While it's clear that a very small portion of a health plan's membership represent a disproportionately high percentage of total medical costs, it's not as clear how to engage all of these members in a positive and proactive approach to impacting their own care. Most care management outreach programs can achieve a 50 percent engagement rate and some may even get as high as 60-70 percent but is that good enough? Not even close – because many of these non-engaged members have the most inappropriate utilization resulting in high costs and poor quality of care.
The reality in care management engagement is that the majority of engaged members are often the most compliant and easiest to impact. Even without a health plan's intervention, many of them would be stable.
What do we know about the members who are hard to engage?
Many do not feel valued or respected and don't believe that a health plan could care about them; some are distrustful of health plans, providers or the government; some have behavioral health conditions that cause them to be excessively anxious or suspicious of strangers; some have language and/or cultural barriers; some don't understand the connection between a health plan and their healthcare; some don't have reliable addresses or phone numbers; and, some are purposefully hiding because they're doing things they don't want known.
Six ways to engage the right members
Aretha Franklin spelled it out – R E S P E C T. First, demonstrate respect for all members. Get rid of IVR systems and answer the phones with real people who are respectful and approachable on the phone. Make your social media posts and any materials you provide to members as user-friendly as possible. It is important to remember that for many of these members, despite their critical healthcare issues, their health may not be in even the top five biggest problems in their life.
Give hard-to-engage members a reason work to with you. Incentives like gift cards for food, free phones, public transportation passes, transitional housing or in-home care can go a long way to making it easier to engage and stay engaged with these members.
Employ outreach staff with roots similar to the members you're trying to engage. Who better understands the needs of those who are homeless than someone who once was? Hire people with the chronic conditions and other issues experienced by your members. Empathy, gained from having lived through the same problems that these members are experiencing, can go a long way to making progress in finding, understanding, and engaging with these members.
Influence the influencers. Who sees these hard-to-engage members on a routine basis? Do you have strong relationships with those organizations? Do they understand the benefit your company brings to those who most need it? Family members, welfare agency staff, advocacy groups, faith-based institutions, food banks, soup kitchens and any other person or organization that interacts with these members needs to understand why it’s important for the member to engage and the benefits it can bring.
Use the data in your system. High cost, hard-to-engage members are using EDs, pharmacies and other providers. How do you coordinate with these providers to get their help in engaging these members? Having robust, timely, member-centric data is critical for these interactions to be most effective. If you can't get this information out of your system – find a vendor who can help.
Finally, once you get even a tentative response from a hard-to-engage member, strive to have the greatest possible impact on their health. Care managers should be trained in behavioral health issue recognition, as many of these hard-to-reach members will have co-morbid physical and behavioral health conditions. Consistency is important for keeping these members engaged so be cautious in changing the staff and processes related to them. Social supports, easy access to care and appropriate follow-up are critical to keep the engagement going.
By incorporating these six ways to engage members in appropriate and effective care management, you’ll be able to greatly impact the health status of those that most need it while reducing unnecessary or inappropriate medical costs.
Many of our clients have had success implementing these engagement strategies, please let us know if we can help you as well.