86 the Medicare Advantage Primary Care Gap: Insights from MedCity News

I recently had the pleasure of joining the MedCity News Influencer Program and sharing my insights on a critical issue, closing the Medicare Advantage primary care gap. In my article, Will We Close the Medicare Advantage Primary Care Gap in 2024?, I shared 86Borders’ proven tactics for eliminating this problem in healthcare, especially for health plans and payers.

Over the years 86Borders has worked effectively with health plans to engage vulnerable Medicaid, Medicare Advantage (MA), and DSNP populations. Our work reiterates the significant challenge health plans face – members without primary care physicians (PCPs) directly and adversely impact a plan’s Star ratings and other quality scores.

This gap in care is particularly alarming for health plans, given the prevalence of complex patients within the MA population. Complex patients are the fastest-growing member segment, constituting over half of a plan’s overall spending. Without intervention or SDOH screenings by a PCP, these members exacerbate setbacks for plans and the overall quality of health within the population.

Addressing the Medicare Advantage PCP gap requires health plans to proactively engage with members, facilitate ensured PCP interventions, and monitor follow-up care closely. Here are 86Borders’ best practices for achieving proper member engagement to close the MA primary care gap:

• Use public and private data sources to locate current and correct member information
• Outreach across multiple channels in a timely manner to quickly engage with high-risk, complex members
• Leverage local phone numbers to increase member comfort in answering outreach
• Empathize with common reservations and distrustful feelings held by members when interacting with their plan
• Build trusted, individual-level relationships with members and use their preferred outreach methods and times
• Guide members through each step to book appointments, secure transportation, and schedule follow-ups for primary care appointments

Using these proactive, member-first engagement methods in other vulnerable populations has resulted in the following:

• 43% increase in member engagement
• 3% improvement in medication adherence
• 57% conversion rate from inactive to active members
• 247% increase in PCP appointments