Medicaid Member Engagement Strategies That Work


Today’s Medicaid programs and managed care organizations (MCOs) need to improve costs at the same time as they improve quality and outcomes for this vulnerable population. Yet connecting with and encouraging members to take needed health-related next steps can be complicated.

Factors that contribute to that challenge range from invalid and frequently changing contact information to low health literacy to lack of childcare or transportation access.

This complexity demands a specialized member engagement approach that can address the specific needs of the Medicaid health plan population.

At Carenet Health, we typically recommend three essential strategy components for effective Medicaid population engagement. Those are highly proactive outreach, 24/7 on-demand telehealth care and around-the-clock support for plan members. Let’s take a look at each one.

Think proactive member engagement

To boost member communication, health literacy, compliance and outcomes, you’ll need solid pre-emptive outreach. And that outreach needs to be carried out by contact support teams who understand this specific population’s needs and barriers to care.

Those teams should be trained in demonstrating empathy and understanding, using motivational conversation tactics and working with individuals to uncover their identify obstacles to getting the health and wellness information and care they need. (Read more about social determinants of health).

There are a few specific healthcare areas that your proactive strategies should focus on here to give you the best ROI and member activation rates. (Activation rates are numbers that quantify how many of your health plan members take predetermined, specific actions after being contacted.)

ER (or emergency department – ED) avoidance is one of those targeted areas. With this kind of upfront engagement, you can reach out to frequent flyers and low-acuity ER users and help them transition to more appropriate and less expensive care options. This should be a key education initiative.

Another critical area of upfront communication is member onboarding. This is often your best chance of contacting some members of your Medicaid population because you have very recent contact information, and that information can change frequently when a member is experiencing housing and job insecurity, or stops and starts with different mobile phone carriers. (Read more about successful member onboarding.)

Use your member onboarding/welcome engagement to tackle as many needs as possible. Educate members about the importance of well child visits, immunizations and other services, as well as the availability of resources such as a Nurse Advice Line and virtual care that require no transportation access. Combine health risk assessment completion with your welcome communications.

Two other important areas of engagement include perinatal and well child exam communications. Connect with those members who are expecting a child and identify indicators of high-risk pregnancies and offer targeted, timely interventions that can ultimately improve outcomes for both parents and infants. Explain the importance of well child visits and regular check-ups. Discuss the importance of a consistent provider-patient relationship, and assist with appointment scheduling with three-way conference calls.

Encourage telehealth utilization

Since you likely offer 24/7 access to on-demand virtual care, be sure your members know about it (get tips here) and understand how easy it is to use, and especially what types of issues it can be used for. You may want to talk about the different kinds of virtual care you offer, such as nurse advice lines, online behavioral health crisis lines, teledoctors, remote patient monitoring and more.

Provide around-the-clock member support

Medicaid plans should also consider the benefit of member support services that never close. Think about that individual who works two jobs and gets home from the last one at 2 a.m. That’s the only time he or she may have to connect with you. Translation services, of course, are important and should be just as available as your 24/7 support: after normal hours, on weekends and holidays.

These after-hours support teams should be able to handle everything from benefits eligibility questions to transportation coordination to referrals to providers and programs.

How to engage: Channels for Medicaid population outreach

Once you’ve outlined your care, support and outreach plans, you need to consider what channels you’ll use to reach your Medicaid audience. Automated voice messaging is a nice tool to have in your toolkit, especially for reminder messages, and text messaging can often reach members who can’t be reached any other way. (Read more about the success of Medicaid population outreach and the use of mobile engagement technology here.)

However, it’s also important to remember that healthcare is a highly personal matter, and rarely are minds changed about things like making a needed appointment (that can be tinged with fear and anxiety) via only an email or other digital communication. One-to-one human connections are still the best and most powerful way to have those conversations with meaningful results.

Want to talk about health plan engagement a bit more? Carenet works with a large number of Medicaid plans. Contact us to set up a time to discuss member engagement – health plans. We also have more information in our ebook: An Engagement Success Formula for the Medicaid Population: Improving Activation, Outcomes and Costs.

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