CipherHealth was pleased to be an exhibitor at the 11th Annual Medicaid Innovations Forum in Orlando, Florida last month.
Some key takeaways from CipherHealth attendees Friso van Reesema and Alyson Farrell include the partnerships that Managed Care Organizations (MCOs) across the country are forming to improve outcomes, how these organizations are focusing on social determinants of health, and the use of data to target population segments to improve results.
MCOs are partnering with hospitals, community organizations, and even other health plans, to improve outcomes and reduce costs.
Competing MCOs are coming together for the good of members in their community. By finding new ways to partner, it’s easier to encourage members to take the right steps to better manage conditions – and even prevent them in the first place. One example comes from L.A. Health Plan and Blue Cross of California Promise Health Plan. Although this type of partnership is unusual, the benefits to members can be extremely positive.
Francisco Oaxaca, Senior Director of Communications and Community Relations at L.A. Health Plan, presented alongside Kristin Cerf, Vice President of Medi-Cal Growth Strategy at Blue Cross of California Promise Health Plan. Together, their health plans are planning 14 new and existing co-branded community resource centers throughout Los Angeles County. Both health plans are transforming the delivery of Medicaid services through incorporating technology and addressing social determinants of health at the community level, with a combined total investment of $146 million over a five-year period.
As we learn from this type of investment, the question is: Will other plans take the cue and work together in a fiercely competitive landscape?
There is a greater focus on social determinants of health to address member needs.
More health plans are partnering with hospitals and other community organizations to address social determinants of health such as housing, education, language, and nutrition. As we’ve highlighted before, health plans can find immense value in identifying opportunities to engage members to improve their overall outcomes and reduce the total cost of care. This was echoed by speakers from the Community Health Plan of Washington and CareSource, among others.
Melissa Stevens, Vice President of Community Engagement and Growth, explained how the Community Health Plan of Washington’s program is designed to reduce housing instability and homelessness. Their community program gives members, who are discharged from the hospital with no stable home situation for their recovery, a safe place to go until they are ready to re-enter the community. The program, which provides funding for social services – as well as care and case management to make linkages to ongoing support – has reduced hospital readmissions by 20%.
CareSource, which serves Medicaid members in Ohio, is working to meet the full spectrum of member needs by matching them to existing community resources to address social determinants of health including education, housing, and healthcare. Amy Riegel, Director of Housing for CareSource, spoke about their program to provide housing for homeless moms in order to decrease child mortality rates. Their ROI is not just a financial one – “you have to look past the benchmarks when it comes to social determinants of health and look at the member holistically to address more than just disease-specific issues”, she said. CareSource is looking further into the data to determine the relationship between homelessness and health outcomes.
Organizations are using data and targeted care strategies to treat populations with varying needs.
By segmenting patients according to degree of need and crafting strategies specifically targeted to each population, health plans are improving outcomes at scale.
Joanne Scillian, VP of Medical Management, shared how Affinity Health Plan in New York uses a targeted strategy for Medicaid beneficiaries with complex care needs to reduce avoidable ED visits and readmissions. With the goal of reducing avoidable readmission costs by 10%, they are shifting from “disease management” to “barrier management”, focusing on social determinants of health. Affinity Health Plan uses a member-centric/whole-person approach to managing their population with integrated care teams – including RNs, social workers, behavioral health workers and pharmacists – who work together to lower barriers to care.
For Affinity Health Plan, accurate data on readmissions is essential to tracking member recovery. Members are stratified via claims data on a monthly basis, with a goal of decreasing skilled nursing facility admissions and increasing home health care. They work closely with Federal Qualified Health Centers to identify members who are likely to “bounce back” into the ED.
MCOs are clearly looking to data, partnerships, and targeted care strategies to address social determinants of health as a way of improving health outcomes and reducing costs. We look forward to seeing more of the great strides that health plans are taking throughout 2020 to improve member outcomes and experiences.
CipherHealth empowers managed care organizations to engage all members throughout their health journey to close gaps in care, improve chronic disease management, and reduce avoidable readmissions and ED visits with engagement software that enhances communication and care coordination. Reach out to Friso or Alyson on our Managed Care team for more information.
