Contributors: Lisa Soroka and Wren Keber
To learn more about Lisa and Wren, click here.
In this second article in our series, we continue to cover meaningful tactics for healthcare organizations to recover and thrive post-pandemic. We underscore the importance of safety-net providers, ranging from hospitals and health systems encompassing facilities, physicians, and other providers to community health clinics (CHCs), federally qualified health centers (FQHCs), and public health agencies in recovery from the pandemic. The Institute of Medicine (IOM) defined safety-net providers as “those providers that organize and deliver a significant level of healthcare and other needed services to uninsured, Medicaid, and other vulnerable patients” (Lewin & Altman 2000). We will also share tactics to position these indispensable providers to help maximize their value and influence.
One of the consequences of the economic impact of the pandemic was a dramatic change in employment status nationally for the workforce across multiple industries. People entered and left jobs, were placed on furloughs, or became unemployed or under-employed. Not surprisingly, this resulted in a surge in Medicaid enrollment, often away from traditional employer-sponsored coverage. Looking only at Medicaid from February 2020 to 2021, enrollment increased nationally by ten (10) million enrollees, or approximately 14.97%. A constantly changing payer mix puts the community of safety- net organizations in an increasingly important role.
As a result of this enrollment surge, we are seeing an almost universal increase in patient populations served by the safety-net community. A key tactic to employ in the coming months is to continue to lean on telehealth/telemedicine tools to reach both new and existing patients “where they are.” This will help safety-net providers ensure patients enter into and/or remain in important care delivery programs (e.g., care management/care coordination) even without an in-office visit. This is an especially important tactic if the pandemic continues to have a lasting impact on patients’ comfort levels in seeking in-person/in-office care.
Beyond telehealth, we are focusing on the importance of building and expanding partnerships/affiliations with other provider constituents - both in and out of the safety-net community, such as health systems, public health agencies, and community-based organizations (CBOs). These partnerships/affiliations should help to ensure access to primary care services remains in place for patients with shifting coverage (e.g., during periods of non-continuous coverage across multiple plans.)
A key differentiator of safety-net providers is the capability to deliver engagement, education, and clinical care in a culturally competent manner. This makes the safety-net provider indispensable in:
- identifying and implementing clinically and socially appropriate changes in care plans, especially those related to delayed care during the pandemic
- avoiding hospitalization or other adverse events by identifying and addressing social determinants of health (SDOH)
- coordinating non-clinical service providers to address population health needs, such as in-home care, supply/durable medical equipment, transportation and more
- securing patient trust in the ongoing value of the delivery system, thus helping to increase patient compliance and adherence to medication and care plans.
We believe safety-net providers must build partnerships with major payers, particularly Medicaid Managed Care Organizations (MCOs), to design programs to maximize these valuable impacts to effectively manage non-adherent patients and newly-enrolled members. The safety-net providers can add unique value to MCOs by:
- directing patients to seek care at the appropriate level
- engaging chronically ill and/or co-morbid members to proactively manage complex care plans to avoid catastrophic, costly interventions
- managing – overall – unnecessary and potentially avoidable emergency department utilization through multi-pronged, culturally competent programs and services
Aside from engaging in clinical care, we suggest safety-net providers develop outreach programs, with funding provided by MCO partners, to re-engage with patients who have suspected gaps in care (identified based on historical claims activity) and engage with newly-enrolled Medicaid patients. Safety-net providers understand how to effectively contact and engage with these members more so than the managed care organizations. This should translate into value for all parties involved in successful partnerships/affiliations.
Perhaps one of the most important roles for the safety-net provider community is the stewardship of health equity across diverse, underserved populations. The importance of partnering with others in the safety-net community, as well as with MCOs, cannot be overstated. New or expanded partnerships/affiliations should include programs that address and/or expand capacity and could include:
- joint advertising to direct newly-enrolled members to clinical resources to both maintain primary care access and get off to a good start
- building out “on the street” care navigation programs to bring in trusted individuals from the neighborhood who can explain what health services/programs are available and help ensure the hyperlocal healthcare system is accessible to the population in need; these programs have shown to have a positive impact on each organization’s ability to reduce barriers to access in both primary care and specialty services.
- adding additional capacity for outreach in navigating healthcare coverage options, such as partnering with religious organizations and community centers.
In conclusion, as with other parts of the healthcare ecosystem, we believe recovery is going to take many shapes and will take longer for some providers than others. The safety-net community will play an important role in mitigating public health crises and returning the healthcare payment and delivery systems to a “more normal” steady state in the coming months.
Contact Lisa at: [email protected]
Contact Wren at: [email protected]