With the changes in the market luring physician practices and long-term care organizations to jump into the Medicaid managed care business, churn is one obstacle among many to overcome. But one health plan has found a way to attract and retain members through a life coaching and assistance program called Life Services. An Optum white paper says retention in the Medicaid sector is difficult, but not impossible, with good care coordination and other strategies.
Attracting customers is important for any business, but with Medicaid it’s especially important, says Kris Rossi, director of consumer experience for Dayton, Ohio-based CareSource, a non-profit managed care organization. Operating in Georgia, Indiana, Kentucky, Ohio and West Virginia, CareSource has 1.9 million members and a nearly 30-year history of serving low-income members.
According to Rossi, CareSource is one of the largest Medicaid managed care organizations in the country. “We do have a fairly stable population, which speaks to our service,” she says. “We don’t have much churn. We prevent churn with our brand reputation and the service we provide; it’s not a coincidence.”
Commercial health plans attract members through premiums, but with Medicaid, the brand reputation is critical, and that leads to word-of-mouth referrals. “There’s no replacement for word of mouth,” Rossi says. “The best way to attract new members for any health plan is by providing great services. Start there for retention.”
According to Rossi, patients have high expectations, and the benefits of loyalty programs can be two-fold. Consumers benefit through a loyalty program’s perks and rewards, and health plans benefit by strengthening relationships with patients and providers. An effective consumer loyalty program embedded in a health plan can convert patients into brand evangelists, she says.
Pilot Turned Into Loyalty Program
In 2015, CareSource created a pilot that turned into a loyalty program. Life Services couples Medicaid with a holistic approach to addressing economic well-being and social connectedness through life coaching and social assistance. According to Rossi, the long-term goal of the program is to help members become financially, emotionally and socially secure so they are able to live a subsidy-free life. The program may be unconventional for a managed care company, but CareSource is going on the premise that 80% of a person’s health is determined by social and economic factors.
“When we look at members who are very vulnerable, preventative visits aren’t the biggest fire they are addressing,” Rossi says. “They are worried about where they will sleep tonight. We recognize that Life Services is more of a philosophy of how we help our members who have complicated and challenging lives, the same as we do, but the stakes are different.”
One member, featured in the CareSource Life Services promotional video, was a highly educated woman who lost her job and had health issues, Rossi says. Her health issues weren’t her biggest problem, but they were “a lynchpin to building her stability.” All of her problems worsened, and eventually she took advantage of Life Services and rebuilt her life. She needed help in many areas. “It was a mosaic, really,” Rossi says.
CareSource says the Life Services program is voluntary. When a member signs up, a Life Services life coach is assigned to the case to do a short assessment of the member’s needs, identifying potential available resources and prioritizing what should reinforced, including the need for emotional support, food stability, child care and physical health.
By building partnerships, Life Services is able to coordinate local community, state and federal program resources for members. Once stable, members are connected with education or employment opportunities. After members have been guided through the process of getting a job, their Life Coach stays with them for a period of 24 months to help ensure their success.
As of this June, CareSource reports that 5,757 of its members have interacted with Life Services. Among those, 1,332 have opted to participate in the program, and 1,262 are working with coaches. There are 62 employer partners working with Life Services, and 502 members have gained jobs through the program. The employment retention rate is 88%.
Optum, a health services company owned by UnitedHealth Group, issued a white paper on attracting and retaining Medicaid members in the wake of the Affordable Care Act’s Medicaid expansion. “Although these new enrollees create the prospect of new customers for health plans, they also put an additional administrative burden on plans — many of which are already struggling to attract and retain new members through health care exchanges,” Optum says. One challenge Optum points to is the lack of communication between stakeholders, which can impact quality of care, increase duplication and lead to higher costs.
“Lack of communication between stakeholders is not a Medicaid issue, it’s a health care issue,” Rossi says. “This is a known issue across the spectrum of health care.” That’s one reason for the rise in primary care medical homes and the emphasis on care coordination, she says.
Optum also cites the lack of consumer engagement and understanding of eligibility, resulting in poor use of benefits and poor member loyalty. “Medicaid member churn is high due to a lack of awareness and confusion around certification periods and eligibility requirements,” Optum says. “Medicaid churn can be especially costly for plans, yet it also can be preventable.”
Rossi says to keep in mind that often Medicaid members are busy with multiple redetermination periods — for different federal and state benefit programs — at the same time. “To assume that everyone is just confused and that’s why there’s churn, is naÃ¯ve,” she says.
CareSource’s success in the Medicaid market has been enhanced by its business philosophy of empathy. The company has an internal saying, according to Rossi, which goes along the lines of, “we are all one life event away from being one of our members.” The company doesn’t consider the members apart from themselves. “These aren’t other people,” Rossi says. “They are us.”
Read Optum’s paper on Medicaid retention at http://bit.ly/2h62iPN.