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Drivers of Patient Experience in Medicaid Managed Care
November 30, 2016

Drivers of Patient Experience in Medicaid Managed Care

Jeff Blake, MBA is a healthcare strategy and communications leader with expertise in regulated healthcare marketing, community engagement, public/government relations and strategic partnerships. Over the past decade, he has directed marketing and communications for major integrated healthcare systems, operating at the intersection of strategic planning and corporate communications. His writing often covers topics such as reputation management, strategic growth and patient experience in both provider and payer settings.
Metric-Aligned Provider Incentives (Pay for Performance)
Many MCOs offer pay for performance (P4P) to providers that reach certain goals. However, thanks to their investments to obtain actionable, provider-specific data, both L.A. Care Health Plan and Molina Healthcare have been able to establish P4P incentives that effectively reinforce the strategic goal of improving patient experience. Throughout Molina’s many plans, Syiek explains, provider engagement teams work collaboratively with strategic providers to encourage the mutually beneficial outcomes that lead to more performance incentives. Molina’s P4P incentives are aligned with HEDIS metrics, and are designed to drive overall quality measures, which correlate with higher patient satisfaction.8

Molina has also instituted shared savings programs as an additional incentive for some of its larger providers. Said Syiek, “The gateway to savings is achievement on quality measures. We view quality as the basis for all value-based reimbursement. The providers who gravitate to P4P are the ones that have gotten there to set themselves apart from other competitors. Quality is what makes them different, as well as what makes us different.”

Syiek and her team have found that by offering these incentives, providers quickly realize improving quality and patient experience makes them a more advance and competitive practice, not only with Medicaid and Medicare members, but with commercial health insurance customers as well. Other insurers have also developed customized provider incentive systems to drive performance on patient experience metrics, such as paying providers more for expanding office hours, conducting longer patient visits and engaging with members via email and phone.9

Member-Focused Patient Experience Initiatives
Patient experience ratings of health plans and MCOs share some of the key drivers of patient experience by providers, and include: 

  • wellness-based service offerings3
  • ease of getting care and appointments as soon as needed 
  • how well doctors communicate with patients; and 
  • the helpfulness of the health plan’s website, call center and customer service personnel.7
MCOs can leverage these member-side drivers of patient experience by focusing on patient education and engagement and offering meaningful and intuitive self-help options.

Patient Education and Engagement 
Studies demonstrate patient education can minimize many of the variable overhead costs of a plan’s member services, such as the volume of complaint investigations, telephone contacts, claims appeals, adjustments and outstanding medical debts.6 As an additional bonus, patient engagement also leads to higher customer loyalty and improved profitability.10 One effective method of reducing the volume of costly incoming calls is to place targeted outgoing engagement calls to reduce missed opportunities and clarify expectations. For example, some plans call members who have upcoming appointments to remind them of the visit or confirm their out-of-pocket costs, avoiding a frustrated call from a patient after they receive the bill.9 Molina employs many bilingual call center agents for this purpose, and utilizes the member’s local area code when calling from its national headquarters to improve call answer rates.

New member engagement also presents opportunities to build trust and reduce systemic costs for MCOs. For instance, an easy to understand on-boarding process is particularly critical for those newly eligible for Medicaid who may previously have been uninsured.

“Simply giving them a card to put in their wallets doesn’t help them understand how to utilize their care options,” said Baackes.

During orientation, first-time insurance customers who may have relied on hospital emergency departments learn about the conditions their new primary care providers will manage, as well as how to take advantage of L.A. Care’s wellness programs and family resource centers. These programs not only reduce costs for L.A. Care and its providers, but also support the proper utilization of the healthcare system as a whole.

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