Stephanie Gibbs, JDNovember 9, 2017
Many health plans that integrate Medicare and Medicaid services for dually eligible beneficiaries are exploring how to use digital health technology (e.g., apps, wearables, remote monitoring tools) and telehealth — health services provided using web- or telephone-based platforms — to improve care. These technologies offer potential for enhancing member engagement, care management, health information exchange, and person-centered care. As plans invest in these approaches, they want to know what platforms their dually eligible members have access to, as well as members’ preferences for receiving health information and engaging with their plans and providers. To answer these questions, the Center for Health Care Strategies (CHCS) recently supported two health plans participating in PRIDE (PRomoting Integrated Care for Dual Eligibles) to survey a sample of their members.
Member Technology Use Survey
PRIDE, a national initiative led by CHCS and supported by The Commonwealth Fund, is working with integrated health plans to advance best practices and improve outcomes for dually eligible members. PRIDE plans have used or are testing a variety of technologies to support members, including:
- Text messaging campaigns;
- Tele-education and remote monitoring for diabetes and other conditions;
- Automated pill boxes;
- Telehealth visits with urgent care providers, behavioral health specialists, nutritionists, nurse practitioners or physician assistants via home computer or smart phone;
- Lifeline wireless phones; and
- Real-time transmission of data from individuals’ homes or other remote sites.
CHCS worked with two PRIDE plans — Independent Care Health Plan (iCare) (Wisconsin) and CareSource (Ohio) — in developing a member survey to inform the plans’ use of technology for effectively engaging with dually eligible members. Health plan care managers and care coordinators distributed the survey to 200 community-dwelling, dually eligible members during in-person visits. Almost half the surveyed members were under 65 years old.
Opportunities for Engagement: Survey Findings
Key survey findings include:
- Telephones are the most common technology used to communicate with providers. Of the health plan members surveyed, 67 percent said they had access to a landline phone, 62 percent had a mobile phone, and 37 percent said they had a smart phone that could connect to the internet. Survey respondents said they usually communicate with their providers by telephone to make appointments, receive appointment and prescription reminders, and, less frequently, obtain health information from their providers. While 39 percent of respondents said that they had access to text messaging, few communicated with their providers in this way. However, this does not necessarily mean that members would not use text messaging, “apps” with smart phones, or other text-based methods to communicate with providers if those opportunities were available.
“The survey confirms that technology-based initiatives should augment, not replace, 1:1 telephone or case manager-driven communication with members.”
- Many members have access to computers and the internet. Some members (41 percent) had access to a computer or tablet, and 19 percent reported that they had a web cam. Almost half had internet access either in their homes or at another location, such as a friend’s home or the library. However, members who did not have home internet access were less likely to use the internet regularly in another location. Less than half of members surveyed used computers or tablets to receive health information from their providers, with 60 percent of those members citing security, fraud, and privacy concerns.
- Members have preferences for interacting with the health plan. Almost half of members said they talked with their health plan’s customer service department over the phone during the past months and received a member newsletter. Members preferred to interact with their health plans in these ways, rather than visiting the plan’s website for information.
“Older members, particularly the frail elderly, value personal interaction with their physicians and are less likely to use telehealth. However, younger members find it convenient to see a practitioner without leaving home, particularly when a clinic visit means braving cold weather, bus travel, or long wait times.”
- Most members prefer in-person interactions. More than half of the members surveyed preferred to visit their providers in-person. Most members (80 percent) said that they understand information better when it is presented face-to-face. Members reported a desire for “hands on” care and discomfort with using the internet. However, 32 percent of those surveyed said they would like the option to have telehealth visits with their providers, especially during inclement weather or if they were not feeling well.
Technology Can Be Useful, But More Support is Needed
The survey results paralleled an earlier CHCS study, which used focus groups to understand opportunities for effectively using digital health technologies with high-need, high-cost Medicaid populations. Participants of those focus groups reported that they were most comfortable with text messaging, voicemails, and computers.
While the recent PRIDE survey found that technology provides some new opportunities to increase member engagement, plans and providers should:
- Consider members’ comfort level with various technologies;
- Ensure flexibility and variety in technology-based engagement approaches to account for member preferences; and
- Provide in-person support when members need it.
Bearing in mind that many members prefer in-person provider visits, health plans might partner with providers to demonstrate technologies during office visits or hold community outreach events to introduce new technologies and show their benefits. Plans could also consider investing in education opportunities to alleviate members’ concerns about internet safety. With additional support, health plans can help members to become more comfortable with technology.
CareSource and iCare thank the following staff for their contributions to the survey: CareSource: Marcia Willis, navigator; Latasha Robinson, navigator; Devin Russell, navigator; and Shannon Saraigianopoulos, navigator; and iCare: Jayme Moker, director of Family Care Partnership, and the care coordination team.