’s needs.  

One point of contact for your members 

Independent healthcare navigation can address issues across multiple categories, including care management, member services, prior authorization, member education, and member questions and complaints. It offers the type of personalized attention that adapts to membership demographics, providing a direct way to address the unique needs of diverse populations. 

Offer options

In addition to contacting members in the traditional ways, consider the profound difference that speaking directly to a person, offering support and empathy, can make. Connecting with a compassionate healthcare navigator who provides care guidance and goes the extra mile can deeply engage members. This personal touch isn’t just about following a script — it’s about offering guidance and support throughout the healthcare journey, fostering a sense of trust and connection that leads to greater member involvement, positive outcomes and improved Medicare Advantage Star Ratings.  

Focus on health equity 

According to the 2021 Medicare Current Beneficiary Survey (MCBS), as of 2021, approximately 59% of Hispanic or Latino/a individuals and 57% of Black individuals eligible for Medicare choose Medicare Advantage plans. Overall, 54% of Medicare beneficiaries who belong to diverse populations choose Medicare Advantage. Medicare Advantage has a higher overall share of diverse populations (29%) compared with original Medicare (19%).  

Source: 2021 Medicare Current Beneficiary Survey (MCBS) 

Medicare Advantage health plans are facing new changes to the Star Ratings calculation, because, starting this year, plan performance will take into consideration a new Health Equity Index (HEI). The data collected during measurement years 2024 and 2025 will impact the Star Ratings that are released in 2027. 

The Health Equity Index incentivizes MA plans in two areas, two ways: 

1. Rewards plans that have a high percentage of enrollees with social risk factors. That population includes individuals enrolled in income-based programs such as Medicaid, the Medicare Savings Program (MSP) or the Low-Income Subsidy (LIS) program, as well as those eligible for Medicare due to disability.  
2. Recognizes plans that deliver strong Star Ratings performance within the high social risk population. This new HEI is part of a broader federal initiative to use payment incentives as a catalyst for closing the health equity gap.

Healthcare navigation offers a way for MA health plans to address HEI requirements by supporting Star Ratings performance in multiple ways, including: 

• Ensuring member populations enroll in programs linked to health equity gap efforts such as low-income assistance 
• Providing a solution that can scale to provide outreach and member engagement and can determine member eligibility

Offer a unified member engagement solution

To address members’ needs effectively, health plans should consider offering a unified solution, such as healthcare navigation, that touches multiple categories of member support. 

For example, when members connect with their Quantum Health Care Coordinator to learn more about their benefits, the coordinator:  

• Provides information about supplemental benefits available to the member 
• Notifies the member that a provider they’ve used in the past is no longer in-network, and offers alternatives for choosing a new provider 
• Informs the member about pending preventive exams 
• Assists the member with finding a nearby lab or radiology center 

By offering holistic insights and tailored assistance, health plans can boost member satisfaction, foster better health outcomes, and drive organizational success. 

Members want easy solutions to their problems 

As people age, their health needs often become more complex, requiring closer and more frequent monitoring. When this complexity arises, timely and accurate answers are essential. 

Understand people from all health perspectives 

Serving thousands or even millions of members, health plans face the challenge of delivering both immediacy and personalization. 

Quantum Health’s independent healthcare navigation addresses the needs of a health plan’s senior population, with three key objectives: 

• Provide solutions to pressing issues: Clarify benefits, assist in finding nearby providers, assist in getting prior authorization and offer help with scheduling preventive tests — all to ensure members receive timely and relevant support. 
• Educate members to better manage their chronic conditions: Provide guidance on chronic condition management, offer detailed information about providers and assist with scheduling appointments — knowledge that empowers members to take an active role in their healthcare. 
• Be the support network during critical health events: Quantum Health’s Real-Time Intercept® technology platform assists members during critical health events (e.g., a cancer diagnosis) by ensuring they are fully informed about their benefits and any supplemental options available, providing essential support during these significant health challenges.

Most important, independent healthcare navigation delivers personalized solutions to even the most complex issues, fostering member rapport and brand loyalty. 

Enhancing member engagement not only benefits the member but also supports the health plan’s goals of improving Star Ratings, boosting CAHPS and HOS performance, and meeting CMS requirements, including Health Equity Index reporting. 

By implementing strategies like healthcare navigation, focusing on health equity, and offering unified engagement solutions, you can create meaningful interactions that turn satisfied members into loyal advocates. In doing so, you enhance member engagement, drive better health outcomes and stronger Star Ratings, and ensure your members receive the care and attention they deserve.  

Engaged members are not only more likely to stay with your plan but also to thrive under your care — achieving the ultimate goal of any health plan. 

Sources: 

KFF Report on Disparities in Health Measures by Race and Ethnicity among Beneficiaries in Medicare Advantage 
CMS 2021 Medicare Current Beneficiary Survey 
2024 Medicare Advantage and Part D Final Rule (CMS-4201-F)