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As the healthcare industry shifts to more value-based and patient-centered care, the issue of access to medical services has surfaced as a critical concern for many plan members. For Medicare Advantage (MA) plans, this issue is particularly crucial as member feedback on this topic continues to bruise Star ratings—negatively impacting plan reputation and credibility. To bolster Star ratings in the coming years, MA plans must take swift action to implement solutions that improve access to needed care—especially when it comes to treating back and joint pain.
Shifting cut points: unveiling the access challenge
Many of these member satisfaction insights come from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and cut points. As a major part of Star ratings, CAHPS surveys offer a look into the patient experience and satisfaction with healthcare services. Likewise, CAHPS cut points define the thresholds within which a plan must score in order to achieve a particular Star rating.
According to initial Star Year (SY) 2024 data, the healthcare industry’s emphasis on improving member satisfaction has yet to significantly move the needle on CAHPS measures (Bell, 2023). Despite industry-wide initiatives, lack of access to needed care continues to frustrate members, as indicated by poor survey scores on this topic and a significant lowering of cut points compared to last year. With clear signs of underperformance, now is the time for plans to take action.
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Understanding the multifaceted barriers to care
Reversing this change, however, is not as simple as tweaking a plan’s network or coverage levels. The issue of access is a deep-rooted challenge with many underlying causes, including common drivers of health inequity as well as the ripple effects of the recent pandemic. The top barriers restricting access include:
- Decrease in clinician availability: From job dissatisfaction to the lasting effects of the pandemic, more than 230,000 healthcare workers quit their jobs in 2021, with over half of these resignations coming from physicians (Popowitz, 2022). As a result, access to clinicians—especially doctors—continues to shrink by the minute, closing doors to much-needed care.
- Lack of specialists in rural areas: Among the communities across the country impacted by healthcare staffing shortages, rural areas are faced with the steepest decrease in practicing clinicians. This is especially concerning for specialty care, such as musculoskeletal (MSK) health and oncology, as only five percent of specialists still practice in rural areas (Kwan, 2017).
- Surge in post-COVID demand: Healthcare utilization significantly declined during the pandemic due to restrictions on elective surgeries and patient fear of COVID exposure. Now that we’re on the upswing and elective procedures are at an all-time high, new bottlenecks are stressing an already overloaded healthcare system.
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MSK issues complicate the access equation
Nearly one in two U.S. adults struggle with an MSK issue or disorder (most commonly back pain, arthritis, and injuries), all of which can impair mobility. (USBJI, 2023). Convenient access to care is paramount as pursuing in-person care can be challenging for many MSK patients.
Access is particularly important for elderly MSK patients. Not only are MSK conditions more common in this population (approximately 60 percent of older adults 60 years and above experience MSK pain), but so are baseline mobility and transportation issues (Welsh, 2020). With limited access to care, MSK conditions can grow significantly worse, leaving older members with even more mobility restrictions on top of a reduced quality of life. As conditions and outcomes worsen, so does the cost of care.
Nearly one in two U.S. adults struggle with an MSK issue or disorder—which can eventually lead to impaired mobility.
Vori Health unblocks access to appropriate MSK care
The combination of diminished access to care and the complexity of treating MSK pain generates the perfect storm for health plans. Even if older members can see their clinicians, the chances are high that they—along with MSK patients of all ages—may not be able to see a specialist trained in evidence-based, non-operative care. As a result, high volumes of patients start down a path of inappropriate steerage to spine and orthopedic surgeons that leads to unnecessary imaging, opioid prescriptions, and operative treatment. When members who already struggle to get in front of a clinician are met with inappropriate, ineffective, and low-value treatment, plan satisfaction plunders and the cost of care soars.
Vori Health tackles this challenge directly with a virtual-based MSK program that connects each member to a specialty-trained, doctor-led care team from the comfort of home. Through one telehealth platform, patients struggling with pain gain easy access to evidence-based care from non-operative doctors, physical therapists, registered dietitians, and health coaches. Additionally, with the nation’s largest hybrid network of virtual and in-person MSK offerings, Vori offers a flexibility in treatment options that caters to each member’s needs and preferences.
With an 85 percent plan adherence rate and a 90 percent satisfaction rate, Vori Health is helping health plans provide their members access to the MSK care they truly need—and want.
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REFERENCES
- Bell, 2023: Bell A, Ardolino J, Yarish R. (2023, August 3). Medicare Stars CAHPS Cut Point Analysis. ProspHire
- Popowitz, 2022: Popowitz E. (October 2022). Addressing the healthcare staffing shortage. Definitive Healthcare
- Kwan, 2017: Kwan MMS, Kondalsamy-Chennakesavan S, Ranmuthugala G, Toombs MR, Nicholson GC. The rural pipeline to longer-term rural practice: General practitioners and specialists. PloS ONE 2017;12(7):e0180394
- USBJI, 2023: United States Bone and Joint Initiative. Musculoskeletal Diseases And the Burden They Cause in the United States, https://www.boneandjointburden.org/, accessed August 18, 2023.
- Welsh, 2020: Welsh TP, Yang AE, Makris UE. Musculoskeletal Pain in Older Adults: A Clinical Review. Med Clin North Am. 2020;104(5):855-872.
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