Contributor: Engaging With Dual-Eligible Members During a Pandemic

When a crisis hits and members become isolated, how can a health plan continue to play an active role in maintaining their health?

Managing the health of a large population of dual-eligible individuals—those who qualify for both Medicare and Medicaid programs—demands a high level of flexibility and innovation, even under normal circumstances. Over the years, InnovaCare Health has developed a successful, value-based model for improving the health and wellbeing of these complex patient populations.

One element that has consistently proven crucial to achieving better outcomes is aggressive, proactive member engagement—no matter the situation, and even for those who live in the most remote corners of our service areas. We have built our model around a holistic approach that requires frequent in-person interactions to build meaningful relationships and, ultimately, improve health for these members.

But when a crisis hits and members become isolated—whether because roadways are shutdown or communities are locked down—how can a health plan continue to play an active role in maintaining their health? And how can a plan move quickly enough to prevent a drop-off in member health?

One of our Medicare Advantage plans, MMM Healthcare in Puerto Rico, treats an aging population suffering from some of the nation’s highest rates of chronic disease, including hypertension, obesity, diabetes, and depression. Many of MMM’s approximately 150,000 dual-eligible members lack consistent access to transportation and communication methods, so even before the coronavirus disease 2019 (COVID-19) pandemic changed how all of us interact, meaningful engagement with this population was a challenge.

However, on March 15, Puerto Rican Governor Wanda Vázquez ordered one of the nation’s strictest shutdowns. Despite remaining open as an essential service, no-shows at InnovaCare’s specialty care clinics skyrocketed from 11% to 70% within the first week of the shutdown. Continuity of care is critical for dual-eligible populations, and many of these members lack access to basic resources. We knew our members’ ability to get medications, fresh food, timely medical interventions, and more could be the difference between successfully managing their chronic disease or it rapidly declining.

We also knew we could quickly mobilize to reimagine our services. We quickly set up virtual health visits for plan members with mobile phones and access to the internet, and we expanded hours for those who still needed in-person visits.

We also immediately invested in expanding programs to ensure members with chronic conditions continued to receive their medications and had access to fresh food and groceries. Before the pandemic, we covered roughly 2000 such deliveries per month. In April alone, the number of deliveries spiked to more than 75,000. In just the first 10 days of this program, we delivered more than 30,000 prescriptions. Our data show these deliveries are making a marked difference in helping members to control their chronic diseases. In addition to increasing our home deliveries and ensuring members have access to fresh food, we have continued to source meat and produce for these deliveries from local farmers, keeping critical dollars local and supporting the economy.

Our standard of in-person member engagement may never return to the way it was—and that’s okay, because as always, we will go where the data tell us there is value for members and providers. We will find new ways to empower dual-eligible members to take control of their health and implement new processes that prove to strengthen outcomes and satisfaction while reducing costs and inefficiencies.

Amid the ongoing wave of COVID-19, and before the next inevitable wave can hit, we are continuing to invest resources into stabilizing our members’ health and enhancing our capabilities for serving our most vulnerable and difficult to reach. Everything is on the table. And no matter what happens next, our members will continue to know we’re looking out for their wellbeing—whether that’s from close by or farther away.

Waldemar Ríos, MD, serves as chief medical officer for InnovaCare Health, where he oversees the company’s medical management programs and has been instrumental in developing InnovaCare’s physician-focused model.

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