How to Improve Medicaid Member Engagement, Care Coordination

California’s whole person care 1115 Medicaid demonstration waiver illustrates the challenges Medicaid programs face in providing care coordination for Medicaid beneficiaries and offers insight on how to overcome these challenges, according to Health Affairs researchers.

“Under whole person care, eligible beneficiaries receive care coordination and other services to address identified medical, behavioral health, and social needs with the aim of improving their health outcomes and overall well-being,” the study stated.

“Successful implementation requires significant investment in the development of infrastructure and processes needed to effectively integrate care, and challenges and lessons learned may inform similar efforts elsewhere in the US.”

The study observed 25 whole person care pilots spread across nearly every county and one city in California. The program cost $3 billion.

“Pilots had to provide care coordination services and demonstrate increased access to social services (for example, housing support, or benefits assistance), but otherwise they had the flexibility to tailor their programs to reflect local needs and available resources,” the researchers explained. “Pilots were also encouraged to develop infrastructure needed to facilitate effective cross-sector care coordination and to report progress on selected health outcomes.”

Financial incentives influenced Medicaid programs to find positive practices and solutions to care coordination challenges, the study found.

Funds largely went toward developing three areas

• Organizational partnerships
• Infrastructure
• Integrated care services

The California pilot saw an increasing demand for data sharing and delivery system infrastructure due to the complex care coordination involved. The pilot also improved its ability to identify Medicaid beneficiaries who were most likely to need services. The participating Medicaid programs also were able to track beneficiary engagement and enrollment.

However, there were setbacks.

Partner engagement was one of the primary challenges.

Eight of the lead entities involved in the pilots cited low partner engagement as one of the biggest challenges that they faced in rolling out whole person care. Specifically, pilots that collaborated with the justice system found it particularly difficult to engage with these partners. Differing incentives and privacy concerns were among the reasons that partners withheld from fully engaging with the pilots.

To move past these barriers, pilots were persistent in their communication, identified shared aims and incentives, and set up contracts that delineated the expectations for each party’s participation.

Data sharing also proved difficult to manage for a variety of reasons.

Given the high demand for data sharing, privacy concerns often delayed the pilot progress. For the same reason, pilots should have been investing more in infrastructure, but some held back based on financial uncertainty. Instead, they chose to inject the whole person care pilot funds into current programs or apply the funds more broadly in order to reinforce their infrastructure.

Regulatory restrictions related to data sharing proved problematic for many pilots.

To overcome these challenges, pilots utilized universal consent forms which, when signed, enabled data sharing with all whole person care pilot partners. Another approach was to develop a consent form with sections, so that beneficiaries could control what type of data the pilots could share with their whole person care partners. In terms of technology, many pilots relied on temporary data sharing solutions, instead of investing in permanent technologies.

Medicaid beneficiaries can be elusive and difficult to engage. Sometimes the barrier to engagement is simply communication challenges. The whole person care program aimed at better connecting with this population.

The pilots discovered several  components to overcoming Medicaid beneficiary enrollment and engagement, namely:

• Face-to-face, personal connection
• Field-based outreach
• Benefits support

On the whole, the program also confirmed that using funding to address social determinants of health—specifically with regard to housing and rehabilitation—is instrumental in covering gaps in care.

Going forward, California is considering putting this program in the hands of managed care organizations, instead of under the purview of counties and local governments. While this would better utilize managed care organizations’ built-in infrastructures and data sharing capabilities, it would also require more funding to retrieve human services data and to develop the capabilities to address social determinants of health directly and incentivize outreach.