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© Copyright 2019, Carenet Health.
EB O O K
An Engagement Success Formula for the Medicaid PopulationImproving Activation, Outcomes and Costs
© Copyright 2019, Carenet Health.
State Medicaid programs and Medicaid
managed care organizations (MCOs) are
feeling pressure to elevate engagement,
care and outcomes for this underserved
population. Yet motivating enrollees—and
even connecting with them to encourage
action—can be a challenge.
Many factors contribute to the issue, including invalid
contact information, insecure housing, language and
cultural differences, low literacy rates, behavioral health
issues, and lack of childcare, transportation, telephone or
Internet access.
It’s clear that a thoughtful and comprehensive engagement
strategy is required. With the right approach in place, you
can improve risk assessment, increase care access and
more. Specifically, you can:
• More easily identify high-cost, high-need members with
chronic conditions and under-treated health conditions
• Ensure routine patient-physician interaction
and relationship establishment by overcoming
socioeconomic barriers to care
• Drive appropriate use of care resources and decrease
costly care like non-urgent ER visits, unnecessary testing
and duplicative treatment
• Control costs by reducing avoidable admissions and
readmissions
• Drive care compliance by empowering members to
become active participants in their care
• Elevate member retention to reduce gaps in care
and coverage
• Provide cost-effective options for long-term care
The key to improved cost and care lies in
overcoming the many engagement and activation
barriers that often block the Medicaid population
from getting the ongoing preventive and disease
management care they need.
© Copyright 2019, Carenet Health.
Five major components of a Medicaid engagement success formula
To significantly drive engagement and improve compliance,
outcomes and performance measures, a multi-faceted
strategy is necessary. That strategy must incorporate five
key high-level components:
1. Design a comprehensive contact plan
2. Increase the types of proactive outreach
3. Promote access to on-demand telehealth care
4. Provide around-the-clock member support
5. Leverage progressive technology and actionable data
In addition, each of those elements must include critical tactics
that combine for a proven Medicaid engagement model.
Let’s explore each of these components individually.
#1 Design an effective contact plan
Based on Carenet Health’s Intelligent EngagementTM
methodology—rooted in 30+ years as an industry learning
lab and engagement knowledge leader—our experts know
that creating an effective contact strategy for vulnerable
populations requires high-touch, multi-layered, empathy-
driven outreach.
Like all patient and plan member populations, there are
subtle differences that need to be accounted for in Medicaid
populations in different state, counties, cities and even
neighborhoods. But as a general guide, Medicaid population
contact strategy should include these elements:
T I P
Broadening and maximizing each
member interaction to discuss multiple
engagement objectives is critical—
because a single interaction may be the
only one that’s successful.
Don’t forget snail mail. For those members who could not
be reached by phone, mail is still a viable option due to postal
forwarding capabilities.
Address language barriers. For populations with a high
percentage of bilingual members, language interpreters
specific to population needs must be available for
communicating with non-English-speaking and limited-
English-proficiency members.
Use multiple touchpoints across multiple channels.
That should include phone, mail, email, text, interactive
voice messaging (IVR) and chat. Numerous channels and
touchpoints, when combined, provide as much access
and visibility as possible in the most convenient ways for
members. Many Medicaid programs have found success
asking members to opt into Facebook in-messages, as well.
Leverage external data appends. To overcome the
often transient nature of some Medicaid population
members and achieve higher contact rates, data appends
should happen frequently and involve data integrity and
integration oversight.
Mix it up. Attempting calls (or other forms of communication)
on different days and at varying times is essential to
increasing the odds of reaching members.
Embrace text messaging. More than 90% of those living in
U.S. households with incomes below $30,000 annually have
cell phones.1 Texting is especially useful when a member has
an unpredictable housing situation. Addresses change more
often than mobile numbers.
Make the most of your first interaction. When an initial
contact has been made, such as during a welcome call, it’s
important to gather communication preferences from members
at that point. That way, you know that, for instance, the best way
to reach Joe Smith is via text at 8 p.m. on Wednesdays.
© Copyright 2019, Carenet Health.
#2 Increase the types of
proactive outreach
For any state Medicaid program or MCO looking to improve
education and engagement, improving the types and content
of proactive outreach is a crucial starting point. A successful
outreach approach for the Medicaid population should
consist of at least eight complementary initiatives:
Effective member onboarding
Welcome calls and other multi-channel initial interactions are
essential for introducing members to available services and
resources. Establishing a personal connection from the start of
the plan-patient relationship lays the groundwork for building
trust. That groundwork will pay off later as you attempt to
reach the member for appointment scheduling and closing gaps
in care. Onboarding outreach also helps you emphasize the
importance of well child visits, prenatal care, immunizations,
health screenings, medication adherence and more.
Education on unnecessary ER and urgent care use
Reducing costs and avoiding unnecessary ER and urgent care
visits require proactive and ongoing member education. For
the Medicaid population, unwarranted emergency care use is
often driven by factors such as unmet health needs and poor
chronic care management, intermittent healthcare coverage,
inadequate access to appropriate care settings and a lack of a
dedicated primary care physician.
A pre-emptive and holistic engagement approach should
be designed to ensure Medicaid members are aware of the
availability of less expensive care (including at-home care, retail
clinics, primary care offices and virtual nurse and physician
consultations) and when it’s appropriate to use which care
setting. Some studies show that eight in 10 consumers report
being unsure or unaware of the telehealth services they have
available to them.2
Ongoing outreach can be timed around predictable healthcare
periods such as flu and allergy season. Triggered and targeted
continuous education should be a part of the strategy, too. Set
up triggers so that you can contact members after an ER visit to
use the opportunity to educate the member on the 24/7 virtual
care available to them.
Perinatal engagement
Improving the care of pregnant women and their infants
requires trusted and compassionate engagement throughout
the duration of the pregnancy. By identifying and engaging
with high-risk pregnancies early, clinicians can offer timely
interventions, ultimately improving mother and infant health
outcomes. Ongoing outreach services can also help connect
pregnant women to initiatives and programs, such as smoking
cessation, and address social determinants of health.
Well child visits
Regularly scheduled well child visits are important for ensuring
the ongoing health and care of children. These routine checkups
enable physicians to monitor the child’s growth, administer
immunizations, encourage healthy lifestyles and more. With the
right engagement approach, you can explain the importance
of these well-child visits and assist with not only appointment
scheduling, but also transportation.
Gaps in care/HEDIS measures
Proactively managing HEDIS measures requires a strict focus
on quality and gaps in care. With consistent monitoring of
HEDIS measures, you can identify gaps in care throughout the
year and engage with patients (and their physicians) before
those gaps become a problem. And with active engagement, you
can involve Medicaid members in their own care and ultimately
improve HEDIS scores. Education topics should include the
value of well child visits, immunizations, vaccinations, and health
screenings for breast cancer, cervical cancer, diabetes, high
blood pressure and high cholesterol.
Engagement for gaps in care should be implemented with highly
personalized, one-on-one communications via teams trained in
motivational conversation skills and influence. To help ensure
activation, live provider appointment scheduling via three-way
calling is important, as is follow-up engagement to confirm
appointments were kept. If appointments were missed, the
follow-up communication can address and solve for the reasons.
T I P
Address multiple gaps in care during each member
interaction as appropriate.
© Copyright 2019, Carenet Health.
Annual provider visits
For many, primary care professionals are the first point of
contact with the healthcare system. With routine visits,
primary care physicians have the opportunity to spot
depression, early signs of cancer, symptoms of chronic
disease and other health concerns.
Adults in the U.S. who have a primary care provider have
19% lower risk of premature death than those who only see
specialists for their care.3 In addition, if the U.S. spent closer
to 12% of its healthcare dollars on primary care (rather than
a mere 4% to 7%), it would lead to a significant decrease in
overall healthcare expenditures.4
Engaging Medicaid members and educating them on the
need for primary care visits is crucial. This might involve
helping them select a primary care physician, scheduling
routine visits, arranging transportation and conducting
follow-up calls to confirm compliance.
Health risk assessment (HRA) assistance
By motivating Medicaid members to complete health
assessments, you can better assess the population’s health
risks, close gaps in care, enroll high-risk members into
case management programs, and develop and execute
personalized care plans.
When gaps in care are detected, you can give members the
motivation, information and support they need to become
proactively engaged in their healthcare and make better
health choices.
Member surveys
Member surveys can help you capture satisfaction levels
as they relate to benefits, care access, service delivery, and
provider and plan performance. This information enables you
to refine programs and processes and address issues in the
specific Medicaid population before they escalate.
T I P
Technologies like automated messaging
enable you to efficiently broadcast
messages to promote your virtual care
options, ensure medication adherence,
explain mail-order prescription benefits,
influence perinatal education and
promote ER alternatives.
#3 Promote access to on-demand
telehealth care
On-demand, 24/7 telehealth availability can help address
some of the most pressing Medicaid challenges. Virtual care
improves access to care when transportation and childcare
are issues, ensures cost-effective care delivery for payers
and patients and addresses the concern of distribution of
limited providers. Members can often be diagnosed and
treated earlier in virtual care environments than in traditional
care settings, which can improve outcomes and costs, as well.
There are two major components of on-demand telehealth
care that should be offered and promoted heavily: nurse
advice and MD consults.
Expert nurse advice
Nurse advice lines, also called nurse triage services, are often
under-utilized in the Medicaid population. But when leveraged,
they can make an early and often impact. A successful
nurse advice line offers knowledgeable, compassionate and
experienced registered nurses, available any hour of the day
or night, to answer questions, assess symptoms and provide
care recommendations by phone, chat or email. That level of
convenience and accessibility can be especially important for
underserved populations. At Carenet, our nurse advice line
averages industry-high performance levels. More than 80%
of members are directed to non-emergent resources and
nearly 50% are resolved with at-home treatment—resulting in
substantial cost-savings for health plans.
Medicaid-focused telehealth nurses should provide a range
of services including:
• Symptom assessment and triage
• Urgent and non-urgent care advice (and three-way calling
and location lookup for care direction when necessary)
• Health and wellness education, coaching and resources
• Condition, procedure and treatment explanations
• Medication information including drug interactions,
appropriate use and adherence benefits
• Program, provider and facility referrals
• HEDIS measure gaps in care discussion and coordination
Consistent and ongoing promotion of the nurse advice line is
recommended to escalate utilization.
© Copyright 2019, Carenet Health.
Virtual physician consultations
When members need care beyond what nursing triage can
provide, a virtual physician consultation can help. Medical
doctors, psychiatrists and psychologists can offer support for
urgent care, behavioral health, preventive health and chronic
condition management.
Virtual physician consultations improve access to care
amid a growing provider shortage and remove many of
the roadblocks Medicaid members face, including the
inability to take time off work for in-person visits. These
consultations can significantly reduce ER overutilization
by providing high-quality care when and where it is most
convenient for the patient.
Physician visits conducted virtually offer multiple benefits
to your Medicaid program and its members. Patients save
time and appreciate the convenience, which leads to higher
satisfaction scores. Virtual consultations also reduce costs
and improve outcomes where care might otherwise be
unavailable.
Common conditions treated by virtual physicians include:
• Allergies
• Asthma
• Bronchitis
• Cold and flu
• Ear infections
• Eye infections
• Fever
• Gout
• Headache
• Insect bites
• Joint aches and pains
• Nausea and vomiting
• Rashes
• Sinus infections
• Sore throat
• Sunburn
• Urinary tract infection
A M O R E M O D E R N TA K E O N T E L E H E A LT H A N D N U R S E T R I AG E : T H E V I R T UA L C LI N I C
An innovative version of the typical MD on-demand solution is available now—seamlessly
combining a nurse advice line with virtual MD and behavioral health services. The traditional
telehealth model separates the nurse line from virtual doctor consultations. A Virtual Clinic,
modeled after a conventional brick-and-mortar clinic experience, delivers cost-savings and a
more efficient member experience. Upfront nurse triage ensures members are guided to the
right care setting at the right time. Only those in need of an MD consult are moved quickly on
to the MD e-visit. Carenet offers the only integrated Virtual Clinic in the industry.
With virtual physician consultations, you will want to
ensure that recommended treatment plans can include
prescribing medications when necessary. All interactions
must also be secure, confidential and HIPAA-compliant.
© Copyright 2019, Carenet Health.
The right platform also enables you to leverage every
interaction at each touchpoint by providing contextually
relevant service and information, addressing all open gaps in
care. You can capture comprehensive data, including health
risk assessments, HEDIS measure information, medication
adherence content and vaccination records.
By combining robust data collection and analytics with a
finely tuned engagement plan, you can identify and prioritize
high-opportunity members by level of risk. This enables you
to effectively manage risk, target care management and
allocate quality improvement resources appropriately.
When evaluating a technology platform, you will want to
prioritize flexibility and scalability, so you can expand your
engagement strategies as needed.
#4 Provide around-the-clock
member support
Providing 24-hour, 365-day support to your Medicaid
members is fundamental to ensuring effective engagement.
This includes support availability during high-volume
periods, after hours, and on weekends and holidays.
Effective Medicaid member support programs should
include:
• Benefit eligibility
• Transportation coordination
• Translation services
• Provider, program and facility referrals
• Customer service such as ID card replacement
• Easy connection to wellness and disease management
programs for quick answers
• Guidance to other public programs that might help with
social determinants of health, such as a meal delivery
service
By providing a highly individualized experience, you can
build rapport, trust, loyalty and accountability. As a result,
members are more receptive to guidance, motivated to
actively manage their health and feel empowered to make
better health decisions.
If your Medicaid plan lacks the resources to provide adequate
support, you may choose to outsource the function to
organizations that serve as a trusted extension of the plan. In
addition to educating themselves about the specifics of your
plan, these organizations can truly immerse themselves in the
plan’s culture to provide a consistent seamless experience to
your members.
#5 Progressive technology and
actionable data
For today’s Medicaid programs, technology plays a key
role in ensuring engagement, reducing gaps in care and
limiting risk. By unifying knowledge, processes, data and
communication channels, a comprehensive and modern
technology platform offers many benefits. You can use
the platform to eliminate operational silos, develop
robust member profiles and deliver customized member
experiences across multiple channels.
© Copyright 2019, Carenet Health.
CONSIDER HELP FROM AN EXPERIENCED PARTNER
If your organization lacks the technology, infrastructure and
internal team resources to implement a holistic Medicaid
engagement strategy, Carenet Health can help. Carenet
has extensive experience engaging successfully with the
Medicaid population on behalf of plans around the nation.
We’re experts in integrating our technology and team with
our clients’ systems, processes and workforce.
In addition, we leverage our proprietary Intelligent
Engagement model to guide our custom-developed
engagement solutions. The Intelligent Engagement
approach is made up of a collection of more than 20
finely tuned elements—a unique combination of quality,
operational and team excellence.
We apply Intelligent Engagement to everything we do,
whether that’s closing gaps in care or delivering virtual care.
© Copyright 2019, Carenet Health.
More About Carenet Health
Carenet Health is a leading provider of healthcare engagement services and
24/7 access to medical care. Our team of healthcare professionals supports
more than 65 million healthcare consumers on behalf of 250+ of the nation’s
premier health plans, providers, health systems and Fortune 500 organizations.
Our mission is to drive market-leading consumer engagement outcomes
through our proprietary Intelligent Engagement model.
CO N TAC T U S
Call us at 800.809.7000 or email us at [email protected].
Or visit us online to learn more at carenethealthcare.com.
© Copyright 2019, Carenet Health.
R E F ER E N C E S
1. Pew Research Center, Mobile Fact Sheet. Accessed June 28, 2019.
2. “Study: 8 in 10 consumers unaware of telehealth care,” Dec. 19, 2017. Healthcare Dive. Accessed April 1, 2019.
3. National Coalition on Health Care Primary Care Forum report, American College of Physicians, September 20, 2017.
4. “Delivering value in healthcare starts with increased primary care investment,” Modern Medicine Network, August 6, 2018.
