On May 2, at the World Health Care Congress, held at the Marriott Wardman Park Hotel in Washington, D.C., Frances Martini, R.N., and Katrina Miller, M.D., presented a session entitled, “Consumer-Centric Care: Member Engagement and Retention Strategies for Complex Populations,” as part of the Medicaid & Health Policy Summit and Behavioral Health Summit tracks, at the Congress.
Miller is chief medical information executive at L.A. Care Health Plan, a health plan that serves primarily Medicaid recipients in Los Angeles County, California. Martini is director of integrated population health at BlueCare, the Medicaid division of the Chattanooga-based Blue Cross Blue Shield of Tennessee. BlueCare manages the care of about 600,000 individuals, out of the total of 3 million BCBST members. At their presentation, Martini and Miller discussed the complex and manifold challenges of managing the care of, and attempting to improve the health status of, a population that is beset by problems of poverty, housing instability, food scarcity, behavioral comorbidities, and general instability around the personal and socioeconomic factors of life, while also attempting to engage members of that population around their health. Yet both L.A. Care Health Plan and BlueCare have been making significant strides in managing the care of their Medicaid plan members, and in engaging them around their health concerns.
Recently, Martini spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding recent initiatives and developments at BlueCare in Tennessee. Below are excerpts from that interview.
Qualitatively speaking how might you characterize the Medicaid population that you and your colleagues help to manage at BlueCare?
I would tell you that 60 percent are children. Of the adult population, many are pregnant women. We also have developmentally disabled adults, and adults with significant complex illnesses. And 40-50 percent, especially the high-risk population, also has behavioral comorbidities, which adds to the complexity of their care management.
Frances Martini, R.N.
What kinds of elements make it challenging to connect with them around their care?
You can’t look at all 600,000 people at once; it would be totally overwhelming. So we look at sub-populations. We look at age-based cohorts, including 0-4 years of age, and 5-20. And clearly, a four-year-old is very different from a 15-year-old. And clearly also, different things affect newborns from those that affect 55-year-olds. So we divided our population into sub-populations—small children, school age, young adults, and so on. And you know that a 0-4 doesn’t have behavioral or chemical dependency, but they could have disability, etc. And with school-age kids, behavioral or chemical dependency might be high, but cancer won’t be. So we looked at those elements. And for the 5-20 population, behavioral and chemical dependency is number one in terms of risks, and asthma is second. Behavioral is around 15 percent and asthma is 10 percent, and of course, you can have both. Obesity is also very significant; and so are developmental disabilities. So for me, in putting my team together, I have to be familiar with those conditions, know I have a network that can handle it, where those members are, and have a staff to manage them. Because the kind of staff that would manage newborns would be very different from a staff that could manage school-age kids.
And I have to look at what’s happening in the community; and what’s going on in the schools; things like what the school nurses are doing; the contact level with the parents; the educational levels of the schoolchildren. And that’s where the data is so important.
In your presentation that was part of the Medicaid & Health Policy Summit track and the Behavioral Health Summit track, you talked extensively about the value of data, to population health management and care management work of the type that you and your colleagues are engaged in.
Yes, in fact, I actually participated in two panels at the World Health Care Congress; I did a second panel around informatics. And the thing is that, without the data and being able to have someone help you interpret the data and make sure you’re tracking it correctly, it’s useless. So he and I did a presentation together, and he did one of those ‘be careful what you ask for’ kinds of things. Because sometimes clinical people don’t want they’re asking for. We actually call people like him “data clinicians.” He helps us think through what’s happening and what we’re doing, and how to track it. So we might start out saying, for example, we want to set up an asthma program. But what we found out was that the asthma problems we had are with children from zero to four. Clinicians will tell you that most children that age don’t have asthma diagnoses. But we had so many children in the ED with asthma symptoms, that we ended up creating a program to help manage that. So that’s the beauty of informatics, not only helping us to identify a population, but also how to manage that population, and how to intervene.
So once you’ve identified a subgroup, then what are the next steps that you take?
Yes, for example, we had a very small subset of our population—less than 1 percent—with very high medical costs, and who were frequently admitted, but who still weren’t getting better. Our data showed us that they were utilizing services, particularly hospital services, but they weren’t going to the doctor. They weren’t utilizing primary care.
Were they usually just going to EDs with symptoms?