Managed Care

 

We Better Not Blow It

We Better Not Blow It

Craig Keyes, MD, MBA

It seems many of us have some preconceived ideas of what new Medicaid members will look like: They’ll be older, sicker, higher utilizers of services and, more challenging to care for.

But when we take a closer look at populations that will qualify for Medicaid over the next several years, a different picture appears. Chances are the new Medicaid member is going to be that part-time waiter at your favorite local restaurant or the young woman with a toddler and another on the way who decided to go back to school.

In fact, according to a 2012 report by PriceWaterhouse Coopers (now PwC), the median age of Medicaid recipients will be 31 and more than half will be female. The vast majority will be in relatively good health. That’s a far cry from the stereotype some have about new Medicaid populations. So what does this population need?

Quite a bit, and we in the health care industry have a unique opportunity to help them. For example, this is a population that needs help with basic health and wellness programs such as tobacco cessation, weight loss, and disease prevention. We can make a real difference in their short and long-term health.

It’s important we do not squander this opportunity. I think we’re already well ahead of the game in terms of a critical component of health improvement: engagement. I believe this is already a highly engaged population — hungry for knowledge and access to quality health care services.

When I’ve worked with underserved populations in the past, including expectant mothers and HIV patients, my experience has been that even those populations that haven’t had good access to care can have excellent outcomes.

For example, a program for a leading Medicaid managed care program showed that among high-risk expectant moms enrolled in a Maternal Health program, rates of office visits and biometric monitoring, such as blood sugar, were higher than in populations with similar risk levels in many commercial health plans. Critical components of this program were telephonic and in-home nurse case managers who provided education and support to help guide patients through pregnancy.

However, I also believe this program was successful because participating members had a keen desire to have a healthy baby that drove them to higher levels of engagement — which translated into adherence — which then translated into outcomes. Such results aren’t exclusive to maternal health; I’ve seen similar results in programs targeting Medicaid patients with diabetes or heart disease.

I’m not saying that bringing millions of new patients into our health care system will be easy. I am saying it’s up to us as providers to find ways to recognize that these patients are engaged and to turn that engagement into knowledge and action.

How can we do so? Education is key, of course. But it’s going to take more than a brochure. We’ll need to embrace every tool we can muster, from gaming apps to Twitter. We also need to reach this population in ways that are compelling and relevant to them. For example, 80% of the Medicaid population has a cell phone. As a result, telephonic health coaching and online behavior change programs are the best way to reach and engage this population and to encourage and promote accountability.

For those who are hard to reach, we’ll need to collaborate with community organizations to identify and train volunteers who live in vulnerable communities to knock on doors and have conversations that lead to sustained engagement. We need to meet Medicaid members where they are physically, as well as psychologically and culturally.

As an industry, we have a lot of work to do to ensure that as these new members enter the health care system, we do not to let them down. As health plan leaders, what has your experience been to date with Medicaid populations? What are you anticipating from your new Medicaid populations — more adherence and engagement or less? What are your thoughts on studies indicating higher levels of utilization?

Craig Keyes is the chief executive officer of Alere Health.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014