CMs in key position to help managed Medicare plans gain patients

Apply these tips for improving your retention rates

You just might hold the key to your managed Medicare plan's bottom line. The Health Care Financing Administration (HCFA) in Baltimore opened the floodgates, and a steady flow of new managed Medicare plans continues to pour into the market in search of members. And case managers are in an excellent position to help their plans gain new members and improve retention rates.

The average disenrollment rate for managed care plans was 13% in 1997, says Don E. Hawk, PhD, vice president of sales development for On Target Health Solutions, a communications company in Cincinnati. For a 25,000-member plan, that translates to a loss of 2,600 members annually. With acquisition costs for new members running as high as $4,000, disenrollment could cost a 25,000-member managed care plan upward of $5 million annually. "That's why plans pay so much attention to retention rates," says Hawk.

The key to long-term member loyalty is based on "creating caring relationships based on quality care," he says. "Older adults place primary importance on their health. They don't just want their insurance company to be a claims payer. The want to develop a caring relationship with their plan."

There are nine strategic "touch points," or openings, case managers and other plan representatives can use to gain loyalty from managed Medicare members, says Daniel E. Ansel, BS, MA, MHA, vice president for business development for On Target. Those are:

1. Community awareness. "Every time you go out into the community to do public relations or present a disease management or health education program, you create an opportunity to gain and retain members," says Ansel. When you do education, make sure you are using adult learning techniques, he adds. "The literature is full of data about what works for older adults. Yet I still see pamphlets and brochures done in dual tones like black ink on blue paper, which are impossible for older eyes to read."

Similarly, too many health plans use learning videos that are inappropriate for older audiences. "Many plans send members a video when they join, but the videos use narrators who talk too fast."

2. Acquisition and sales process. Many times, seniors experience "buyer's remorse" after signing up for a managed Medicare plan, Hawk says. The key is to reach them before they disenroll. "Send them messages confirming that they've made a good choice," he suggests.

One plan On Target works with sends new members plan information within the first week of enrollment. "The information clearly outlines everything that the member can expect from the plan. It also answers the many questions that seniors often have about when their coverage starts," Hawk says.

The literature provides detailed information about what members will receive from the plan in the next 60 days. "Of course, never promise something that you can't deliver," he cautions. "That only leads to dissatisfaction."

3. Application for approval from HCFA. "Some plans sign new members and lose them before they even receive HCFA approval," Hawk says. "Again, buyers like to hear they've made a good decision. Hit them with messages that list the top six benefits of your plan before they have time to change their minds."

4. First 90 days of enrollment. "Almost two-thirds of seniors who rapidly disenroll never see their primary care physician," he says. "Does this contribute to the feeling that you care about them as a plan? Of course not!"

Case managers should encourage plans to develop strategies that get new members into their physician's office early on, he notes. "Seniors lack an understanding of managed care. You can help by breaking down barriers to access."

5. Physician interactions. "Any time a member interacts with a physician, that physician represents the plan," Ansel says. "Spend some time working on provider relations. If a member complains that it took too long to see their primary care physician or that the physician seemed rushed, talk to provider relations. Have someone from provider relations pay a call on the physician."

It also helps if you foster a more personal relationship between members and their physicians. "One plan asks physicians to fill out information on their hobbies, interests, and schooling and sends that information on to seniors to make them feel closer to their physicians," Hawk says.

However, make sure you don't ask physicians to fill out information you can find somewhere else. "Physicians hate the hassle factor," he cautions. "If you make unnecessary work for them, they'll hate you. Fill out the information you already have and just ask physicians to verify it and add the pieces you don't have on file."

In addition, plans that make the physicians' job easier will win points that spill over and indirectly help the plan gain and keep members, Ansel says. (For an example of one winning strategy, see p. 147.)

6. Times of perceived need. Here's where case managers can step in and really make a difference. When members call with a problem, complaint, or specific service need, plans have an opportunity to create that essential caring relationship, Ansel says.

The process can start even before a problem arises, Hawk notes. "One plan sends two postage-paid 'call me' cards to new members," he says. The cards include the name of their case manager or member representative and have room for seniors to write out questions about the plan.

The bonus is that it gives you an opportunity to do your homework and find the answers to those questions before you call the member back, Hawk says. "It makes you appear both prepared and caring."

7. Hospital interactions. "Every time a member enters the hospital, they have a perceived interaction with the plan," Ansel says. Anything the case manager does to help make that hospital stay pleasant benefits the plan in terms of member retention.

8. Time of disenrollment. "The communication channels are cluttered because plans are relying on the same tired ways of acquiring and keeping members," he says. "You have to find ways to differentiate yourself. Focus on grass roots efforts. What other members, the children of members, and physicians say about your plan will determine the winner."

9. After disenrollment. Track who is disenrolling and, more importantly, why, Hawk says. "Use that information as part of your [continuous quality improvement] process to retain members."

Creating a positive image

On Target has identified several key retention strategies managed Medicare plans can use to gain and keep members. Those are:

o Branding. "The key is to make yourself different from other plans on the market," says Ansel. "Think of the features of your plan that you can use or create that set you apart."

o Building bridges. "Look for senior issues you can use to create a bridge between seniors and your managed Medicare plan," he says. "One excellent driver is pharmacy benefits. Other good ones are personal or financial security."

o Unique communication channels. Too many plans rely solely on telemarketing and direct mail. Explore other channels, he suggests. "Is there a unique communication channel consumers or HCFA haven't see before? Look for the 'Wow!' factor. And remember that sometimes the simplest channel makes the biggest 'Wow!'"

o Word of mouth. "The average managed care member tells 10 other people about their health plan," Hawk says. "That message can be a good message or a bad one. That's why it's so important to create member loyalty." In addition, the case management payoff is that loyal health plan members are more likely to comply with their physician's orders, he says. "They also follow plan policies and procedures."

o Member satisfaction. "The bottom line is that members defect when they feel no one paid enough attention to them," Hawk says. He and Ansel urge managed care plans to make good use of member satisfaction surveys. "Don't gather the information if you aren't prepared to act on it," Hawk says. "If you do, it's just a waste of time."

A good case management program definitely impacts member retention in Medicare populations, says Denise Kress, MS, RNC, CRRN, director of Senior Health Partnership, a managed Medicare plan in Woburn, MA. "At this point, we work with two physician groups and retention rates for the two groups we work with are higher than the network average."

However, she cautions case managers to look closely at how retention rates are calculated. "The problem is the way some plans collect data every time a member changes physicians; it looks like they've disenrolled and re-enrolled."

It takes support from the top down to improve member retention, but case managers play a big role in creating the caring relationship seniors crave. "Think about how your plan touches its members and what you are doing that's good to foster that relationship," Hawk suggests.