Who pays the price for poorly coordinated Duals benefits? You do. And your members do too.

It’s no secret that our healthcare system is difficult to navigate, especially for members who are covered by multiple benefit programs like Medicaid, Medicare, and even the Supplemental Nutrition Assistance Program (SNAP). evermore conducted proprietary quantitative research exploring the challenges of a siloed, fragmented system where members are managing the complexity of coordinating their benefits largely on their own. 

evermore surveyed the financially constrained populations who receive Medicaid or  Medicaid + Medicare (Duals), and those same populations who also receive SNAP benefits. These are the people who face a higher burden of managing the complexity of the healthcare system on their own. For these members, benefits may come from one, two, or three different agencies, with little guidance on how to coordinate them. 

We found that fewer than one-third receive any education on benefit coordination. That number drops even further for Duals also receiving SNAP, members juggling three different benefits on three different cards. This is the lowest-income segment with 78% earning under $25K, nearly a third are also enrolled in Low-Income Home Energy Assistance Program (LIHEAP), and they carry the highest level of comorbidities. 

Without clear guidance on how to optimally access and coordinate benefits, members are making it up on their own – using the first card with funds available, the first benefits to expire, or whichever seems easiest. In some cases, the card is programmed to decide for them. A member buying groceries that qualify under both a condition-specific food benefit and a general flex benefit may not know that the card may be programmed to draw from the most restrictive purse first; that logic may be invisible to the member. Cashiers may help or they may give conflicting or incorrect advice. 

Rewards help drive behaviors and provide support, but they are underleveraged. They are a proven motivator with 92% of Duals saying they like rewards as a way to support healthy behaviors, but only 62% have actually earned a reward. Fewer than half of Duals on SNAP earn the maximum rewards, which means the most vulnerable of your members aren’t completing the proactive health measures recommended and they’re leaving valuable dollars on the table. When they do earn rewards, they are most often spent on essentials like groceries and meals. 

In the end, members are the ones bearing the cost of this complexity – financially, mentally, and in their health outcomes. The lack of coordinated benefits and harmonized engagement leaves members likely to fall through the cracks of a system designed in pieces to support them. Dollars aren’t effectively managed. Proactive health actions aren’t taken. Necessities remain out of reach. The cost of failure isn’t just borne by your members; it’s borne by your health plan in poor health outcomes and increased cost of care. Improving your focus on benefits coordination pays dividends for all: 

• Focused coordination improves operational efficiency 

• Improved outcomes reduce the cost of care 

• Better member experience drives improved retention 

• Stronger regulatory alignment reduces the risk of waste, fraud, and abuse 

Health plans that partner to solve issues of fragmentation will be preferred by both members and government stakeholders.