States and their private sector partners are, with increasing frequency, directly and meaningfully engaging consumer voice in their Medicaid programs and seeing the benefit of such engagement. Through focus groups, advisory boards, survey tools, and other information gathering efforts, involving Medicaid recipients in the planning and implementation of system design and managed care programming can yield a more effective and more responsive Medicaid system.
At UnitedHealthcare Community & State, we are committed to collaborating and designing solutions that are informed by those we serve. We know that to create healthier individuals, healthier families, and healthier communities we must listen to the individuals we serve and seek to serve to better understand their needs, what they want from providers, and what has worked to improve their health and quality of life.
Two examples of this direct consumer engagement at UnitedHealthcare are: our National Advisory Board and our consumer insights research.
National Advisory Board
Since 2013, UnitedHealthcare has convened an advisory board to serve as an independent advisory council to provide us with input on the design and delivery system that supports individuals with special health care needs. The National Advisory Board (Board) makes recommendations, develops and champions innovations, and advises on member engagement strategies that support clinical approaches. The Board is comprised not only of leading experts and aging and disability advocates but also current UnitedHealthcare plan members and family caregivers.
The goals of the Board include cultivating a consumer-centered culture and advancing awareness and knowledge of individuals served in the Medicaid system. The Board has focused on such issues as: elder abuse, quality, caregiving, and currently access and benefit design. With each of these initiatives, it has been critical to have the consumer perspective integrated and the related policy and practice changes that have been recommended by the Board have been focused on improving the quality of life for individuals served by Medicaid. The insights from the Board have directly shaped how UnitedHealthcare supports our members, collaborates with advocates, and encourages states to design their health and human services systems.
Consumer Insights Research
In the more than 40 years that UnitedHealthcare has been partnering with states on their Medicaid systems, we have learned a lot from those we serve or seek to serve. Recently, we engaged in extensive consumer research with individuals across the country who are eligible for Medicaid or enrolled in Medicaid to refine our understanding about what consumers want and need from the Medicaid system. Many of the individuals were not members of a UnitedHealthcare Community Plan.
What did the research tell us was most important to people who access Medicaid?
- Help me get the care I need.
- Help me navigate the health care system.
- Help me improve my health and well-being.
- Communicate with me in a way I can understand and means something to me.
Help me get the care I need.
Having coverage does not mean an individual can get care. Provider availability and willingness to accept Medicaid recipients prevent many individuals from getting the care they need, despite having health care coverage. In addition, competing demands on time and resources (such as childcare or work) and lack of transportation are other obstacles that can hinder a Medicaid member’s ability to access the services they need.
In our research among Medicaid consumers not currently enrolled in a UnitedHealthcare Community Plan, more than one third (36%) indicated that it is not easy to make an appointment to see a doctor. This number increases to more than half (51%) when it is a health care specialist.
Making it easier for individuals to find and get to providers is a critical issue for the Medicaid system and Medicaid managed care programs. Success means more than just a better consumer experience. It means creating new, more engaged health care consumers — consumers who are more active in their health care decisions, who more frequently access vital preventative care services, and who will rely less on high-cost emergency rooms for routine care.
Help me navigate the health care system.
Health care is complicated. The Medicaid system has a complex array of programs, agencies, and rules that make it even more difficult for consumers to easily navigate. Fragmented benefit design means individuals get behavioral health from one health plan, physical health services from another, and long-term services and supports (LTSS) from a different agency. The challenge of navigating the system increases with the complexity of the needs of the individual needing care.
Family caregivers, or natural supports, manage much of the care for Medicaid consumers, particularly those with complex conditions. Caregivers shoulder the responsibility to adjust care, communicate with health care professionals, and serve as an advocate with providers, community services, and government agencies. In many cases, caregivers are forced to handle everything from navigating the system to providing direct care, all while managing the details of the health care services their loved one is accessing.
To more successfully navigate the system and ensure the best care, caregivers and members want support. Care coordination can help reduce the burden and ease anxiety by helping keep track of medications, appointments, and social services, and more. By providing care coordination, managed care programs are addressing a critical need of both their members and the individuals who support them.
Help me improve my health and well-being.
Policymakers, providers, and managed care plans are growing more aware of the connection between poverty and health. Commonly known as social determinants of health, or SDOH, these issues undermine the ability to get care and one’s capacity to adopt healthy behaviors. Our research shows that lack of transportation, unstable income, and food insecurity are key barriers to focusing on one’s health and accessing needed care.
Primary research by UnitedHealthcare shows that nearly 1 in 5 (19%) Medicaid recipients feel strongly that they need help getting to/from medical appointments. Frequently, Medicaid consumers rely on others to take them to their appointments. This can be due to the distance to the provider’s location as much as not having one’s own vehicle. Given the emphasis managed care plans place on preventive care and routine doctor visits, removing transportation challenges is essential to improving health.
The vast majority (75%) of Medicaid consumers indicate that they worry about their financial status. More pressing needs and bills often come ahead of their health, and can lead to skipping medications, delaying surgery, or choosing the least-costly care route.
Additionally, access to healthy, nutritious food is a challenge for many. Difficulty affording and accessing fresh produce often leads to unhealthy food choices. Only 25% of Medicaid consumers feel there are places to buy fresh, nutritious food in their neighborhoods.
By emphasizing whole-person care, managed care plans are well-positioned to support a broad approach and implement a broad range of strategies to address SDOH.
Communicate with me in a way I can understand and means something to me.
Culture affects how people understand, communicate, and respond to health information, and can contribute greatly to health literacy. Among those served by Medicaid, 45% of Hispanics and 41% of African Americans indicate that it is important for them to have doctors of the same cultural background. That is compared to 23% of non-Hispanic white consumers. As a result, managed care plans have significant opportunities to improve the way they share information, which can help to positively impact the health outcomes of their members.
A strong connection between individuals and their preferred providers is also critical to ensuring engagement in care and health. As a result, it is imperative to build high-performing networks that align with the preferences and needs of the population being served. Managed care plans can help connect individuals to those providers and help establish relationships that encourage continued engagement.
By understanding the day-to-day needs and pressures of those who access Medicaid, we can improve the health and well-being of the millions of lives covered by Medicaid and deliver simpler, person-centered, and more effective health care.