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Engaging vulnerable populations: Making the right connections for better health


Medicare, Medicare Advantage, seniors

A woman from a low-income neighborhood chooses not to receive care from her closest health center, which is located in a wealthy community, because of a demeaning interaction she previously had with the office staff there.

A Spanish-speaking man whose prostate cancer has been in remission avoids making a follow-up appointment because he’s uncomfortable navigating discussions with staff in English. His daughter would go with him if he asked, but he doesn’t want to impose. Instead, he takes his chances and stays home.

As these two examples demonstrate, barriers to healthcare access among those most vulnerable go beyond social determinants of health (SDoH) such as lack of reliable transportation or economic instability. Cultural, racial and socioeconomic barriers also play a role, from cultural hesitancy around seeking care to distrust of healthcare institutions to the stigmatizing of Medicaid beneficiaries. As a result, engaging these populations is highly complex, highly nuanced work.

How can health plans strengthen engagement of vulnerable populations—particularly at a time when SDoH, which are significantly impacted by inflation, are worsening access to specialty care, decreasing life expectancy and threatening stability? Here are three considerations.

Approach every conversation with authenticity and respect. To establish trust, care managers and customer service representatives must listen with intent to the member’s concerns and seek to understand their health goals, not what plan staff assume these goals should be. Professionals also need to demonstrate empathy with the member’s circumstances by assuring them: “We care about you, and we want to help.”

One way to demonstrate authenticity is by delivering communications in the language they understand best. This involves more than simply translating a script or brochure from one language to another. It also necessitates that health plans take into account the patient’s cultural or ethnic background in crafting messages that will resonate with specific populations.

Emphasizing transcreation over translation—adapting messages from one language to another while paying careful attention to intent, tone, style and content—enables health plans to connect more effectively with the populations they are seeking to engage. For example, in appealing to Spanish-speaking populations, health plans should leverage cross-cultural teams comprising individuals from various Latin-American countries and territories such as Mexico, Peru and Puerto Rico. This is important because words and expressions used within Puerto Rican communities may have a different connotation in Mexican-American communities.

Communicate consistently and frequently with a multi-channel approach. Medicaid members are at risk of losing coverage this year due to Medicaid redetermination. For the past two years, the federal government directed more money to state Medicaid plans so long as they pledged not to drop members from their rolls during the public health emergency. Now, with the public health emergency anticipated to expire this year, states must begin the process of contacting members to ensure they still meet income requirements and other aspects of Medicaid eligibility.

The problem: These members can be difficult to locate, reach and engage in the redetermination process.

When attempting to reach the most under-resourced populations, health plan representatives should not expect to gain the desired response on the first try. That is especially true with a process as complex as Medicaid redetermination. Rather, a multi-channel approach—comprising a combination of phone calls, text messages, emails and print communications—is key. For instance, the most vulnerable members often have pay-by-the-minute mobile plans, which may impact the chances that members will want to communicate by phone.

The highest-performing health plans deploy a variety of approaches to initiate and maintain contact with their hardest-to-reach populations, taking into account generational preferences as well. They also remember that the more complex the message, the more likely it will be ignored or forgotten. The most effective messages are simple, concrete, and personalized—as well as repeated and relatable.

Strengthen cultural sensitivity and competency training for member-facing staff. Culturally responsive, competent, and empathetic communications can bolster the success of complex interventions, such as closing care gaps and efforts to engage new mothers in expanded postpartum coverage in many states, which was previously limited to 60 days under Medicaid. Such coverage is vital, given that more women are dying in the weeks after birth, with the risk highest among Black women. Yet while extension of coverage is anticipated to improve health outcomes, one study of women in California indicated that Black women on Medicaid were less likely to attend a postpartum appointment. One possible reason: the structural racism that has affected the quality of maternal care Black women tend to receive.

This is an area where recruiting a diverse workforce and conducting cultural sensitivity training can heighten engagement by helping staff understand how specific populations make important decisions—and why they may refrain from choosing a certain path. Such training can also equip staff to reframe questions to ensure they are getting the right answer. This process requires deep understanding of the cultural nuances that can make some members hesitant to respond openly regarding the challenges they face—knowledge that can come through education as well as experience.

Creating a foundation for better member engagement

Covid-19 intensified awareness of disparities in care across populations, but strengthening access to care and health outcomes through focused member engagement will not happen overnight. Instead, it will take patience, sensitivity and awareness to reach a state where health plans and providers are connecting the right resources with the right members at the right time. By investing in culturally aware communications, training and support, health plans can begin to make a substantial difference in quality of health and life for underserved communities, improving outcomes while reducing care costs.

Photo: imtmphoto, Getty Images



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