Individuals eligible for both Medicare and Medicaid are increasingly served by health plans within integrated models, driven in large part by the Affordable Care Act. To realize the potential of improved care coordination and access to services that integrated models offer, plans must contact members and establish trusting relationships. However, the contact information that plans have for new Medicare-Medicaid members is often inaccurate or out-of-date. Moreover, individuals who did not proactively choose a new plan may not be immediately receptive to health plan outreach.

This 90-minute webinar from the Center for Health Care Strategies (CHCS) shared health plan strategies for contacting hard-to-locate Medicare-Medicaid enrollees, building relationships, and creating person-centered care plans that incorporate social service and housing needs. Speakers included representatives from two plans participating in PRIDE (Promoting Integrated Care for Dual Eligibles), a project to advance health plan strategies for providing high-quality and cost-effective care for high-need populations. In addition, a clinician whose work focuses on improving care and reducing costs for high-risk, high-cost populations described how social determinants of health can be included in member care plans and used to prioritize care needs.


I. Introduction

Speaker: Sarah Barth, Director of Integrated Health and Long-Term Services, CHCS

Ms. Barth introduced health plan strategies for locating and connecting with members and creating a culture of engagement.

II. Innovations at the Ground Level – Building Relationships with Health Plan Members


Hany Abdelaal, DO, President and CEO, Visiting Nurse Service of New York (VNSNY) CHOICE (New York)

Anthony Evans, RN, Vice President for Integrated Health Services, CareSource (Ohio)

Dr. Abdelaal described how VNSNY CHOICE opened storefront locations, staffed by program assistants, to engage Asian communities in New York City neighborhoods. Mr. Evans gave an overview of CareSource’s use of locally based care navigators and how this approach allows the plan to directly connect and build trusting relationships with members.

III. Social Determinants of Health – Creating Trust by Focusing on What Matters to Health Plan Members

Speaker: Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine, University of California San Francisco

Dr. Raven explained how social determinants of health can influence an individual’s use of health care services and outcomes. She drew from her research to illustrate how focusing on social determinants can help plans and providers in better tailoring person-centered care plans to address supports and enable members to engage in medical care.

IV. Moderated Q&A – Sarah Barth