Getting to know the Medicaid member

For Medicaid plans and MCOs, member engagement is a key factor in improving quality standards, including healthier outcomes and a better patient experience. Before plans can engage, however, they first need to understand who they’re engaging with.

There is ample information available on Medicaid members that allows plans and MCOs to build profiles of various member groups. This knowledge can then be leveraged to target each group in relevant ways, both in terms of the message as well as the manner in which that message is delivered.

Here we will examine some basic demographic information on Medicaid members, a segment of the population primed for significant growth, and an example of how to engage with specific segments based on their habits and needs.

The Basics: Medicaid Member Demographics

Here is a broad overview of Medicaid member demographics, according to 2017 data from Kaiser Family Foundation:

  • Ethnicity: According to the data, 41 percent of Medicaid members are white, 25 percent are Hispanic and 22 percent black, with 12 percent identifying as other races. As a comparison, the U.S. population as a whole is 61 percent white, 18 percent Hispanic, 12 percent black and nearly 6 percent Asian, according to Pew Research Center analysis of U.S. Census Bureau data.
  • Gender: Medicaid members are 59 percent female and 41 percent male. The U.S. as a whole is roughly 51 percent female and 49 percent male.
  • Age: Among Medicaid enrollees, 48 percent are age 18 or under, while 12 percent are 19-26, 18 percent are 27-54, 12 percent are 45-64 and 10 percent are 65-plus.

As you glean these figures, a few trends become apparent. For example, compared to the general U.S. population, a higher percentage of Medicaid enrollees are minorities. Also, the male-female ratio skews more female among Medicaid members and nearly half of enrollees are 18 and under, indicating that women and their children make up a significant chunk of this population.

An Opportunity for Huge Growth: Dual Eligibles

A recent study by MACPAC surveyed more than 1,100 U.S. consumers and focused on three groups: current Medicaid members (Medicaid only and also dual eligibles, those eligible for both Medicaid and Medicare), those who are eligible for Medicaid but not enrolled (EBNEs), and those who became eligible for Medicaid as a part of the Affordable Care Act (new eligibles).

The study also included a segment of commercially insured consumers to allow for comparisons. The report yielded loads of useful insights, but this was among the most striking: a significant portion of dual eligibles are not being reached and engaged with effectively, due in part to misconceptions about this group.

Since this group also qualifies for Medicare and is made up of consumers age 65 and older, it’s not particularly surprising that the segment is fairly active when it comes to health care. For example, 75 percent of people in this group reported three or more health conditions, and 90 percent said they had visited a primary care provider within the past year. Further, another 8 percent said they made at least three visits to the emergency room over the past 12 months.

What is surprising, however, is how limited engagement with this group seems to be. Nearly a quarter of dual eligibles, 22 percent, said they were never contacted by their health care provider outside of care delivery, while 46 percent said they’d never been contacted by their insurance company or program.

These numbers signal an opportunity for increased engagement, which could lead to healthier outcomes across the board. If that 46 percent who said they’re never contacted by their insurance plan were instead encouraged to take part in preventative health measures to help avoid serious illness or chronic conditions, the number reporting three or more health conditions would almost certainly go down.

Using Insights to Improve Engagement

Once plans and MCOs begin to understand who their members are, they can make more informed decisions about how to engage them. Similar to tactics used in advertising, plans should target their desired audience where they are, which means both in the physical locations they visit, and utilizing the types of media they’re most likely to use.

Continuing the dual eligible example, the MACPAC survey found that 28 percent of this group identified the internet as a go-to source for health-related information, while 43 percent identified TV. This would indicate that among these older Americans, TV remains one of the most effective forms of engagement.

As a comparison, the same survey found that 71 percent of commercially insured individuals cited the internet as a source of health-related information, while just 26 percent said TV. That means using digital channels to target these consumers would likely be more effective than TV.

With all of this in mind, text messaging can be an effective way to engage with Medicaid enrollees across the board due to one simple fact: nearly everyone owns a cell phone. A full 95 percent of U.S. adults own a cell phone of any type, according to Pew, and that includes 85 percent of people age 65 and older and 92 percent of those with annual household incomes below $30,000.

This opens up all sorts of engagement opportunities via text, such as confirmations of upcoming appointments, or reminders to take medications. It’s a practical way to reach lower-income families because while their address may change more frequently than the average, their cell phone number is likely to remain the same.

There are many pools of data available on Medicaid enrollees, and it’s up to plans and MCOs to scour these sources to learn as much as they can about their populations. If you use as many tools as possible to understand who your Medicaid members are, you give yourself a better opportunity to engage with them in the most efficient and effective way.

To learn more about how to engage with Medicaid members, download the NovuHealth’s “Medicaid Managed Care Member Engagement Guide.”

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