Medicaid Member Engagement: One Size Does Not Fit All

There’s a certain catch-phrase going around related to Medicaid members: they need to have “skin in the game.”    This phrase seems to imply that individuals receiving Medicaid are somehow different than other individuals—those who have private insurance—but they’re not.  Individuals receiving healthcare through Medicaid are just like you and me.  They want their children to be healthy and happy.  They want to improve their health.  They want to live happy and productive lives.  However, due to life circumstances, some of them may need a little more assistance than others in understanding the role they play in their healthcare.  Effective member engagement can help guide individuals through the complex Medicaid system of care.  

Medicaid’s population is very diverse and serves individuals from different socioeconomic backgrounds—the aged, blind, disabled, children, pregnant women, relatives taking care of children, and childless adults can qualify for Medicaid if they meet state specific guidelines.  Activities to engage Medicaid members in their healthcare need to be as diverse as the population.  Mass mailings to the entire population may not be as effective as specific information targeted to a select group of individuals.  

Want to increase the percent of women who receive mammograms?  A simple postcard mailed to only those women who do not appear to have had the service may be the way to go.   States may also want to follow up with phone calls or texts to those women.  This approach sounds good in theory but is hard to put into practice.  State Medicaid agencies simply do not have the resources to allocate towards focused member engagement activities.

Increasingly, state Medicaid agencies are turning to Managed Care Organizations (MCOs) to provide an array of services to Medicaid members, including activities related to member engagement.  While MCOs have more resources to devote to member engagement activities, including dedicated staff, they cannot reach every Medicaid member.

MCOs can mine their data and perform outreach activities to selected demographics to engage members in their healthcare.  They can also host events to attract Medicaid members and provide some one-on-one educational information.  However, providing effective Medicaid member engagement remains a challenge to state agencies and MCOs.  Communication barriers, incorrect addresses, literacy challenges, limited state or MCO resources, and, often, a basic lack of trust hampers many member engagement activities.  

Many of the barriers to effective member engagement can be overcome.  Understanding the population and developing grassroots efforts aimed at education and informing Medicaid members about the role they play in their own healthcare is vital for the future of the program.  Effective member engagement can reduce unnecessary medical visits, promote healthy lifestyles, and increase preventive services.  

To achieve these benefits, it is important that Medicaid agencies develop a system of engagement that is sustainable with limited resources.  Most importantly, engagement activities need to be flexible and tailored to the specific population the Medicaid agency is trying to reach.   Mass mailings or other activities aimed at reaching the entire population will not be as effective as a tailored approach for a specific population.   

Considering the potential costs savings associated with member engagement, it would be advantageous for Medicaid agencies and the MCOs they employ to engage members using a variety of targeted methods.  Keeping Medicaid members engaged and informed is not an easy task, and states face many challenges in doing so, but we must find ways to overcome these challenges, especially in times of change and uncertainty. The sustainability of the program, and the health and well-being of members, depends on it.