Innovations in Member Engagement and Outreach. WV Rural Health Association October 2016

Transcription

1 Innovations in Member Engagement and Outreach WV Rural Health Association October 2016

2 Innovations in Member Engagement and Outreach Sarah White, MBA Manager, Provider Relations Aetna Better Health of WV Jason Landers, MBA VP, WV Medicaid Market Highmark BCBS of WV

3 Member Engagement Has arisen as a significant factor in the effectiveness of the Medicaid program Higher percentage of no shows lessens physician s willingness to accept Medicaid members 1 Missed appointments = $0 revenue Limits effectiveness of the benefit package Increased ED visits Harder to manage medications and dosage Harder to manage complex diseases Limits the ability of the MCO to improve health Reduces effectiveness of care managers 1 Gorman, Linda Yet More Reasons Why Doctors Do Not Participate in Medicaid National Council for Policy Analysis Health Blog 6/5/14

4 Barriers to Member Engagement Transportation 2 Need for more public transportation in rural areas Extended travel times to find good doctors Attitude towards healthcare Low priority on well care 2 Reluctance to change unhealthy lifestyles Distrust of providers/insurance companies 3 Difficulty in adhering to medication regimens 3 Lack of understanding related to the importance of change 3 2 King, Patty WVDHHR/OMCFH Adolescent Health Initiative OMCFH Fall Meeting October Roby, Dylan ; Kominski, Gerald; Pourat, Nadereh Assessing the Barriers to Engaging Challenging Populations in Disease Management Programs The Medicaid Experience Center for Health Policy Research and the Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA June 2008

5 Barriers to Member Engagement Socio-economic issues Stigma toward certain types of care (behavioral health) 4 Stereotypes Public Medical Self-Stigma Structural Stigma Perceived Stigma Limited access to fresh, healthy foods 5 Lack of local high quality grocery stores or famer s markets Lack of transportation to high quality grocery stores or farmer s markets Higher prices on fresh produce Lower quality of fresh produce Prevalence of fast food restaurants 4 Corrigan, Patrick; Druss, Benjamin; Perlick, Deborah The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care Association for Psychological Service 8/1/14 5 Why Low-Income and Food Insecure People are Vulnerable to Obesity Food Research and Access Center

6 Barriers to Member Engagement Fewer opportunities for physical activity 5 Fewer parks, gyms and rec centers Higher levels of crime and traffic Unsafe playground equipment Limited access to providers Complex geography of the State Limited availability of certain specialties (Otolaryngology, Speech Therapy, Psychiatry) Literacy issues 6 Estimated 80 million Americans have low health literacy, which studies suggest lead to poorer health outcomes As few as 24 percent understand key health terms 6 Long, Sharon; Shartzer, Adele; Politi, Mary Low Levels of Self-Reported Literacy and Numeracy Create Barriers to Obtaining and Using Health Insurance Coverage Urban Institute Health Policy Council 10/27/14

7 Barriers to Member Engagement Interference with work/school 2 Desire for extended office hours Cannot afford loss of pay

8 Traditional Engagement Methods Relies on mail and telephone calls Complicated by transient population Seen as junk mail or nuisance calls Relies on providers to drive compliance Provider is sent a list of non-compliant members Sometimes incentivized, but little assistance Some plans penalize providers for poor scores

9 Innovations in Engagement - WVFH Welcome Kit Improvement Many members simply do not know how to access the health care system Welcome kits include step by step instructions on how to find a doctor, make an appointment and arrange for travel Additionally, rewards programs are easily identifiable Enhanced Member Services Members are encouraged to contact member services with any concerns Member Services are providing assistance with transportation, appointments and where to find services

10 Innovations in Engagement - WVFH Identification of Members WVFH has begun a regular program of identifying those members who are seeking care outside of their PCP offices Internal WVFH outreach staff are provided with strategic lists of those members who are accessing the system in ways other than a PCP office A pilot project is in place to provide the outreach staff at participating Health Centers lists of their patients who have sought care outside of the PCP Member Incentives WVFH highlights rewards opportunities in every communication to members WVFH has follow-up care pilot programs in the market to encourage follow-up to inpatient services

11 Innovations in Engagement - WVFH In Community Care WVFH has begun a program of delivering care to the members directly in key areas WVFH is using the Highmark Healthcare Bus to create health fair days in communities where engagement is an issue WVFH has begun partnering with health departments to help identify and outreach to those members who are seeking services outside of the PCP office

12 Innovations in Engagement - ABHWV Community Outreach Workers Attend community events Foster trust, facilitate communication Some live in the community Enhanced Member Services/ Care Management Arrange appointments and transportation Follow up with appointment reminders Develop relationships with members Educate members

13 Innovations in Engagement - ABHWV Member incentives Gift cards Pack n play, baby wrap carrier Voxiva phone program Text reminders Unlimited calls to member services Well child drives On site incentives After hours in some cases Mobile unit in the neighborhood

14 Innovations in Engagement - ABHWV Enhanced physician incentives HEDIS reports available on demand Foster collaboration between medical and behavioral health Assistance from Provider Relations Partnering with resources Bonnie s Bus Big Creek People in Action Food drives Telemedicine School based health