Health Information & Vulnerable Populations: Health Plans
To gain a better understanding of how various healthcare stakeholders see their role in developing and providing health information to vulnerable populations, Oliver Wyman, with support from the Robert Wood Johnson Foundation, is conducting a multi-disciplinary study of the health information landscape. Over the course of the spring and summer of 2016, Oliver Wyman conducted interviews with nearly 100 marketplace leaders. The preliminary findings from that research were previously published. (Read the report.)
Here, Oliver Wyman Partner Helen Leis and Principal Graegar Smith, with consultant Gary Zhu, provide further details from our interviews with health plan leaders. They highlight efforts that health plans are making to provide more effective health information for vulnerable populations, especially low-income, uninsured, and non–English speaking individuals, and their caregivers. The following insights are drawn from plans that have lines of business in the Medicaid and/or Health Insurance Exchange markets:
Organizational Priorities
Health plan leaders we spoke to said they recognize the importance of providing information that helps their members understand their benefits, receive care, and manage health and wellness. However, some indicated that market pressures are making it increasingly difficult to prioritize health information over other organizational needs. When asked how health information stacks up to other priorities, an executive at one plan said: “I think it is a competing priority that doesn't make the cut during a time of massive transition that has cost us a lot of money.”
Nevertheless, most plans that we spoke to remain committed to providing health information. These plans view health information as playing an important role in driving broader organizational goals, such as achieving better cost and quality outcomes, fulfilling regulatory mandates/receiving accreditation, and securing better member satisfaction. “We believe that an educated consumer with good information is more apt to make good choices and take action in a way that will drive better cost of care,” one plan executive told us.
Current Health Information Offerings
Interviewees responded that the most sought-out information pertains to finding providers and understanding coverage. As a result, that is where plans are directing their resources. “The number one thing … is finding a primary care physician,” one executive noted. “Number two is finding a specialist.” Another stated: “They're calling for I think what you'd expect. ‘Am I covered for this? Is this provider in my network?’”
Plans with lines of business in Medicaid and ACA generally provided the same types of health information as plans serving the commercial population. Both provided information around basic insurance concepts, triaging tools, and price-comparison guides to educate their members in choosing suitable – and less expensive – sites of care. They also both provided health and wellness materials to help their members stay healthy and avoid unnecessary visits. Plans serving Medicaid and ACA members understood that these individuals have specific needs, and so some are offering customized information offerings, such as sending text reminders for care visits and providing translated materials for non-English speakers.
Success Stories: How Plans are Improving Health Information for Vulnerable Populations
Developing more culturally relevant content. Many stakeholders acknowledged that the U.S. healthcare system is very difficult to understand and navigate and there is a lack of culturally relevant health information materials. One insurer, which has a significant Latino member population, has conducted research studies to better understand the needs and preferences of their non-English speaking members. Then, taking the learnings from the studies, they have tried to create materials that better resonate with those members. For example, recognizing that family is very important in the Latino culture, health information brochures are populated with images that highlight family ideals, such as a husband and wife surrounded by their children and grandchildren as opposed to images displaying single individuals.
Utilizing more effective communication methods. Several health plans focused on improving health information delivery. Aware that the communication preferences and capabilities of vulnerable individuals might differ, one Medicaid-specific plan is looking to connect with its members in new ways, such as texting, calling, and patient portals. Another plan that offers Medicaid coverage has engaged community health workers to disseminate health information. According to an executive at that plan: “[These] individuals are not just culturally competent, but they're embedded in the communities and they really know the individuals, and the individuals trust them.”
Addressing non-clinical health needs. Some vulnerable individuals are unable to effectively manage their health because they have more pressing needs, such as paying for food, shelter, and utilities. “If someone has food insecurity, they're not worried about their diabetes or their hypertension,” one plan executive noted. While non-clinical needs have been recognized as important to determining health outcomes in the past, plans are now putting more emphasis on addressing them. For example, an executive from a health plan that caters to the Medicaid population told us: “We're working with the support system; we're helping people with low-income electricity, with the reduced cost gas program. Our success is the whole human, not necessarily just a medical piece of it, because that really is only one piece of the equation.”
Ways to Accelerate Progress
The innovative efforts that health plans are undertaking to improve health information offerings to vulnerable populations are certainly encouraging. However, challenges to greater progress remain. Interviewees identified the following areas for future efforts:
- Regulatory reform.
Some plans highlighted regulations as hindering their efforts to deliver better solutions. One plan executive suggested that existing policies are outdated and prevent the development of innovative offerings. “It's just because policy hasn't caught up with technology. They're a huge hindrance,” he said. Another interviewee pointed to policies that regulate consumer-facing communication methods, such as texting, as obstructive, and said they prevent plans from exploring new ways to connect with members. - Payer-provider collaboration.
Plans acknowledged that in order to improve health outcomes, it is imperative for them to support providers in the care of their members, especially when providers are facing difficulties in managing patients. As to why plans would develop internal care-planning capabilities, one plan executive said: “I think the providers have basically failed in doing this. Providers would like to be the source of the care plan, they just don't have the resources.” Another plan executive highlighted providers’ capability restrictions, noting: “Most physicians in office-based practice don't have the resources to be able to do the level of healthcare management that, for instance, a health insurance company or a disease management program can do.”
In closing, we recognize that health plans are generally attuned to the importance of providing health information, and we are encouraged that many have proactively taken steps to improve their offerings for vulnerable populations, despite other organizational needs. Further progress in the area now depends upon internal improvement efforts, as well as collaboration with other stakeholder groups to align on common goals.