- When it comes to beneficiary engagement, healthcare payers cannot go it alone. Strong healthcare partnerships with plan members, community stakeholders, and providers help payers understand the best avenues for member outreach.
This much became clear to Krista Beckwith, the director of population health at Colorado Access, a regional organization for Health First Colorado (Colorado’s Medicaid Program), when she began looking at engagement strategies for especially hard-to-reach members.
Traditionally, the payer has looked at major red flags for patients who are out of compliance with typical wellness activities – preventive screenings, wellness checks, and other hallmarks of self-management.
“We look at being out of compliance with certain health care screenings or preventative or wellness exams,” Beckwith told PatientEngagementHIT.com in a recent interview. “Are patients not engaging in the health care system at all? Are they not engaging in a way keeping up with their own preventative care with cancer screenings and things of that nature? We catch a large majority of our population with that kind of lens being applied.”
But it’s the patients who fall through the cracks who take that extra bit of effort, Beckwith suggested. This population of members with low engagement tend to be more complex, with multiple comorbidities and social and lifestyle barriers to obtaining meaningful engagement. It takes an out-of-the-box approach and strong beneficiary partnership to address challenges these populations face.
“We look at different ways that we want to get a member engaged or efforts that we've tried that aren't working,” Beckwith stated. “For example, direct mail does not work for our members who are experiencing homelessness as part of the populations that we serve.”
Homeless beneficiaries often use day shelters as their residencies, meaning that the individual cannot receive direct mail. Additionally, members experiencing homelessness do not have reliable phone access, making strategies that leverage phone call or text message engagement futile, Beckwith explained.
These trends push Colorado Access to employ non-traditional patient outreach efforts with all of its different populations, she added. Beneficiary engagement is about meeting the patient where they are, by any means necessary.
“We recognize with getting that population engaged, no communication channel is a one-size-fits-all model for everyone,” Beckwith noted. “For a homeless population, we've had to learn that if they're not engaging it's because the method we're trying isn't working and so we need to think outside the box. How do we go into their community and engage directly with them in their own setting?”
Beckwith and her team work to ensure they engage with all members in a meaningful way. What communication lines are preferable to the patient? Do patients truly respond to those outreach messages? And how can Colorado Access do better to engage patients who are still being missed?
Answering those questions and finding effective outreach strategies is no easy feat, Beckwith acknowledged. Conducting beneficiary outreach that matches member preferences requires a lot of trial and error, and positive outcomes are not immediate.
“Member engagement is a marathon and not a sprint,” Beckwith advised. “That mentality allows us to ebb and flow and have continuous improvement in partnerships with our members in order to ensure the right approach is tailored to meet their needs.”
The key to finding the best approach to member engagement is to cast a wide net, Beckwith shared. It is essential to her and her team that they offer multiple engagement channels for the plan’s members. Engaging beneficiaries through mail items, phone calls, text messages, emails, and other out-of-the-box strategies will ensure the patient can respond to at least one nudge.
Colorado Access also has a member advisory committee aimed at developing their operations and engagement programming, ideally determining the best avenues for engaging all beneficiaries, Beckwith shared.
“We rely heavily on members telling us how they like to receive communication and engagement from us,” Beckwith explained. “Often times we'll run multiple channels for engagement, so we'll have a care coordination piece. We may be out in a community doing work on the same topic area or on the same strategy as well as having a texting program or an email program.”
Those efforts lead to the second form of partnership Colorado Access employs: community partnerships. This community outreach piece has become essential for the payer, especially given its more complex, Medicaid population.
Just like much of the rest of the country, Colorado Access is working to understand the social determinants of health (SDOH), or the elements of an individual’s lifestyle that impact her ability to be healthy and engage with the healthcare system.
“If some of our members do not have a roof over their head every night, or are not sure where their next meal will come from, how can we expect that they will be focused on engaging with their primary care provider?” Beckwith posited. “Or being compliant with their care and not going to the emergency room when that is the most feasible option? We just can't ask that of our population.”
Community health partnerships have become a dominant, non-traditional beneficiary outreach method. While engaging with the community may not send the same message as a postcard prompting a patient to receive a screening, it still addresses a barrier the member experiences when accessing healthcare.
After all, it’s difficult for an individual to achieve good health when she is searching for a permanent home or is deciding between a copay and dinner.
Colorado Access recognizes that it must address those social issues before it can address the issue of a missed preventive screening or wellness exam. And by leaning on the community, the payer is doing just that, Beckwith explained.
“We work as partners with those in the community that are also focusing on these social determinants to create a network or a neighborhood of sorts that engage agencies in supporting the entire population and their needs,” she noted.
Currently, the state of Colorado is focused on establishing a resource directory that spans across various sectors to allow for easy integration across community agencies.
“We're determined to be one of the partners working to support a solution that works for everybody, not becoming a driving force on our own,” she said, noting the importance of meeting all stakeholders where they’re at.
It is the “partnership” aspects of “community partnership” that is essential, Beckwith asserted.
“We've been extremely lucky because our leadership that oversees our community engagement and outreach work knows our communities well,” Beckwith said. “They are very in tune with understanding the political makeup, the funding makeup, the environmental makeup of our communities in terms of the partners. First and foremost, that would be the best place to start - understanding the lay of the land that you're going to start partnering within.”
Each community has its own set of state, federal, and local standards and regulations that inform how community health partnerships can be formed, Beckwith explained. Between funding issues and regional priorities, healthcare organizations must understand that their agenda may differ from community partners. It is essential for both entities to partner and develop a common agenda.
“Walking in with our own agenda as healthcare isn't going to work with organizations that are working on ensuring access to high-quality food,” Beckwith asserted. “We potentially have a different agenda. But think through proactively where do we have commonalities.”
Outside of community health partnerships, Beckwith and her team work to engage with provider organizations. This drives better care coordination for beneficiaries and ensures providers receive the support they need to engage their patients.
As noted above, Colorado Access is a regional organization for the state’s Medicaid program. In this position, Colorado Access is a hybrid organization that is at-risk for the behavioral health Medicaid benefit. The payer also serves as an accountable care organization of sorts for the physical health side of Colorado Medicaid.
Nonetheless, Colorado Access makes it a priority to engage with organizations to help in these risk-based payment models. Again, collaboration and partnership has been essential, as the payer works to understand the unique needs of their provider partners.
“We've established governance councils that are comprised of some of our largest provider networks in the regions we serve,” Beckwith said. “They partner with us in governing our approach to achieving success as a payer organization. One piece that we were really working towards is bringing those larger provider partners to the table with us to help kind of strategize and understand how best to manage our populations in general.”
The task of beneficiary engagement has evolved into a dynamic and fluid one, Beckwith noted. Members with various lifestyle circumstances need to see different approaches to engagement in order for those strategies to truly resonate and yield positive behavior change.
To that end, Beckwith and her team have prioritized partnerships. By partnering with members, community stakeholders, and providers, Colorado Access has been able to determine the best step forward to create a culture of health that enables beneficiaries to meaningfully engage.