Medicaid programs are increasingly interested in fostering cross-sector alignment as a means to provide quality and cost-effective health care services. At the center of these efforts are the individuals, families, and communities that depend on the health and social services provided by the state. For MaryAnne Lindeblad, Medicaid Director for the Washington Health Care Authority,  building opportunities to engage consumers and understand their perspective is crucial to continuously refining the state program that provides health care coverage to more than 1.8 million residents.

CHCS recently spoke with Ms. Lindeblad, a fellow of the 2010 inaugural class of CHCS’ Medicaid Leadership Institute, a national initiative made possible by the Robert Wood Johnson Foundation. Ms. Lindeblad shared her approach for engaging consumers to improve the effectiveness of service design and delivery for Washington’s Medicaid program.

Q: What are your goals for consumer engagement? What strategies for identifying and actively engaging consumers have been most effective for you and your team?

A: Our Medicaid agency is fortunate to have access to both physical and behavioral health experts within the Health Care Authority who have substantial expertise in consumer engagement. Their expertise has helped inform our approach to involving the people who use our agency’s services. Today, as we make decisions, programmatic changes, and evaluate the success of our work — we make sure that the people we serve are part of those discussions. We bring them in through focus groups, surveys, including consumer engagement through our Accountable Communities of Health, and through our Title 19 Advisory Committee. This is done with the goal of hearing consumers’ voices, meeting their needs, and finding out how the system is or is not working for them. Taking these steps to engage them in meaningful ways has given us an opportunity to reshape and rethink how we respond to the individuals we serve.

A particularly valuable tactic has been our community forums, which we initiated as a part of our 1115 Medicaid Transformation waiver. We focus on topics that are important to our beneficiaries, such as the types of behavioral health programs available. These forums serve as a good opportunity to not only collect feedback, but also share information with people about how our programs work. We make an effort to be where Medicaid beneficiaries live and address topics that are important to them. This strong focus on taking a regional approach to care is infused throughout our various programs. We look for any opportunity to be in their communities to provide information or answer questions. It’s about showing up — so people see you not as just an insurance company or policymaker, but as a person who is trying to deliver health care in ways that are the most useful to them as an individual.

We’re also very active on social media, which is one of the best ways to connect directly with the people using our services. We use their feedback to help inform our decisions, and it is also a forum to help educate people about programs they might not be aware of but are eligible for.

Q: How has engaging directly with consumers changed the way you manage Washington’s Medicaid program? How has it impacted the organizational culture and the way your team approaches the work you are doing?

A: One important change is a new focus on how we communicate. We’ve changed materials based on our engagement with consumers, such as during the rollout of our online state benefits exchange (where people also enroll in Medicaid). After bringing in actual clients, they told us things like “you don’t want a picture like this,” or “if you explain it this way, it won’t make sense.” And we listened.

We have also made systems more accessible for individuals with limited English proficiency, as well as individuals with disabilities such as blindness. We listen to what folks are saying and make changes where we can. Another change is our effort to hire individuals with lived experience navigating the Medicaid system. It is helpful to have them on staff, and available to bounce ideas off of, because they’ve been the user of the systems we’ve created.

Ultimately, our changes have been aimed at making the system more “user-friendly” and consumer-oriented. You’ll see that in how people will stop and think for a minute — they’ll take a breath, and think about why that person is providing that input. They’ll try to put themselves in their shoes and understand their frustration when they’re trying to get a question answered, or they can’t get a service delivered.

Q: Developing ways for consumers to provide feedback during the program or policy development process as well as after implementation are equally important, but present different challenges for the state. How does Washington State ensure continuous opportunities for consumers to provide their perspectives both for new and long-standing programs?

A: Quite often, consumers are left out of the early stages of policy planning and development. In the past, during community forums, we would learn things after the fact that would have been useful. This might include how the policy could have been delivered or explained better, or what materials and mechanisms were needed to communicate the changes to our members. We made sure community-based organizations and advocates were at the table from the beginning, but we were missing something by not having consumers themselves involved from the start.

In the future, our goal is to have consumers involved before policies are even decided. The voice of the consumer is as critical in policy development as it is in post-implementation.

Q: What advice or lessons would you share with other Medicaid leaders who are looking to increase consumer engagement in their state?

A: My advice would be to stay open to lots of approaches. Getting out and engaging the beneficiaries you serve is important. And bring a variety of people with you — not just the director, but also the people on the ground who will be implementing the program, create opportunities to engage with consumers, and use that as a mechanism for getting feedback. Look for opportunities for people to tell their stories, and then sit back and listen. Many times, we offer them a solution to what we think is their problem, when all they really wanted was someone to hear their experience. Anything that you can think of in terms of engaging with clients is worth trying.