Diabetic Medicaid Members May Need More Than Phone Outreach

As if the worsening diabetes epidemic were not enough to worry about, this chronic condition also increases risk for complications like heart disease, stroke, and kidney failure. This is a major challenge for health plans managing the care of a growing population of Medicaid members, who tend to overutilize emergency rooms for routine or non-urgent care.

While preventive and disease management programs are helping improve outcomes for people with diabetes and other chronic conditions, more must be done beyond just phone outreach to adequately engage Medicaid members. For instance, the single mother with young children and no car doesn’t need a call to remind her of an A1C test; she needs help resolving socioeconomic barriers like lack of transportation or child care.

Her story is one example of many. To address this population’s challenges, health plans can:

• Partner with community organizations to meet members in the community. Feet-on-the-street programs train people who live in the Medicaid member communities to find and talk to members about the need to address their diabetes and how they can enroll in programs. People within the communities are better equipped to communicate with Medicaid members on a level that resonates with them and spurs action.
• Help members resolve socioeconomic barriers. Chronic diabetes is complicated by the continuance of behaviors that aggravate the condition, especially among low-income patients. Working with them to identify and remove barriers, such as trouble paying their electricity bill or being able to feed their children, is the first step toward improved lifestyle choices.
• Provide flexible care coordination. It is important that the right type of care coordinator (nurse, health coach, social services professional, etc.) be assigned based on each member’s individual needs to stand a better chance of successfully shepherding Medicaid members through the complications of managing their diabetes.

What’s needed is a mixture of barrier removal and health management programs adapted to the specialized needs of this diverse population. Health plans may find more success improving quality of care and outcomes if they are willing to integrate into the population and meet members where they are in their communities.

Norman S. Ryan, MD, has been senior vice president for health intelligence at Alere Health since August 2013. Earlier, he was senior medical director at Rush Health, the physician-hospital organization at Rush University Medical Center in Chicago, where he is now an assistant professor. Previously, he was national medical director for medical management programs at United Healthcare. Ryan has also been senior medical director of Humana Health Care Plans in Illinois and Northwest Indiana, accountable for all lines of business as well as a 220-physician multispecialty medical practice and hospitalist program.