Medicaid health plans want to engage difficult-to-reach members and share helpful programs. But it’s complicated. The Medicaid population is well-known as challenging because of complex life circumstances: poverty, mental illness, systemic racism.
During the Medicaid Innovations Forum last week, Medicaid health plans shared successes engaging high-risk pregnant moms, children with asthma, and people with substance use disorders.
1. Data and analytics pinpoint members most in need
Plans are matching claims data with community/demographic data for risk stratification and outreach. CareOregon uses customer segmentation and cluster analysis to identify rising risk members, while their clinicians look at data continuously to understand patterns and flag issues, such as medication non-adherence.
“Data is so powerful, especially for underserved patients who don’t always tell us what’s going on in their lives,” said one medical director.
2. But personal attention is critical to changing behavior
While data is a first step to identifying issues, members benefit from one-on-one attention from care managers or health coaches.
“We spend one-on-one time with members, sitting down and answering questions,” said one health plan CEO. Said another, “It’s critical to not tell people what they need, but ask them what they want.”
3. Trust is a bank you invest in
The COVID pandemic laid bare inequities that were hundreds of years in the making, one medical director shared. One plan noticed that members of the community were hesitant to get vaccinated. Yet the more the plan pushed vaccines, the more community members pushed back.
“Why do all you folks want us to get vaccinated, when you didn’t care about our diabetes or other health issues?” the health plan CEO recalled members saying.
The moral of this story: Health plans (and other institutions) need to invest in communities in the good times, so they can be trusted in the difficult times.
4. Mobile engagement can work
Most members have cell phones, health plans report. But calls from care managers can get flagged as SPAM, so responses to outreach vary. Members may not want to use up their data. These issues require technology workarounds.
Successful member engagement programs are centered on users and pair patient consent with ongoing incentives and engaging content.
5. Social, economic, and emotional issues underlie many medical problems
Housing insecurity, behavioral health issues, food insecurity, addiction, and loneliness top the list of social-emotional factors that weigh against medical interventions.
“Sometimes the physical health situation is unravelling,” one clinician said, “and the root cause is behavioral health. We had all these sepsis patients, and once we dug deeper into their problems, we realized the core issue was infected IV lines (from opioid injections).”
Said one plan’s director of community partnerships: “During the beginning and middle of the pandemic, the No. 1 need we saw time and again, with our community-based agencies, was that people didn’t have enough food. People were saying ‘hey, I do not have enough to eat.’” Today the plan is working with a mobile meal delivery service to address this need.
Medicaid plans are tackling these issues by working holistically in order to develop integrated care plans that include housing, family, behavioral health counseling, meals, and support.