Senator attacks centene’s callous behavior

As the healthcare industry continues the shift toward value-based medicine, Medicaid plans and providers have two clear avenues to pursue in demonstrating success in managed care and population health that can improve their HEDIS scores:

  • In the near term, closing gaps in screening procedures to improve adherence.
  • Over the long term, working to change the health behaviors of patients with chronic conditions to improve outcomes.

These two goals share one important characteristic: attempts to make headway frustrate providers, who note that “patients don’t do what I tell them.”

Physician advice regarding screening schedules, a better diet, regular exercise, and so on may get a nod of agreement during an exam. But  the agreement seems to disappear soon after.

And so it goes—patients will continue not doing what providers tell them to do and lamenting the situation won’t change anything. What’s required is a view from the patient’s perspective.  Understanding barriers is a requirement for removing them.

With screening, for example, the fact that tests are provided at no cost doesn’t mean they are without barriers.

One Medicaid patient may have not access to transportation and won’t make a screening unless transport can be organized.

Another may have called a primary care provider for a flu shot and been told an appointment would be necessary, unaware that a pharmacy around the corner provides more convenient immunization.

Myriad reasons exist for screening adherence gaps. They must be identified and removed, patient by patient, for improvement.

Changing the health behaviors of patients with chronic conditions is more complex. Lifelong bad health habits will take much more than a doctor’s advice to correct. Changing behavior may require one-on-one engagement with a skilled health coach.

While there are no ready-to-go, turnkey resources to engage in addressing these issues, they must ultimately be addressed if we are to get serious about improving population health among Medicaid members—and if plans are to see their HEDIS scores rise as a result of their concern about screening adherence and health behavior change.


Medical Devices Summit Boston, MA February 19–20, 2015
3rd Annual Summit to Improve Adherence and Enhance Patient Engagement Philadelphia, PA March 9–10, 2015
Value-Added Solutions for Enhanced Customer Experience Philadelphia, PA March 9, 2015

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