A woman from a low-income neighborhood chooses not to receive care from her nearest health center, which is located in an affluent community, because of a demeaning interaction she previously had with the office staff there.
A Spanish-speaking man whose prostate cancer was in remission avoided making a follow-up appointment because he was uncomfortable conversing with the staff in English. His daughter would go with him if she wanted, but he didn’t want to have to. Instead, he took a chance and stayed home.
As these two examples show, barriers to accessing health care among the most vulnerable go beyond social determinants of health (SDoH), such as lack of reliable transportation or economic instability. Cultural, racial, and socioeconomic barriers also play a role, from cultural hesitancy about seeking care to mistrust of health care institutions to stigmatizing Medicaid beneficiaries. As a result, engaging these populations is extremely complex and highly nuanced work.
How health plans can increase engagement of vulnerable populations – especially at a time when SDoHs, which are significantly affected by inflation, are worsening access to specialized care, reducing life expectancy and threatening stability? Here are three considerations.
Approach every conversation with authenticity and respect. To establish trust, care managers and customer service representatives must listen intently to members’ concerns and seek to understand their health goals, not what plan staff assume those goals should be. Professionals should also demonstrate empathy for the member’s circumstances, assuring them, “We care about you and want to help.”
One way to demonstrate authenticity is by providing messages in the language they understand best. This involves more than simply translating a script or brochure from one language to another. Health plans also need to consider a patient’s cultural or ethnic background when crafting messages that will resonate with specific populations.
Emphasizing transcreation over translation—adapting messages from one language to another, paying particular attention to intent, tone, style, and content—allows health plans to connect more effectively with the populations they want to engage. For example, to appeal to the Hispanic population, health plans must use cross-cultural teams that include people from different Latin American countries and territories such as Mexico, Peru, and Puerto Rico. This is important because words and expressions used in Puerto Rican communities may have different connotations in Mexican American communities.
Communicate consistently and frequently with a multi-channel approach. Medicaid members are at risk of losing coverage this year due to Redefining Medicaid. Over the past two years, the federal government has funneled more money to state Medicaid plans as long as they commit to not dropping members off their rolls during the public health emergency. Now that the public health emergency is set to expire this year, states must begin the process of contacting members to make sure they still meet income requirements and other aspects of Medicaid eligibility.
The problem: These members can be difficult to find, reach, and engage in the rebranding process.
When trying to reach the most under-resourced population, health plan representatives should not expect to get the response they want on the first try. This is especially true in a process as complex as Medicaid redetermination. Rather, a multi-channel approach – involving a combination of phone calls, text messages, emails and print messages – is key. For example, the most vulnerable members often have pay-per-minute mobile plans, which can affect the chances that members will want to communicate on the phone.
The most effective health plans employ a variety of approaches to initiate and maintain contact with the hardest-to-reach populations, while also taking into account generational preferences. They also remember that the more complex the message, the more likely it is to be ignored or forgotten. The most effective messages are simple, specific and personalized, as well as repetitive and relatable.
Strengthen cultural sensitivity and competency training for member-facing staff. Culturally responsive, competent, and empathetic communications can strengthen the success of complex interventions, such as closing care gaps and efforts to engage new mothers in expanded postpartum coverage in many states that was previously limited to 60 days under Medicaid. Such coverage is vital with this in mind more women die in the weeks after giving birth, with the risk highest among black women. However, coverage is expected to expand improving health outcomesa study of women in California found that black women on Medicaid were you are less likely to attend a postpartum appointment. One possible reason: structural racism which has affected the quality of maternal care that black women tend to receive.
This is an area where recruiting a diverse workforce and providing cultural sensitivity training can increase engagement by helping staff understand how specific populations make important decisions—and why they might refrain from taking a particular path. Such training can also prepare staff to rephrase questions to ensure they get the right answer. This process requires a deep understanding of the cultural nuances that can make some members hesitant to respond openly about the challenges they face—knowledge that can come through education as well as experience.
Creating a foundation for better member engagement
Covid-19 has raised awareness of care disparities between populations, but strengthening access to care and health outcomes through targeted member engagement will not happen overnight. Instead, it will take patience, sensitivity and awareness to reach a state where health plans and providers connect the right resources with the right members at the right time. By investing in culturally aware communications, training and support, health plans can begin to make a significant difference in the quality of health and life of underserved communities by improving outcomes while reducing the cost of care.
Photo: imtmphoto, Getty Images