From Barriers to Solutions: Transformative Member Engagement on PopHealth Week Podcast

December 18, 2023

I recently had the pleasure of participating in a compelling episode of PopHealth Week, hosted by Fred Goldstein and Gregg Masters on the Healthcare NOW Radio platform. Together, we delved into the complexities of patient and member engagement, emphasizing the crucial role of addressing everyday life challenges to improve healthcare outcomes.

Two overarching themes emerged during our podcast:

  1. The industry must do a better job of understanding and tackling social determinants of health (SDOH) needs for individuals.
  2. Stronger collaboration among health plans, providers, and policymakers is needed for effective population health management.

Removing Barriers

With regard to SDOH, we all agreed that self-actualization in healthcare is unattainable without addressing basic human needs. I shared insights from my personal experience working with a newborn nurses’ health visiting program, Help Us Grow Successfully (HUGS). While at HUGS, I saw the barriers faced by impoverished mothers. Government assistance programs failed to meet even the most basic needs such as housing and diapers.

Failure to meet basic human needs creates significant barriers to care and health plan interventions, especially for the nation’s most vulnerable and unreachable populations. Five common unmet social needs:

  • Inadequate housing or utilities
  • Transportation to appointments, pharmacies, and more
  • Costs of childcare and transportation for such health excursions
  • Access to technology necessary for interacting with providers and plans
  • Healthcare terminology understanding and language translations

Addressing these barriers requires an effective member engagement strategy. In the podcast we discussed how 86Borders specializes in the following practices:

  • Use highly trained care coordinators who specialize in active listening and are well prepared for conversation pathways that unveil each member’s SDOH concerns
  • Understand that the basis of every interaction is a human-to-human conversation
  • Actively follow through and help address individual social needs and be part of each solution

Health Plans Focus on SDOH

Our dialogue progressed to the benefits health plans gain from focusing on SDOH and engaging their members effectively. Health plans have recognized the need to retain and grow their memberships, with crucial emphasis on member satisfaction rooted in addressing SDOH. We discussed how quality measures including CMS Star Ratings, HEDIS®, CAHPS®, and NCQA are intrinsically tied to SDOH concerns, making population health synonymous with addressing these determinants.

Documented Outcomes

Perhaps the most valuable segment of our podcast was sharing documented outcomes from 86Borders’ engagements with health plans and providers. For example, in working with a patient-centered medical home and Federally Qualified Health Center (FQHC), our team achieved a remarkable 247% increase in attended appointments for patients who had not recently seen a primary care provider (PCP).

In another example, our work with a payer on diabetes and statin medication adherence resulted in an 84% engagement rate. Sixty percent of the members adhered to their medication and 20% were referred and scheduled with a PCP. These proven outcomes demonstrate the impact of effective member engagement in healthcare.

Listen to the Full Episode

I am deeply grateful for the opportunity to shed light on the critical need for more effective care coordination and member engagement, particularly for health plans’ unreachable and vulnerable populations. SDOH is more than a strategy. It is a population health concern and moral responsibility for health plans, providers, and policymakers. For a more in-depth exploration of our conversation, listen to the full episode here.