Getting Ready for Medicare Advantage: Five Tips for Marketers, Liaisons and Leaders

Working with Medicare Advantage payers is very different from navigating Medicare/Medicaid. In fact, it can be like learning a whole new language. While CMS speaks in regulation and compliance terms, MA payers speak the language of business. Those providers looking to grow through MA partnerships need to become fluent in a whole new set of communications norms.

Here are five key considerations for building mutually beneficial relationships with those in the corporate set. For more practical advice on working with MA payers, check out the recent interview my colleague Stan Massey did with Bluegrass Care Navigators’ CEO Liz Fowler. Our friends at Bluegrass Care Navigators have worked diligently to diversify their services and payer mix over the past few years.

1.  View this as a relationship, not a set of transactions. While MA payers are big businesses, they’re made up of people and people make purchasing decisions based on emotion. If you treat this as a relationship from conversation #1, you set yourself up for an honest, authentic, collaborative and mutually beneficial conversation moving forward.

2.  Define what value means. Because “value” means something different to every organization. Understand the problems the payer is trying to solve. Perhaps it’s post-surgical readmissions; pain management ER visits; or complex care, like dementia patients with more than two comorbidities. Understanding the pain point helps you determine the services and value you can deliver.

“They all want to know the value, why should they refer? What does it mean to them? How does it help them accomplish their goals? Building that trust between us and them happens through effective communication.”

Liz Fowler
CEO, Bluegrass Care Navigators

3.  Differentiate and distinguish yourself from other providers. Sound a bit like branding? That’s because it’s the same kind of thing. Don’t put your brand in a box … or leave it on the wall. Maximizing your agency’s differentiators should be a constant theme with leadership. Once you know the payer’s pain point(s), demonstrate how you’re different from other providers. Just make sure you use data to define and communicate these differentiators. And, keep using data to spotlight the value you create once you’re working together. This means you need to have at least a basic analytics practice. Don’t be intimidated. Payers want to see you be successful in this space and will often work with your agency as you build competency.

One more moment on brand … If you want to check the health and future readiness of your brand, we’ve developed a new brand assessment tool (freebie!). For a sneak peek, email me at sjohnston@r-p.com.

4.  Have a process for managing issues AND for continuously improving how you work together. In every relationship, a little rain must fall. Be ready for the rainy day. Have a clearly understood process for either party to express and address issues. And, have a method for evaluating and proposing improvements to the relationship. Continuous improvement methodologies aren’t just for QAPI, they’re invaluable in payer and referrer relationships to head off issues before they become problems, deepen value and show appreciation. These techniques also improve staff engagement. Classic win-win situation!

5.  Frame contracted service levels for staff and align your people and processes to maximize value. All payer relationships and service agreements are not the same. Help your staff understand the level of expected service for each payer. Even better, do a segmentation analysis on your payers and align IDT groups or care teams by payer. If your bench isn’t quite that deep, consider other softer techniques in documentation or internal communications to create shorthands that quickly cue your team into the scope of service for each payer.

After more than 40 years of a largely government-driven payer model, effectively shifting to an entirely new relationship and value model will take time, planning and effort. If you want to go further faster, the team at Transcend understands the language of business and can help you adapt your approach for this new market.