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Solving Data Decay to Improve Awareness and Access for Medicaid Members [PODCAST]

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In this episode, we’re pleased to welcome Adam Rarick-Varner, Senior Director of Healthcare strategy at LexisNexis Risk Solutions, and Ken Walters, Senior Vice President and COO at Community Care Plan, to discuss solving data decay to improve awareness and access for Medicaid members.

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Highlights of this episode include:

  • Background on health plan and member base
  • Member engagement challenges
  • The main pain points around contact data for members and patients
  • Community Care Plan challenges
  • Solutions

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Adam Rarick-Varner and Ken Walters. Adam is a senior director of healthcare strategy at LexisNexis Risk Solutions. Adam has spent over 20 years working at national health plans in a variety of roles, including leading back-office operations, customer-facing operations, call and claim center innovation, business and IT support, product development, and process improvement. During his time at LexisNexis Risk Solutions, Adam has served as a subject matter expert in payer operations, provider data, and the healthcare ecosystem. In his current role, he focuses on market strategy for payers. Adam holds an MS in Industrial Organizational Psychology from the University of Tennessee, Chattanooga, and a BA in Psychology from Bryan College. Ken Walters is the senior vice president and chief operating officer at Community Care Plan, the health plan with a heart, and is responsible for spearheading and overseeing all daily operations for the organization. Ken plays a major role in monitoring local activities of the health plan to ensure they are in accordance with contract requirements and is responsible for ensuring that all operations are run efficiently and effectively. Ken has been involved in government programs for over 20 years, delivering services to Medicare, Medicaid, and special needs populations. Ken holds a Bachelor of Science degree in Industrial and Systems Engineering from the Georgia Institute of Technology. In this episode, we’re discussing solving data decay to improve awareness and access for Medicaid members. Thank you for joining us today, Adam and Ken.

Adam Rarick-Varner: Thanks for having us, Kelly.

Ken Walters: Kelly, it’s good to be here.

Kelly: Great. Well, let’s jump in. This first one is for Ken. Can you give us a little background on your health plan and member base and share some of the challenges you’re seeing in terms of member engagement?

Ken: Sure, Kelly. Community Care Plan is a health insurance plan based in Broward County, Florida, which is in the Fort Lauderdale area in South Florida. We have over 100,000 members in various lines of business. Those include Medicaid; our CHIP program in the state of Florida, which is called Florida Healthy Kids; self-insured commercial; and plans for the uninsured in several counties in South Florida as well. We are owned by two health systems, by Memorial Health System, which represents the south part of Broward County, and Broward Health, which actually represents the north part of Broward County. Again, I said we’re not-for-profit. Really, a large percentage of our membership is in the Medicaid space, and that always presents some interesting challenges because Medicaid, being an underserved population, what we find is that they’re very fluid, they move around a lot, a lot of times don’t offer their forwarding addresses or their forward phone numbers. So really engaging members in this population can always be challenging, even when presented with good information as we can receive from the state. Often that information can become stale, and we find that phone numbers are not working or they’re not accurate.

Kelly: Thank you for that, Ken. This one’s for Adam. What are some of the main pain points around contact data for members and patients? And why is the challenge greater for Medicaid members?

Adam: Yeah, Kelly, Ken hit on a lot of the challenges, particularly in the Medicaid population. But just in general, you have 20-plus million people in the U.S. moving every year, millions of people dying, being born, name changes. All of that leads to just a general decay and degradation of data over time. And people don’t always update the US Postal Service when they move either, right? So that just leaves yet another gap in trying to find where people are. And then for Medicaid, the risk is even greater, as Ken was talking about. A lot of times, the Medicaid population is the most at risk for not having consistent locations or phone numbers. The Medicaid population is many times more likely to move. Those 19 to 34, those with limited English proficiency are even more likely to move among Medicaid than the general population. Another thing we see is cell phone numbers, right? Cell phone numbers many times have become almost an alternative ID to our names, but there’s more cell phone numbers in the U.S. than there are people. And then Medicaid members a lot of times have those numbers change as they change carriers or come off or on plans as their ability to pay for things fluctuates. So, it creates a greater challenge in the Medicaid population, even just in the general population.

Kelly: That makes a lot of sense. This is going to be for both of you, but we’re going to have Ken answer first. Without access to quality data, what could this mean for patients, payers, and providers?

Ken: Well, that’s a great question. Really, I think where we start is from the very beginning when we get a member that enrolls in our health plan. So, a member, for any reason, becomes eligible for Medicaid, and then they’re offered a choice to choose a health plan if they wish, or if they don’t choose a health plan, then they are auto-enrolled. So, in some cases, that engagement, they don’t make those initial decisions, and they may be auto-enrolled in our plan. So starting from the very beginning, getting in contact with that member to let them know what health plan that they’re with, let them know who their primary care physician that we’ve assigned to them or if they want to choose to change that up front, and letting them know what their benefits are is crucial for us to be able to start them on that journey of managing their own care, seeking care in the correct place, going to see their primary care physician, getting that appointment upfront. So, what that does is, at a certain point in time, we can avoid the possibility of that person who’s not been educated in all of their benefits seeking care at the emergency room or at higher level of cost places and not appropriately being able to manage that.

Kelly: Thank you. And over to Adam for this one.

Adam: Yeah, I would add on to what Ken said, right. If the providers and care systems are not able to get in contact with their patients, that can lead to delayed care, more costly treatments, and preventable things. Preventable disease or chronic conditions start moving into emergency room settings, right, which is significantly more costly to the entire healthcare system than an office visit or something like that. And then ultimately, that kind of snowballs to impact the entire physician-patient relationship, the healthcare revenue for hospitals and providers. ED visits are expensive, and many times they can go unpaid in some situations. So that puts a financial strain on hospital systems and healthcare systems that are already understaffed and facing financial pressures post-COVID as people come back to getting care. So yeah, it kind of snowballs a little bit when you don’t have this information.

Kelly: Thank you both for that. Ken, could you share some of the challenges that Community Care Plan, or CCP, first saw for Medicaid redetermination and how you approached preparations for this process?

Ken: Okay, well, as many may or may not know, during the public health emergency, during COVID, there was a suspension of the ability to be able to have a member disenroll who was no longer eligible for Medicaid. So, over those few years, what we had is those Medicaid rolls were building and building and building as people were potentially losing their jobs during COVID. They needed that eligibility. And so when the public health emergency ended, what happened is that every state was given the opportunity to put a plan together to start to unwind this Medicaid eligibility. So, knowing that each state had a different plan on which way to go, the challenge was to understand what the state of Florida intended to do and what it was going to look like. We did start this process back in April, and we didn’t know if it was going to be a cliff or it was going to be a gradual slope, but we did know that there were a lot of people that were on the rolls today that were not eligible for Medicaid.

Having this key information on contact information and being able to make sure that we had accurate phone numbers gave us an ability to use a multi-pronged approach to starting that outreach to our members to say, “Listen, the state is going through this process right now. This redetermination is going to impact you. You are going to have to take an active role in taking a look at and ensuring that you are still eligible for Medicaid.” So being able to tell them what to look for. The state of Florida had envelopes that they sent out that had a yellow stripe. So that yellow stripe was part of our campaign. We would tell them, “Take a look out for the yellow stripes.” To our providers, actually, to assist us, we gave them cookies that had yellow stripes on them just to keep in everyone’s mind the yellow stripe. So having that accurate information gave us the ability to call, to send text messages, all these different ways that the members may or may want to be able to hear, to let them know to look out for the information so we could help educate them that they needed to take that responsibility to work on getting their redetermination.

Kelly: Those are great. Those are some great initiatives you had there. Ken, this is for you again. Now that CCP has access to LexisNexis Risk Solutions data, what improvements have you been able to make in terms of contact rate?

Ken: Well, that’s been the most successful thing. Again, it’s great getting this data, but being able to get it in to the people that are member-facing in our organization was a crucial part. So, we really had to work to ensure that we integrated this into our Global Address Book. Global Address Book is what we do to be able to get all good contact information in one place, so when we’re doing outbound phone calls, we can identify. So, in those cases, not only do we receive the information from LexisNexis, but when we’re making those phone calls, we can put a little check mark next to it saying, “This is a good phone number that we received,” so that next person who’s reaching out to that member can look at some historical data to understand what we did. As addition, when a member would call in, call in to the company, we can also find out where they’re calling from. So, gathering all that information, we’re able now take a look at our outbound phone calls, which we call our welcome calls. And that, like I said earlier, is our key contact from the very beginning to be able to work with our members to let them know what their health plan is, know what their benefits are, let them know how to engage themselves on the journey of their own healthcare by working with our primary care physician.

We had a very low contact rate in the very beginning before we used LexisNexis. We were finding out a lot of our members were getting bad phone numbers, and we were just not able to contact them. By doing a combination of using this information and also accessing more texting capabilities, we have been able to increase our contact rate by about 50%. And so that’s really, really critical. Like I said, that first step of being able to contact these members and let them know. 50% is significant. And we’re seeing over time that that’s fairly consistent with what started in the beginning. We’re staying pretty much flat with that number. So, we’re finding that anything in addition to that will be more creative ways of engaging our members, but really the contact information is what got us there. Just as an example, in that first five months, that’s about just under 1,000 members that we were not able to contact before that we now are able to contact and engage. So, if you think about it in that way, 1,000 members, 1,000 families in Broward County that we’re able to help engage in their healthcare, let them know about the community resources that are available, let them know about transportation that’s available to them, all these different things to help them experience a better life.

Kelly: Wow, those are some impressive improvements. This one’s for Adam. What are the benefits to having access to this data for not only healthcare providers and hospitals but for patients as well?

Adam: Yeah, great question, Kelly. It’s really about the patient, right? Getting them involved in their healthcare. Things like reminders to fill prescriptions, follow-up appointments. As Ken was talking about, who their primary care physician is, and if they want to change that, they can. Focusing on preventive care, right, which reduces people going to emergency rooms and all those things we talked about earlier. Another thing Ken mentioned was letting patients and their members know about programs they have available, right? If you don’t have their contact information, they’re never going to know about these resources that you have to help them be healthy or engage with their provider and their local resources. From a healthcare provider and hospital system, when those systems are engaging patients, that patient is going to feel valued, right? And when the time comes to make a choice about if I go to Provider A or Provider B, or if I have a choice about a health plan, being perceived as a valued partner in someone’s care really goes a long way to when they make that choice of who I go to see next. And then for health plans in particular, Ken talked about the increase in their contact rates. Just the administrative cost reductions, right? Not wasting time calling bad phone numbers, or sending email that you’re going to have to not get a response on, or sending mail that you’re going to get returned to the US Postal Service. So, there’s some administrative cost savings there for healthcare providers and payers as well.

Kelly: Those are some great benefits. Thank you. What are some other solutions or considerations for hospital or clinic care settings that our audience should keep in mind? Let’s hear from Ken first and then over to Adam.

Ken: Well, I mean, so telemedicine is something that, as you know, it’s an interesting technology. For years and years and years before COVID, we talked about using telemedicine to be able to engage members for many different reasons, whether it be for living in rural areas or just as a convenience as an alternative to going to see a primary care or behavioral health specialist, or any other type of provider. And what we saw was a fairly flat utilization. Suddenly, during COVID, we saw that explode. It was the only choice at that point in time where offices were closed and being able to access care via telemedicine. And so it was a natural progression. All of a sudden we saw it explode in the usage. We thought, “Oh my goodness, this is amazing. We’ve been wanting to use it before.” So now, as we’ve kind of gotten out of COVID…what do we see and what have we learned from that? What we’ve learned is that it’s flattened a bit, but not as much as we expected it to flatten. I think it’s flattened more in primary care. Now, in primary care, we’re seeing it as being something to extend the care. But the primary care physician really likes to see our members in person. And so, it can be something that they can use in addition to it.

But I think the biggest surprise, at least for many of us in our industry, was that behavioral health was an area where it has not been reduced since COVID. In fact, in our CHIP program, Florida Healthy Kids, we’re seeing about– first of all, about 60% of our members that are between the ages of 11 and 18, our adolescents are accessing behavioral health services. So, everything you read about adolescents and behavioral health issues is true. About half of them are accessing their services through telemedicine. So that’s really great. It takes the stigma of accessing behavioral health away. It allows a more intimate conversation. It allows to extend. So, I think we’re seeing some technologies out there that are really helping our members access care that we did not see happening before.

Kelly: Fantastic. Thank you. Over to Adam.

Adam: Yeah, thanks, Ken. Yeah, telehealth and behavioral health is just a huge trend, right? So just echoing that, a great benefit, a great thing that came out of that change. I would just add to that, right, from a payer and provider standpoint, that ongoing communication and education. As people’s life events change over time, staying in touch on a regular basis and personalizing those communications to what might be going on in that individual’s life is really key to keeping people engaged in their healthcare, engaged in preventive care, continuing to manage conditions and things like that. So, it’s not just a one-time outreach, right? It’s that ongoing communication that becomes really important to keep people moving forward in their healthcare.

Kelly: Thank you both. And thank you so much for joining us today, Ken and Adam, and for sharing your thoughts on solving data decay to improve awareness and access for Medicaid members.

Ken: Thank you so much.

Adam: Thanks, Kelly.

Kelly: If a listener wants to learn more or contact you to discuss this topic further, how best can they do that? Adam, do you want to start first?

Adam: Sure. You can find us on LinkedIn. Just search for LexisNexis Risk Solutions Healthcare. Our page will come up there with some resources and links to our website and other contact information.

Kelly: Wonderful. And over to Ken, what about yours?

Ken: Right. There’s a couple of ways that you can find out more about Community Care Plan. First of all, you could go to our website, which is ccpcares.org. That’ll give you a good overview of the programs that we have and the people that we cover, and the activities we’re doing. As well, we have a very active LinkedIn page that you can find us at as well. You can see what we’re doing out in the community, how we’re engaging our community in Broward County and beyond, just to see some things that we’re doing out there.

Kelly: Thank you both for providing that information. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.

 

If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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