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  • Predict Health Team

Medicare Advantage’s Customer Voice Challenge and CMS’s New Enrollee Advisory Committee Requirements

How does somebody without a permanent address access health care? What if they don’t have a cell phone? And what if English is their second language? Most importantly, what needs do they express? How best to serve them?

The need to demonstrate customer-centricity is one that all business share. As anybody who has ever received an email asking them 'how did we do?' knows, consumer-focused businesses can be obsessive about capturing and digesting the voice of their customers. They know well that their business success depends on being able to stay ahead of customer needs and that customer voice gives them the means of understanding any changes.

CMS has now challenged Medicare Advantage to demonstrate some of the same customer-centricity, especially with regards to Dual Eligible plan participants whose voice is seldom heard and whose perspectives are often reduced to sterile findings around the social determinants of health.

CMS has provided a mechanism to enable this: providers are mandated to convene quarterly Enrollee Advisory Committees in every state where they offer a plan. The EACs are intelligent focus groups composed of a representative set of plan participants who will be encouraged to share their perspectives, frustrations, and ideas around all aspects of the plan experience.

The goal is to help plan providers improve their offerings and experiences for their customers and learn directly and in real-time, the challenges their customers face, based on the voice of individual plan participants. Since the CMS guidelines became effective on 1/1/2023, Dual Eligible Special Needs Plans (“D-SNP”) have begun launching Enrollee Advisory Committees to meet the requirements. This effort has proven to be challenging for plans.

Predict Health has been working with several national and regional Medicare Advantage organizations that offer D-SNPs to help them establish and maintain enrollee advisory committees that are not only compliant with CMS requirements, but also effective in their ability to capture member input and use member input in health plan governance and decision making thereby improving member experience. Currently, Predict Health helps implement EACs for D-SNP plans covering about 5 percent of all Medicare Advantage enrolled D-SNP members across 20 odd states. Additionally, Predict Health has also engaged with several D-SNP plans to understand and guide their strategies as they implement programs to meet their EAC requirements.

While Enrollee Advisory Committees present a great opportunity to systematically capture customer voice and input, implementation of Enrollee Advisory Committees has been a significant challenge for many Medicare Advantage organizations, especially when it comes to recruiting members that are representative of the health plan’s membership, engaging them in a compliant way and capturing and reporting the input effectively to enable compliant plan decision making and governance.

1) How do you build the required representative sample for an Enrollee Advisory Committees and then recruit those individuals?

Sampling, we have learnt, isn’t as easy as looking at the obvious demographics. Plan providers need to have a strategy for accessing more difficult to reach populations. Similarly, an effective recruitment strategy accommodates different individual preferences. No shows are also a major problem. How do you run a recruitment campaign that makes the most of available funds while also minimizing no shows?

2) What’s the best way to engage members before and during an Enrollee Advisory Committee ?

Putting groups of very different people together in a room can run the risk of a disaster. Either the group gets stuck on complaints or a couple of people take the opportunity to lecture the room on their perspective. How do you make sure that the sessions produce rich, actionable data? And easy to ignore but it makes all the difference, but what kinds of facilities do you need?

3) How do you report the output from an Enrollee Advisory Committee (EAC)?

A transcript of the event will not suffice. For one thing, CMS’s interests will be different from the plan’s perspective. Or what the plan leadership needs to improve plan experience and achieve member outcomes. We have learnt how to make it possible to version the content to address the needs of different stakeholders.

This post is a first post to set the scene, subsequent posts will explore each issue in depth. If you have questions about our approach or want to hear more about what has worked or not worked, contact us at [xxxxx].

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