How Whole-Person Virtual Care Closes Care Gaps and Improves Star Ratings

Medicare Advantage (MA) plans are under significant financial pressure, and many are struggling to continue offering competitive benefits while keeping pace with their members’ care needs. MA plans and their partners can look to increased virtual care investment as a lower-cost, more accessible way to reach members. 

Telehealth adoption among MA plans continues to skyrocket, with more than 90% of plans filing for additional telehealth benefits with the Centers for Medicare & Medicaid Services (CMS) in 2023.¹ As virtual care grows and use cases expand, MA plans must adopt integrated, whole-person virtual care strategies that benefit members to improve member retention, clinical outcomes, and their Star ratings.  

Whole-Person Virtual Care Supports the Member Health Care Journey

A recent McKinsey report expects changes in how Star ratings are measured, with expected reweighting of member experience measures and more emphasis on clinical and pharmacy metrics that will place even greater pressure on MA plans.² Plans must take a more flexible, omnichannel member engagement approach to overcome economic pressures, maintain 4+ Star ratings, and help members navigate their increasingly digitized health care journey. 

In-person care isn’t going anywhere, so it’s essential to have a coordinated, in-person and virtual care strategy that allows MA plans to deliver high-quality, whole-person care for primary care, chronic care, specialty care, and more. Fragmented and episodic experiences from a plan’s virtual care strategy can be devastating and lead to poor outcomes, dissatisfaction, and worse Star ratings. 

Expanding access modalities is essential to connecting members with the care they need, especially when existing care networks lack capacity. By adopting a whole-person virtual care approach, MA plans can personalize member experiences and facilitate care across a complete spectrum of care services. 

Personalization Drives Member Engagement 

Member experience and satisfaction play a crucial role in an MA plan’s abilities to improve Star ratings, capture bonus payments, and attract or retain members. And we’re seeing within our network that Medicare beneficiaries are increasingly enjoying the convenience of virtual care when it’s accessible.

Offering a tailored and coordinated virtual care experience for members to access everything from primary care to mental health care to specialty care results in a better member experience. It empowers members to take a highly active role in managing their care journey for better outcomes and engagement. It increases the likelihood they’ll renew their contract and helps MA plans improve their Star ratings performance. 

Bridging Care Gaps Improves Quality Measures

Another benefit of whole-person virtual care is that MA plans can provide multiple modalities for members to seek care and offer at-home testing supplies and monitoring devices to share proactive care insights with providers and close care gaps.

Data-driven, omnichannel, and personalized engagement strategies can help overcome the digital divide or accessibility challenges and identify members overdue for preventive care screenings for better outcomes and experiences. All this, combined with digital coaching, AI-informed reminders, and smart devices, can create a holistic understanding of your member population’s care gaps and deliver insights to drive behavior change and adherence.

Integrated virtual and in-person care strategies allow the plans we work with to provide members with access to new patient primary care visit within a week, compared to the national average of 1-2 months. Additionally, these plans have an average 5 Star rating on blood pressure and blood glucose control, a 3.2% reduction in A1c levels and 98% higher chance of diabetes medication adherence within our member population with diabetes.³

Whole-Person Care Strengthens Financial Outcomes

Expanding virtual care access helps plans improve member satisfaction by delivering faster access to care and avoiding high-cost environments like urgent care settings and emergency rooms that save money for members and plans. From our MA-specific claims analysis, we found that virtual visits result in an average net savings of $241 through cost avoidance, and 57% of our MA members report that they would have gone to the ER or urgent care if not for virtual care, making it a viable option for members and plans to improve quality while reducing costs.⁴ 

Early identification and timely treatment are essential to delivering cost-effective and high-quality care for patients with diabetes, hypertension, and other complex conditions, where virtual care can help make this process more efficient, coordinated, and accessible. Additionally, given how Star ratings can impact billions of dollars in payments, plans can no longer rely on brick-and-mortar provider networks to be a 4+ Star plan and need a comprehensive, hybrid approach to remain competitive. 

Virtual Offers Competitive Edge into the Future

Traditional care delivery and brick-and-mortar provider networks are no longer sustainable options for plans on their own. Competition is fierce, with nearly 4000 MA plans available in 2024, and virtual care presents an opportunity for MA plans to gain a competitive advantage for prospective and current members. Whole-person virtual care is essential for making care sustainable and supporting the complex and changing needs of the aging population. 

References 

1. CMS finalizes policies to bring innovative telehealth benefit to Medicare Advantage. News release. CMS. April 5, 2019. Accessed May 24, 2024. https://www.cms.gov/newsroom/press-releases/cms-finalizes-policies-bring-innovative-telehealth-benefit-medicare-advantage
2. Isaacson G, Jamieson D, Pedersen-Green S, Repasky C. Payer considerations in 2024 as Medicare Advantage changes. McKinsey. March 13, 2024. Accessed May 24, 2024. https://www.mckinsey.com/industries/healthcare/our-insights/the-future-of-medicare-advantage
3. Munshi KD, Amelung K, Carter CS, James R, Shah BR, Henderson RR. Impact of diabetes remote monitoring program on medication adherence. J Manag Care Spec Pharm. 2021(6):724-731. doi:10.18553/jmcp.2021.27.6.724
4. CMS data on plan benefit packages and inclusion of additional telehealth benefits. Internal Teladoc Health. 2024.

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