Housing, Basic Needs Top Challenges of Caring for Complex Populations

Health plans that manage complex populations covered by Medicaid often have to get creative in order to provide care for their consumers, explained panelists at America’s Health Insurance Plans’ National Health Policy Conference.

The complex populations covered by Medicaid often have issues that make it difficult to care for them: disability, low income, homelessness, etc. The health plans that work in this space have to get creative in order to provide care for their consumers, explained panelists at America’s Health Insurance Plans’ National Health Policy Conference, held in Washington, DC.

Paul Tufano, chairman and CEO of AmeriHealth Caritas, kicked off the session by noting that the consumers they cover lack basics that many people take for granted, things like access to doctors and hospitals and fresh food. For many poor and rural residents, these are not things that they can easily obtain.

He followed up with 4 points that need to be remembered when caring for people on Medicaid:

  1. People don’t want to be poor.
  2. Poor people want to work and provide for themselves. There may be some exceptions and examples of abuse, but “bad behavior exists regardless of financial circumstances,” he said and pointed to what has happened on Wall Street.
  3. Poor people are Americans, too.
  4. The poor want to be treated with dignity. “I’m not in the Medicaid managed care business,” he said. “I’m in the dignity business.”

Pat Wang, CEO of Healthfirst, added that the populations they care for are not the ideal patient. These individuals may not be able to schedule or keep an appointment, they may not have transportation, discretionary funds to buy something like cough syrup, or even a roof over their head or heating for the winter.

“Programs have to wrap around the members and where the members are and their reality,” she said.

Wang went on to discuss the importance of having community ties and providers who are the same ethnicity as Healthfirst’s members.

“Our providers are extremely diverse; they are from the communities our members are from,” Wang said. “And we believe that is very important in order to ensure culturally competent care.”

For Molina Healthcare, managing complex populations means aiming to return people to the community and remain at home by shifting from inpatient to some form of outpatient care. However, J. Mario Molina, MD, president and CEO of Molina Healthcare, explained that homelessness complicates the work. For example, patients might have to worry about their pills being stolen. Or, if they are told to take medication with food, they might not be able to follow that instruction.

Kenneth Burdick, CEO of WellCare Health Plans, Inc, echoed the difficulties of caring for a homeless and transient population. WellCare will send people out to find the homeless under bridges and at shelters to ensure they are getting the care they need.

“It’s about getting up close and personal with these individuals,” he said. “They need to know they can trust you.”

Dr Molina added that one of the challenges of caring for this population is that Medicaid does not cover housing, so it’s up to the company to find places for members to live in order to transition them out of facilities.

Tufano called the housing situation the “one of the next frontiers” that needs to be addressed. After providers spend the time to get members healthy, they end up going back to environments that are unsafe and unhealthy.

“We will spend thousands of dollars a day to put someone in the hospital, but Medicaid won’t spend money for housing that would prevent all these medical costs,” Dr Molina said.