Applying Whole Person Care to Digital Care for Underserved Members

February 10, 2022 - Payers have a significant role to play in ensuring that underserved populations receive whole person care, particularly among Medicaid beneficiaries.

First, they can serve as a bridge between Medicaid beneficiaries and their primary care providers. Ideally, payers have a close connection to both providers and members. This makes them well-positioned to incentivize preventive care and primary care utilization.

Second, payers are often at the helm of value-based care efforts alongside their provider partners. These efforts centralize primary care and incentivize a whole person, holistic approach to care. Payers have the responsibility to ensure that these strategies do not leave out vulnerable populations.

Some of the most underserved communities in the US make up the Medicaid population. For example, around 61 percent of the Medicaid population as a whole identifies as a racial minority. Nearly a quarter of all rural residents under the age of 65 in the US are covered by Medicaid.

These factors can significantly impact payers’ efforts to achieve whole person care for Medicaid members. From mid-2020 to early 2022, nearly four out of ten MVP Health Care Medicaid members had skipped primary care, the New York payer reported. Lack of transportation, language barriers, and other factors inhibited Medicaid members’ access to care.

Motivated to address these challenges, Christopher Del Vecchio, president and chief executive officer of MVP Health Care, and Kimberly Kilby, MD, vice president and medical director of health and well-being at MVP Health Care, sought to implement a digital healthcare solution that will promote whole person care for Medicaid beneficiaries. 

MVP Health Care partnered with a medical group to provide e-consulting services and more holistic care to the payer’s Medicaid members. It was not the first time that the payer has leveraged technology to bridge gaps in care, but this endeavor has raised new considerations around how to address frequent gaps in care among Medicaid beneficiaries.

The detailed requirements for a digital engagement or telehealth approach will vary based on state, Medicaid beneficiaries’ demographics, and other factors. But Del Vecchio and Kilby highlighted three overarching facets of a digital health strategy that payers can adopt, based on the MVP Health Care’s experience in creating its own solutions.

Integrate solutions into value-based care strategies

Del Vecchio and Kilby emphasized that in order to prioritize whole person care in telehealth and digital care solutions, these technologies must be integrated into payers’ value-based care strategies.

“You can't underestimate access to primary care, specialty care, multi-condition management, pharmacy lab, the complete whole person approach. In Medicaid especially, unfortunately, their care is very transactional and it's not holistic. We hope to bring about this virtual platform to close those gaps in the whole person approach,” Del Vecchio explained to HealthPayerIntelligence.

Other experts have underscored the need for a value-based care approach to telehealth as the healthcare industry seeks to integrate digital solutions more permanently. 

Providers often take the blame for not being open to integrating digital solutions, but in reality the blame often lies with the lack of incentives around those solutions, experts have argued. By abandoning the fee-for-service mindset which tends to drive higher care utilization at lower value, providers are free to deliver care in a patient-centered way and prioritize what is best for their patients.

“Ultimately it comes down to moving the system to some type of value-based payment strategy, where the system is incentivized to coordinate and not fragment the care, as we move forward,” said Del Vecchio. 

“It certainly is a challenge for all payers to bring it together and unify it because we're not in every interaction where we can have influence. That's why value-based payment structures and financing will matter in the future if we ever hope to get our arms around the ultimate solution which would be equal access and equal equity for the Medicaid member.”

Empower primary care providers, community-based organizations

By offering digital solutions to Medicaid members, payers can fulfill their role of connecting members with providers and community-based organizations that will promote whole person care.

“The biggest thing is moving from a transactional, very siloed, separate clinical experience to something that's actually integrated into the rest of your care continuum,” said Kilby.

Telehealth and digital healthcare solutions have the capacity to separate care received in an in-person setting from care received through telehealth or virtual care, further fragmenting care.

But when payers implement these solutions with a whole person care mentality, these tools can provide a new opportunity to glimpse inside of a member’s environment and identify potential social determinants of health barriers or healthcare needs. In an integrated environment, primary care providers can then use these insights to coordinate care more effectively.

Particularly in an e-consulting platform, payers have an opportunity to give primary care providers more control over referral processes and, as a result, allow them to address members’ needs more directly.

“It gives the primary care doctor their role back. They’re supposed to be the central coordinator and communicator of what's going on,” said Kilby. “That, to me, is the exciting part: almost inherent in the model is the ability to help somebody feel like they actually have an invested team taking care of them.”

In order to empower primary care doctors, the process of implementing and refining these digital solutions relies on buy-in from providers.

“What I'm trying to do is bring the conversation to providers as well, to say: people are migrating in these alternate directions; how can we all work together to help build that virtual-to-physical care continuum?” Kilby shared. “Those are ongoing conversations as providers are struggling to do the things that they're doing day-to-day.”

Listening is a key part of implementing digital solutions that could improve whole person care in underserved communities and it should occur at all levels of the organization, Kilby underscored. 

In fact, implementing such a solution could require internally reassessing the payer’s understanding of Medicaid members and their whole person care. Member-facing employees can be an essential resource for projects like this, offering firsthand insight into factors the payer might have overlooked.

In addition to providing a pathway to primary care services, holistic, digital solutions for the Medicaid population should integrate community-based organizations, Kilby said.

For payers interested in setting up a digital solution like MVP Health Care’s e-consulting model for their Medicaid members, Kilby emphasized that the effort requires grassroots energy. 

Payers should not assume that they have identified all of the barriers to care that Medicaid members may need to be addressed through the digital tool. Instead, they should listen to members and community partners to help assess potential barriers to care.

Enable multi-condition management

Payers that seek to improve whole person care for Medicaid beneficiaries and underserved populations should consider building multi-condition management into their platforms.

In Michigan’s Medicaid program, for instance, nearly six out of ten beneficiaries had two or more co-occurring chronic conditions and 12 percent of beneficiaries had four or more co-occurring chronic conditions, according to a study from the Journal of General Internal Medicine.

Certain conditions are very likely to have a co-occurring condition. 

For example, the overlap between substance use disorders and co-occurring mental healthcare needs is well-documented. Addressing this trend is particularly critical for the Medicaid population, in which almost 12 percent of beneficiaries over the age of 18 have a substance use disorder and which traditionally has a higher rate of opioid use disorder than the general population.

Given the prevalence of co-occurring conditions among Medicaid beneficiaries, MVP Health Care chose a technology partner that could offer an easy referral process and access to specialists. 

The ability to access specialty care input as well as primary care services through a single platform supports care coordination, Kilby said. It helps place the member at the center of a cohesive care team, instead of leaving them to pull together their care management through multiple channels.

“It actually helps to keep the care centralized and not send people out onto these specialty care referral journeys which may or may not bear fruit. We do know they disrupt people's lives, cost a lot of money, and can sometimes continue for a little longer than they really need to,” Kilby explained.

By maintaining centralized care and addressing members’ conditions holistically, payers can minimize the transactional approach to care for Medicaid beneficiaries and elevate whole person care.