How Community Advocacy Improves Health and Outcomes

By Rene Macapinlac

Access to primary care is important, but there are other factors outside of the doctor’s office that determine one’s health. To help its member lead healthier lives, health plans should focus on advocacy and community-based programs.

Speaking to attendees of the Medicaid Managed Care Congress in Baltimore, Carol Steckel, senior director of public policy at WellCare, emphasized how identifying community-based solutions help improve health outcomes of their members and ultimately lower overall cost of care.

At WellCare, Steckel said they examine the health and welfare in the populations they serve. Using that data, they are able to identify the gaps in the network of social services. Where needed they link their members to such services as housing assistance, employment services, food banks and education support. They also improve quality of life for residents by providing transportation for seniors and people with disabilities so that they could go to medical appointments, day programs and shop for groceries.

 

Linking members with the community and social services improves health outcomes and ultimately lowers overall cost of care.

Rene Macapinlac is the Director of Operations at ManagedCareBiz, an online resource for managed care professionals who need to stay up-to-date on industry news, analysis and commentary.

Medicaid Expansion Boosts Insurance Coverage, Use of Healthcare Services

- By Rene Macapinlac

Critics of Medicaid expansion have voiced out several reasons why states should not expand the program. Aside from concerns that it will burden the state budgets, they question Medicaid’s effectiveness in providing quality care. 

Now there are solid facts to support the case for Medicaid expansion.

A recent study found that in states that expanded Medicaid under the Affordable Care Act, insurance coverage increased for low-income adults. The study, published by the Annals of Internal Medicine, also found better healthcare usage and diagnosis rates for chronic diseases.

Researchers at the University of Michigan and the University of California-Los Angeles analyzed data from the National Health Interview Survey between 2010 and 2014. They compared the changes in outcomes among adults (ages 19 to 64, with family incomes 138 percent below the federal poverty level) in the 26 states that expanded Medicaid in 2014 with outcomes for adults in states that did not enact Medicaid expansion.

Among other factors, the researchers looked into coverage improvements compared to the previous year, doctor visits, hospitalizations and emergency department visits.

Here are some of the study’s key findings:

• In states that expanded Medicaid, insurance coverage increased 7.4 percent and Medicaid coverage increased 10.5 percent compared to non-expansion states.

• States that expanded Medicaid saw an increase in adults reporting an overnight hospital stay (2.4 percent), or visit to a physician (6.6 percent) in 2014, compared to non-expansion states.

• In states the expanded Medicaid, the rate of diabetes diagnoses increased (5.2 percent) as well as cholesterol diagnoses (5.7 percent).


It’s important to note that there were limitations to this study. Researchers only looked at the experiences of low-income adults during the first year of enactment of Medicaid expansion. They were not able to definitively rule out other factors unrelated to Medicaid expansion that may have influenced the results.

Although the study showed low-income adults were more likely to go to a physician or hospital, it was not able to determine improvement in the adults’ health because of the limited available data.

The researchers, however, have no doubt that greater use of health services could pay off in the future. They pointed out in the study that increased detection of chronic health conditions under Medicaid expansion could have important implications for both population health and national spending on health care “if it leads to improved management and control of these conditions." Since states began Medical expansion in 2014, Medicaid enrollment has gone up to more than 70 million people.

Monitoring these trends over time will be critically important for Medicaid managed care professionals as they prepare to adapt to changes, particularly when it comes to the people now gaining Medicaid coverage. Under the Affordable Care Act, states are now using Medicaid managed care plans to cover beneficiaries in rural areas, those with complex and chronic conditions, and many new enrollees. It will be interesting to see in the coming months how access to providers will be affected - as enrollment goes up and the number of uninsured people go down.


About the author:

Rene Macapinlac is the Director of Operations at ManagedCareBiz, an online resource for managed care professionals who need to stay up-to-date on industry news, analysis and commentary.

Medicaid Managed Care Congress: Q/A with Carol Steckel (WellCare Health Plans)

With the Medicaid Managed Care Congress (MMCC 2016) right around the corner (May 18-20, 2016) we have reached out with the Q/A to one of the keynote speakers Carol Steckel, MPH Sr. Director,  Alliance Development, WellCare Health Plans, Inc.

What do you think will be the major implications of the Mega-Reg?

- Mega-Reg has the potential to strengthen the states’ ability to use managed care to promote innovative and cost effective methods of delivering quality care to Medicaid and CHIP beneficiaries.

What do you wish someone would have told you before joining Medicaid/healthcare industry?

- Navigating such a complex system can pose challenges and the system routinely and frequently changes. These challenges are offset by the knowledge that the work you are doing is improving the lives of the people we serve.  

What upcoming major trends are you excited about?

- There is great opportunity for states and managed care organizations to work together to empower people to take control of their health. I am most excited about the linkages we are developing between physical health, behavioral health, and social determinants of health.

What is the secret to success in your opinion?

- Working hard to be part of the communities where our members live helps us bring together the resources needed to serve the most vulnerable populations. Our members often face challenges in life beyond their health. By connecting them to needed social and community services, we seek to improve their ability to take control of their health by addressing their overall needs. We also strive to engage them in needed preventive health services to ensure they are getting the right care at the right time at the right place.

For MMCC, what do you hope to learn more about / who do you want to hear from?

- Providing care to vulnerable populations often involves going the extra mile to find and engage members where they live, whether that is in their homes, in a shelter or under a bridge – none of which is possible without collaboration across sectors at the local level. Learning more about the efforts of community organizations working to support the social safety net can help MCOs identify and address care gaps that may be barriers to health. 

Do you have any best practices of success stories you’d like to share? If so, please elaborate.

- WellCare uses a coordinated care approach designed to ensure all of our members receive the unique services and supports they need to achieve and maintain the best health outcomes possible. This is based on our belief that a healthy community is one where social safety net providers and community-based organizations are thriving and supporting the needs of its citizens. We identify care gaps, which occur when the social safety net is stretched too thin. We partner with community groups to address these needs, and close the care gaps. We also work with academic partners to evaluate the programs to quantify the results in terms of cost savings, increased access to health case, and other benefits to the public health system. This approach allows us to deliver on our mission of enhancing our members’ health and quality of life and strengthening the communities we serve. 


Carol Steckel will also be presenting at the MMCC 2016 with a case study "Community advocacy, health connections model" which will cover three important questions:

- How to link a member to a community and/or social service?
- How to support the community in developing needed services?
- How to measure the impact of the program on our members?

To learn more about Carol Steckel's case study or to see who else will be presenting at the Medicaid Managed Care Congress download the brochure here. 

Have a comment? Share your thoughts in the comments section or follow us on Twitter: @healthcarebiz and #MMCC16

Earn a FREE pass to the IIR's MMCC 2016 in Baltimore, MD - Become a Guest Blogger!

Medicaid Managed Care Congress (MMCC ) 

May 18-20 2016
Baltimore Marriott Inner Harbor
Camden Yards, MD

Join the IIR's Medicaid Managed Care Congress 2016 (MMCC) to learn from the government officials, health plan executives and other key players of the healthcare industry who get together for an annual knowledge exchange and networking.

As a Guest Blogger, you’ll have access to the IIR’s MMCC 2016 comprehensive agenda attracting the best insights from around the world, right in Baltimore, MD in May.

We are looking for an industry expert with interest in the following topics:

• Mega Reg;
• Financial and operational success –rate setting, risk adjustments;
• Outcomes and Social determinants of Health (population Health);
• Co-ordination and integration of care – long term care, long term services and support;
• Pay for performance or value based payment strategies;
• Driving Performance at the Provider Level;
• New contract requirements, value based payment arrangements with provider networks
• Innovation Accelerator Program (super utilizers, behavioral health & physical health integration, LTSS);
• Medicaid Eligibility churn;
• Integration of physical and behavioral healthcare services;
• Transparency and rate setting;
• Risk Quarters;
• Medicaid expansion and what the future of that looks like (Exchange models);
• Mental health and substance disorder treatment;

....and who would like to learn about the current state and the future of Medicaid managed care!


The premise is to provide MMCC 2016 related blog posts (300-500 words), whitepapers, and overall light coverage of the event.

What You get is:

• FREE all-access pass to the conference (valued up to $2,695);
• Access to extensive learning activities with the top regulatory thought leaders and policy makers;

• Exclusive admission to a networking community in the industry of your interest!

You also have a chance to GAIN exposure through our Healthcare Insights blog with over 2000 unique visitors monthly and more than 20 healthcare LinkedIn groups.

Learn more about the IIR's Medicaid Managed Care Congress 2016 (MMCC) by visiting the website.

Interested & want to learn more about this opportunity? Please contact Ksenia Newton at knewton@iirusa.com 

We hope to have you join us in Baltimore, MD this May!

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