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Two Common Barriers in Medicaid--and How to Overcome Them

Les Masterson, for HealthLeaders Media, December 2, 2009

Margaret A. Murray, executive director of the Association of Community Affiliated Plans, says CareOregon, a Medicaid managed care plan, works with community health centers to re-engineer practices, such as not requiring Medicaid beneficiaries to make appointments, but allow walk-ins.

Another way is to offer incentive payments to providers that give high-quality services. This will ensure providers are also performing outreach to members.

Another avenue for insurers is to mine claims data to find members' health risks and reach out to those who are at-risk through care management programs.

For instance, claims data may show that a member is getting prenatal vitamins, and the insurer can contact the member to make sure she is getting the proper prenatal services.

With lower income also comes barriers to making doctor appointments. Medicaid plans are capitated for transportation services and insurers new to Medicaid must understand they will have to work with transportation companies in order to help some of their members get the care they need.

"These impediments are a lot more profound than what typically faces employed members or their dependents," says Kelly.

Literacy — health and language

Medicaid beneficiaries often speak other languages and many are not familiar with the healthcare system. Imagine not being able to understand the language and facing the healthcare maze.

Health insurers have the opportunity to educate members and providers about health literacy. AmeriHealth Mercy, a Medicaid managed care plan based in Philadelphia, offers providers a book about health literacy that helps them understand how to communicate with the Medicaid population. Insurers can also provide training for physicians and nurses in community health centers, says Murray.

Insurers in the Medicaid population must also provide bilingual communication through literature, customer service, and care management systems. Kelly says his company recently added member service representatives who speak Arabic and Somali.

"The only way to reach them is to make the connection through language," says Kelly.

But also understand that many Medicaid beneficiaries have limited language and reading skills so insurers need to provide written and oral communications that are understandable in non-clinical and non-technical language, says Kelly.

Schaller Anderson offers a welcome kit to its new members as well as new member calls that help Medicaid beneficiaries understand how to use healthcare services and find primary care physicians.

The company also prepares members for the first doctor appointment, including telling them about Ask Me 3, which is a National Patient Safety Foundation program that suggests patients ask themselves three questions: 1. What is my main problem?; 2. What do I need to do?; and 3. Why is it important for me to do this?

If health reform ultimately expands Medicaid, Kelly predicts language will play an even larger role for insurers. Medicaid members are often mothers who have children who speak the language, but expanding Medicaid will likely bring in more single adults who won't have that benefit.

"Bringing in more adults will probably increase the language challenges because they may not have the support system at home that can help them un-puzzle the language situation," says Kelly.

Health insurers that are not used to the Medicaid population must understand that Medicaid beneficiaries are quite different than the typical employer-based insurance member. Insurers that want to jump into the Medicaid population because they see a growth opportunity, but aren't willing to invest in member services and outreach, won't help their members and could hurt themselves in the long run.


Les Masterson is an editor for HealthLeaders Media.

Follow Les Masterson on Twitter.


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