ACOs and health plans working with state governments soon will be challenged with taking on the risk and responsibility of managing the care of vulnerable populations.
With the expansion of Medicaid and dual eligible demonstrations, ACOs and health plans soon will be challenged with taking on the risk and responsibility of managing the care of vulnerable populations. This includes 10 million dual eligibles with over $300 billion annually in healthcare costs.
While being able to effectively care for vulnerable populations is crucial, discovering the best ways to reach and engage members is the primary challenge. All too often in poverty, homeless and suffering from mental health issues, vulnerables may be hard to locate and difficult to engage because of cultural and social barriers, illiteracy and lack of education.
Managed Medicaid organizations and states need the capacity to provide broad care coordination, as well as long-term support and services that address a high-density of complex medical, psychosocial, functional and behavioral issues.
Locating members requires a range of activities, from sifting through claims and other data sources for the latest address on record, to speaking with people who might know where the member currently lives. Programs should stay up to date with the latest phone search engine technologies, as 80% of this population relies on mobile or smart phones to stay connected within their communities, and for Internet access, which they could not afford otherwise.
Even so, other measures will need to reach those without phones or who fail to respond to telephone outreach.
Many managed Medicaid and state organizations are partnering with community non-profits and churches to implement a “feet on the street” approach that involves finding identified members in their neighborhoods and talking with them face to face where they reside. What makes this approach powerful is that community organizations identify healthier members of the community who are willing to volunteer their time for training and outreach, to knock on the doors and have the conversations that lead to successful engagement. For instance, in ethnic or immigrant communities, multi-lingual volunteers who speak English act as translators to educate the members regarding their Medicaid benefits and services available to them.
Health programs focused on reaching this population could also offer the following:
Providing optimum care to vulnerables includes the capacity to administer a large number of health risk assessments (HRAs) to quickly identify those at the highest risk with the greatest clinical needs driving the majority of healthcare costs. Community organizations can help administer HRAs, but advanced technologies are required to synthesize and analyze the data so that managed Medicaid organizations can effectively target their sickest members.
Other best practices include:
Whatever is ultimately done, the healthcare industry needs to continue seeking innovative ways to reach and engage those with limited resources to make healthy behavior changes that improve their health and overall quality of life.
Norm Ryan, MD, is senior vice president of health intelligence for Alere Health.