7 considerations for evaluating exercise programs for Medicare Advantage

Not all exercise programs are created equal. And that’s especially true for older adults. 

As we age, exercise carries even greater importance. Bone density and muscle mass naturally decline while the risk of health issues like falls or chronic conditions rise – resulting in higher costs of care due to hospitalizations and greater need for interventions like surgery. That’s why finding exercise programs that drive engagement and results is imperative for health plan leaders. 

Yet, traditional fitness programs often miss the mark. While 95% of Medicare Advantage plans offer a fitness benefit or gym membership, fewer than 1 in 10 adults over 65 are members of a gym. 

The U.S. Centers for Disease Control and Prevention (CDC) recommends that adults 65 and older get at least 150 minutes per week of physical activity at moderate intensity, along with strength training and exercises that improve balance. Despite these guidelines and the known benefits of activity, 1 in 4 adults 50 and older report not getting physical activity outside of work. Older adults with at least one chronic condition report even lower levels of activity or exercise.

With Medicare members increasingly making their enrollment decisions based on Star Ratings and benefit offerings – in addition to provider networks and out-of-pocket costs – selecting the right exercise program to engage beneficiaries has never been more critical. The right exercise program for Medicare members not only bridges gaps in engagement to lower costs and drive clinical outcomes, but delights members and encourages healthy habits. The right exercise strategy can help ensure plans stay ahead of the curve and meet the moment. 

Here are 7 considerations for health plan leaders as you evaluate exercise programs for Medicare Advantage to unlock the full benefits of movement as medicine.  

1. Understand who is actually using the program: For too long, fitness has been viewed as a ‘check the box’ solution that is most useful to plans when competing for new members during AEP. But with new regulations from CMS emphasizing engagement, the focus now is on ensuring that the benefits offered to members are actually useful to them. And traditional fitness benefits, even those that offer a grab-bag of online classes to choose from, simply aren’t well-suited to today’s Medicare members. Look for vendors that demonstrate they can engage the unengaged, evidenced by increased physical activity or the number of members who report starting an exercise routine for the first time.
2. Assess how the program combines exercise with education and habit formation: Incorporating behavioral science in programs helps to drive outcomes. Programs should include personalization, skill-building, and commitment devices, along with education and ongoing engagement. Education should come in different forms, like videos, blog posts, emails, or reminders – and should draw from and tap into clinical experts. With exercise programs, adherence is often what spells the difference between good and excellent – and baking in meaningful measures that are proven to drive adherence among Medicare members is critical to see results.   
3. Evaluate the design and fundamentals to determine whether it’s purpose-built for seniors: Accessibility, simplicity, and dignity need to be at the core of any effective exercise program for individuals 65 and older. The exercise needs of older adults look different than Commercial populations, and solutions should reflect that reality. This also means incorporating relevant and clear modifications, and providing effective guidance on form to ensure safety and efficacy across unique needs. 
4. Go deep on the program’s personalization engine: Guidance around exercise largely varies. And it should. Look for programs that gather the right inputs during enrollment about a member’s unique needs, pains, chronic conditions, and experience with, or current level of, physical activity in order to develop customized tracks to make the biggest impact for them.  
5. Explore approach to drive Star Ratings measures and clinical outcomes: With Star Ratings influencing member enrollment and driving bonus payments and rewards, devising strategic programs to enhance these ratings and elevate quality is table stakes for Medicare Advantage leaders. Evaluate your exercise program as a strategic part of driving your Star Ratings across critical measures – especially hard-to-move Health Outcomes Survey (HOS) ratings. Robust programs should include foundational member outreach tactics, touchpoints, and check-ins that are designed with Star Ratings, overall quality, and clinical outcomes in mind. Programs should help you gather data on key Star Ratings measures at different moments, while offering recommendations and pivoting on plans when feedback or learnings point to opportunities for improvement. Most importantly, exercise programs should evolve with Star Ratings – meeting the moment to help you navigate new weights and rising cut points, and remain competitive. 
6. Validate clinical expertise and credibility as an extension of your care team: Exercise programs should be developed by doctors of physical therapy, kinesiologists, and certified exercise instructors – especially those with specific experience tailoring movements for older adults. In addition, they should follow evidence-based guidelines from key sources like the CDC and the U.S. Preventive Services Taskforce. Exercise programs can truly move the needle on member experience when they act as an extension of your plan’s care team for your members – meaning a program’s team should meet the highest standards for your own. 
7. Look for low barriers to entry: Technology and language are key here, along with easy-to-follow guidance on where to start and programs that can fit members’ schedules. Meet older adults where they are, especially your hard-to-reach dual-eligible populations. Ensure exercise programs take into account the different preferences of all member profiles – whether for privacy or mental health issues or fears of starting workouts following a surgery – when it comes to starting and sticking with an exercise program that works for them.

In a tight budget environment, making the most of your supplemental benefits is a no brainer. By using this checklist as a guide, you can be sure to identify the best possible solution for your members and your plan, delivering delightful experiences and tangible value for years to come.

Ready to join the movement for movement as medicine? Get in touch to find out what sets Bold apart in exercise as preventive care for Medicare members, and learn how we can partner.