Strategies for effectively attracting, serving and retaining Traditional Medicare patients

Hospital leaders are grappling with the opportunities and challenges related to the growing number of Traditional Medicare patients.

At the Becker's 10th Annual CEO + CFO Roundtable, in a session sponsored by USA Senior Care Network, Rita Marti, Vice President Hospital Partnerships at USA Senior Care Network, led a discussion about strategies hospital leaders are considering for managing the increase in Medicare beneficiaries.

Four key takeaways are: 

  1. Health systems are facing a surge in the Medicare-eligible population. Over the next 10 years, according to Telios Actuarial, the Medicare eligible population is expected to grow from 64 million to 78 million beneficiaries. "This is being called the 'Silver Tsunami,'" Mrs. Marti said.

    Of today's 64 million Medicare beneficiaries, nearly a quarter (23 percent) have Medicare Supplement (or Medigap) coverage. Beneficiaries who pay a monthly premium for Medicare Supplement have the highest level of coverage. They receive a government-standardized plan that covers everything not covered by original Medicare, including co-payments, co-insurance and deductibles. In comparison with patients who have Medicare Advantage plans, those with Medigap coverage tend to be higher income, healthier and live outside of major metropolitan areas.

  2. Effective, lower-cost-of-care environments offer options to "ride ahead of this Silver Tsunami." Based on the growth of the Medicare population and the expected increase in demand for healthcare services, providers are considering multiple programs to more effectively manage patients outside of hospitals. One trend is hospital-at-home, under a CMS waiver, which presently allows for full Medicare reimbursement. The success of hospital-at-home programs is marked by lower cost of care, fewer readmissions and better outcomes. This programs currently operate under 90-day waiver extensions, which creates uncertainty about its future, but also creates the opportunity for the federal government to make more permanent decisions about acute care hospital-at-home programs moving forward. 

    Another approach to manage the care load for this growing population is the chronic care management program using various technologies to monitor and communicate with patients, such as texting-based programs. This program can be effective at preventing readmissions. One participant said that he found that many Medicare patients like texting and physician practices and that he appreciates being compensated for care he is already providing.

  3. The push into ACOs presents hospitals with an opportunity for shared savings but poses obstacles. Accountable Care Organizations are CMS's leading value-based care initiative. The Biden administration reported that in 2021, ACOs saved the Medicare program $1.66 billion. Based on the success of ACOs, CMS wants all traditional fee-for-service beneficiaries to be in an ACO by 2030.

    For some providers, ACOs represent potential for shared savings, but ACOs also come with concerns. For example, small rural systems can find ACO participation challenging. In other markets, payers may contract with hospitals and delegate care coordination, requiring that providers invest to create significant infrastructure. And because many ACOs operate in competitive markets, there can be a significant marketing investment to attract and retain patients and avoid leakage. 

  4. USA Senior Care Network can be part of the solution. USA Senior Care Network represents      11 million fully-insured Medigap patients. This population is generally healthier than Medicare patients without Medigap and reduces the risk of bad debt to the hospital. USA Senior Care Network's goal is to "partner with one health system in every market to channel . . . these fully-insured Medigap patients, particularly with those systems that are looking to attract and retain traditional Medicare patients for both acute care hospital-at-home programs as well as hospital-owned ACOs " Mrs. Marti said, as participating patients are incentivized to seek in-network care. 

Health systems considering strategies to attract and serve Medicare beneficiaries may find that a relationship with USA Senior Care Network can be an advantage in attracting Medicare patients.

To learn more about working with USA Senior Care Network, click here

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