3 benefits of integrating Medicare Advantage and pharmacy for retirees

Simpler retiree experience? Check. Better health outcomes for retirees? Reduced employer costs? Check, check. While many initiatives tout the ability to achieve the 3 tenets of the health care industry’s Triple Aim, integrating Medicare Advantage plans with prescription drug programs (MAPD) is an approach that is delivering for retirees and employers today.

A typical retiree health program is designed with a Medicare Advantage (MA) plan paired with a “carve-out” Part D prescription drug program administered through a third-party pharmacy benefit manager. However, a new multi-year study of about 500,000 members by UnitedHealthcare shows that integrated MAPD plans resulted in lower health care costs than Medicare Advantage-only plans, achieved better health outcomes for members and simplified the member experience.1

“Employers continuously look to optimize their health programs to ensure they provide excellent value for retirees at the lowest possible cost,” said Jason Schenker, 

National Vice President, Client Development for UnitedHealthcare Retiree Solutions. “Our study shows that when we integrate Medicare Advantage and Part D programs into a single plan design, the plan runs better and at lower cost over the long term.”

Integrated MAPD programs offer practical benefits for employers’ retiree programs by:

  • Leveraging real-time data to inform predictive modeling and customer service tools.
  • Focusing on Centers for Medicare & Medicaid Services (CMS) Star ratings for Employer Group Waiver Plan (EGWP) quality, specifically medication adherence for chronic illnesses such as hypertension and diabetes.
  • Enabling a closer relationship through additional data sharing with prescribing providers and providing incentives for those that maintain a 4+ Star rating on their members.
  • Engaging closely with network pharmacy partners to close medication gaps in care and improve adherence and provide incentives for their performance.
  • Addressing both medical and pharmacy gaps in care proactively and suggesting next-best prescription actions and lower-cost alternatives.

Those benefits roll up into three core reasons for integrating your medical and pharmacy plans: 

1. Enables a simpler, less confusing retiree experience

Integrated plans provide a more simplified member experience by using only one health plan ID card, one Explanation of Benefits, one call center and one website. That’s half the potential touchpoints for members to navigate compared to separate plans, which may lead to less confusion on how to get help and resolve problems. For example, the UnitedHealthcare study showed that an MAPD member made 43% fewer service calls and spent 41% less time on the phone to call centers during the year compared to members in separate MA and pharmacy plans. 

“A simplified experience for members is important, because these members typically are on more medications, have more complex conditions and face a bigger risk of care gaps,” said Michelle Lasics, Director of Account Management-Medicare & Retirement for UnitedHealthcare. “An integrated plan helps ensure they get the care they need as seamlessly as possible.”

2. Contributes to better health outcomes for retirees

A seamless approach to care coupled with real-time data available to the carrier through an integrated plan makes it easier to identify and resolve gaps in care to improve outcomes, particularly for members with chronic health conditions, according to Dr. Katherine Evans, Chief Nursing Officer-Retiree Solutions for UnitedHealthcare. And retirees covered by integrated MAPD plans experienced fewer inpatient readmissions and emergency room visits in UnitedHealthcare’s study.

“We continuously monitor the entire retiree population for ways we can engage them in the right clinical programs at the right time to improve their health,” Dr. Evans said. “Because we have a more holistic picture of members’ health with integrated plans, we can better monitor members with more complex health conditions, such as cardiovascular disease, diabetes, osteoporosis and rheumatoid arthritis.”

Integrated plans also can provide additional member support, such as concierge refill reminders, PreCheck My Script™, medication review and adherence-focused educational mailings. They also help maximize CMS Star Ratings of EGWP program quality by better aligning incentives for providers and pharmacists.

3. Reduces employer health care costs

For employers, reducing costs without reducing benefits is ideal, and overall integrated MAPD plans in the study outperformed Medicare Advantage with separately managed prescription drug plans. 

According to the UnitedHealthcare study, costs for integrated MAPD plans were lower across multiple categories, including inpatient, outpatient and physician costs. Integrated plans reduced the overall medical plan trend by a full percentage point and generated up to $10 PMPM in lower costs in the first year of integration.

“Integration may not be the answer for every employer,” Schenker said. “But our study shows that when you integrate Medicare Advantage and pharmacy benefits it can present some potential financial value for employers and may be a good alternative to consider.”

Not for distribution to retirees or beneficiaries.

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