Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.

There is growth in the number of plans offering virtual care services and expansion in the varieties of services offered.

Telemedicine technology and services company Teladoc Health is seeing utilization rates among Medicare Advantage members up 54% for virtual urgent care services and up 635% for virtual mental health services when compared to 2019.

Some of the most rapid adoption of virtual care for Medicare Advantage plans has been driven by a focus on improving star ratings as more care has shifted into the home. Early in the pandemic, several plans launched Teladoc Health's diabetes and hypertension management programs in an effort to boost the star measures tied to those chronic conditions.

These efforts paid off as average performance of these plans on the triple-weighted blood pressure control and HbA1c control measures was five stars. This is significant as star ratings are used to determine two parts of a plan’s Medicare Advantage outlook: whether a plan receives a bonus, and a plan’s ability to bid against a higher benchmark rate.

Healthcare IT News sat down with Hunter Sinclair, vice president of solution strategy at Teladoc Health, to dive into this subject. Sinclair joined the company in 2020 to grow the company’s chronic care business within the Medicare Advantage line of business.

Based on his success in building chronic care business for seniors, Sinclair’s role was broadened to focus on all government lines of business (Medicare Advantage, Managed Medicaid and Marketplace) and all virtual care offerings (urgent care, mental health, chronic care, specialty care and primary care).

Q. What is the current state of virtual care for those 65 and older?

A. When barriers to virtual care are removed, it’s clear many seniors prefer the convenience of virtual care. When offered virtual care options, Medicare members are increasingly willing to engage, and engagement yields significant benefits for both the member and their plan.

Medicare utilization of virtual care prior to the pandemic was low, around 7%, mostly due to regulatory barriers. According to CMS, this number jumped to 47% of all Medicare fee-for-service members by the second quarter of 2020. And utilization of telehealth has remained high for this population.

Some of the most rapid adoption of virtual care for Medicare Advantage plans has been driven by a focus on improving star ratings as more care has shifted to virtual settings.

Q. What is driving senior engagement with virtual care?

A. We’ve found a few things to be true in terms of driving senior engagement with virtual care, including multimodal communications and targeted marketing of specific features.

A great example of this is our Medicare communication journey for chronic care members. We combine live telephonic outreach from our call center in addition to traditional channels like direct mail and email. We have also seen significant improvements in feature utilization from continued A/B testing, leveraging member communications, product optimization and explainer videos.

What does this look like in action? With these methods in place, one of our large Medicare Advantage plan partners actually saw a 5-7x increase in coaching utilization and food logging for members enrolled in our diabetes prevention program in 2022 versus 2021.

Q. Are you seeing many Medicare Advantage plans offer virtual services?

A. Most Medicare beneficiaries have used telehealth, and we’re seeing strong interest from MA plans in the virtual primary care models popular for the exchange and fully insured markets.

At Teladoc Health, we work with more than 50 MA partners, and more than nine million MA beneficiaries have access to one or more of our virtual care offerings. We’re seeing continued growth in the number of plans offering virtual care services, as well as expansion in the types of services being offered.

Q. There has been a lot of focus on stars. Talk a bit about stars, and what you are doing to help Medicare Advantage plans with their stars performance.

A. For Medicare Advantage plans, stars program performance impacts billions of dollars in payments and has a dramatic impact on profitability and growth ($10 billion in payments in 2022).

Given the importance of star ratings, some of the most rapid adoption of virtual solutions for these plans has been driven by a focus on improving star ratings.

Early in the pandemic, several Medicare Advantage plans launched our diabetes and hypertension management programs as a means to boost the stars measures tied to those chronic conditions.

These efforts paid off, as average performance of our partners on the triple-weighted blood pressure control and HbA1c control measures was five out of five stars, and average outperformance for our partners across chronic care measures has been around one star rating better than the national average.

Moving forward, I think even more aggressive interventions are needed to maintain or improve star ratings, especially with CMS focus on Health Equity Index and more equitable results across members. Relying on bricks-and-mortar provider networks is insufficient to be a 4+ star plan in this new environment.

Plans need to leverage every tool available including virtual chronic care management programs, widespread and convenient access to virtual services, at-home testing, and virtual primary care.

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