On paper, Medicare Advantage enables all the tools payers need to provide the plan of choice in rural communities. This potential, however, has generally not translated to real-world success for Medicare Advantage plans.

Despite consistent enrollment growth in metropolitan areas, rural markets remain relatively untapped. Data from the Centers for Medicare and Medicaid Services (CMS) show market penetration is consistently less in rural areas than non-rural. 

So, what’s keeping Medicare Advantage enrollment from surging in rural America? With most Medicare Advantage plans providing low-to-zero cost premiums, it’s not cost. It’s access to care.

A study published last year in Health Affairs indicates restrictive provider networks can be enough to drive rural seniors in access-constrained areas to switch back to original Medicare. In communities where the emergency room is often miles closer than the nearest in-network primary care provider, Medicare Advantage plans must shift their basis of competition. 

Bringing Medicare Advantage to rural communities to scale will require solving fundamental access issues first, by offering solutions that make providers consistently available. Retaining rural members and keeping them healthy will necessitate benefit plans designed to meet their needs, from transportation benefits to special coverage for chronic conditions.

With the flexibility to invest in preventive care and adopt innovative care delivery models, Medicare Advantage plans have all the assets they need to succeed in rural America. An understanding of the unique needs of rural members and designing purpose-built offerings that can drive enrollment will spell success. 

Shifting the basis of competition to access  

In order to turn access into retention and engagement, a care professional needs to be at the center. Rural communities are struggling with provider drain: Community hospitals are closing, specialists can be difficult to access, and primary care physicians are retiring at a faster clip. Rural provider scarcity has been the biggest challenge to scaling for Medicare Advantage plans. 

This gap in access is an opportunity for Medicare Advantage plans to play a more strategic and innovative role in the way rural care is delivered and how it can be accessed. 

Benefit design can be structured to bridge the gap in access and help members get the care they need when and where they need it. These benefits should be anchored in convenience and eliminate geographic and financial barriers to care.

Many older adults, for instance, want to engage with the healthcare system at home or on their way to the grocery store, and are becoming more comfortable using technology. Medicare Advantage plans that can take affordable services to rural seniors where they are will be all the more appealing for enrollment. 

Virtual care alone, however, will not be enough to bridge the access chasm, particularly as data show a decline in telehealth sessions. Until Medicare Advantage plans focus on solutions that fundamentally expand access to the care rural seniors need – real touches with clinicians they can trust who are sitting directly in front of them – adoption will continue at a lethargic pace.

Simply offering these services will not be enough to keep members who have historically lacked access to quality healthcare engaged. The "If you build it, they will come" approach will not work in rural America. Health plans need an integrated model that can transcend geographic and financial gaps in access to solve the needs that are most important to rural members. This level of service cannot be delivered through traditional fee-for-service Medicare.

Experience will drive growth and retention

Growth and retention in rural markets require not only bridging gaps in access, but doing it in a way members love, and providing a constellation of affordable services layered on top of the innovative clinical models plans enable.

Medicare Advantage plans should think beyond the reach of the traditional healthcare system and provide solutions that solve fundamental problems – offerings members may not expect from their health plan.

Social determinants of health like financial instability and food insecurity are potent underlying factors in our health and wellbeing. For many seniors – especially those in underserved rural communities – concerns over the electric bill may take priority over scheduling an annual wellness visit.  

By providing benefits such as food and transportation health plans are supporting a more robust patient experience. Clinical solutions like remote patient monitoring devices and in-home care services can be leveraged to extend the reach of providers members know and trust in their own communities. These benefits should be structured in a way that reduces financial burden for members by making services low to zero cost. 

The most effective vehicle for these solutions is within a total cost of care arrangement through which providers are accountable for managing cost and outcomes. By unshackling providers from the fee schedule, Medicare Advantage plans can create greater access to the supporting services that will help dismantle the entrenched barriers to care.

In any other market, success in scaling Medicare Advantage has required purpose-built solutions designed to meet the needs of specific populations. Rural communities are no different. Health plans can create a blueprint for success in rural America by working to better understand the needs of members who live there, delivering services that get them the care they need and ensuring the experience is accessible, convenient and affordable. 

Dr. Aaron Friedkin is the chief business officer of Homeward, a company focused on improving access to high-quality, affordable, comprehensive care in rural communities. Previously Dr. Friedkin was the senior vice president of care delivery transformation at Blue Cross Blue Shield of Michigan. Before joining BCBSM, Dr. Friedkin supported large national employers on their healthcare strategies at Blue Cross Blue Shield of Minnesota and developed strategies for both payers and providers as a management consultant with McKinsey & Company. 

Dr. Friedkin is a board-certified radiologist, with subspecialty certification in pediatric radiology. He completed his diagnostic radiology residency at the University of Michigan and his pediatric radiology fellowship at Boston Children’s Hospital. He earned his Doctor of Medicine and Master of Science in Anatomy at Case Western Reserve University.