Are Medicaid members high tech or high touch?
Kelly Munson, President of Aetna Medicaid, serves Medicaid members at both extremes of omnichannel care. Here is what she’s learned.
Many states loosened restrictions around telehealth use due to the COVID-19 pandemic. A recent report to Congress has looked at the implications, some of which have been dramatic. Visits that had been missed because of childcare and transportation difficulties were now attended. Behavioral health care, which could take place in the privacy of the home, was one of the most common services delivered via virtual care during the pandemic.
At the same time, technology troubles kept some users from enjoying those benefits. Physical therapy and well-child visits suffered when virtual visits were the only option. Going forward, the Center for Medicare and Medicaid Services is keeping an eye on telehealth care to track its value, with special attention on whether it might reduce health disparities.
Kelly Munson, President of Aetna Medicaid, discusses this new frontier and how Medicaid members enrolled in Aetna’s own managed care plans have come to navigate omnichannel health care delivery.
Question (Q): In the Medicaid community, how popular is virtual care?
Munson: Our Medicaid members increased their use of virtual care substantially during the COVID-19 shutdowns. For example, before March 2020, 3% of our members had at least one virtual care visit. During the pandemic this increased to 17% of our membership and has decreased slightly over the past year, but still notably higher than before the pandemic.
This may be because Medicaid members are a relatively young population, so they are comfortable using smartphones and other tech. About 80% of our Medicaid members are age 44 and younger, so it makes sense that they are comfortable with virtual health care. About 86% of Medicaid members have access to a smartphone, which is a tool they can use to access services.
Q: What are some of the ways that virtual care has been especially useful to this group?
Munson: Nearly two-thirds of the adult Medicaid population is working. With virtual care, there’s much greater flexibility to fit health care into their work schedules. During a break, for instance, they can go to their car or some other private place and use a smartphone to connect with their provider.
Or consider a mom with three young kids. She can have a virtual visit without worrying about getting childcare or arranging for transportation or the hassle of bringing kids to the doctor’s office. And many Medicaid recipients live in rural areas where there are fewer specialists. Virtual care can patch them into specialty care from their primary care provider’s office or in some instances a CVS location, which is game-changing.
The most underrated benefit, though, may be that it puts more control in our members’ hands. Some Medicaid patients may not trust the health care system. Their doctors may not look or sound like them, and they worry about the stigma that Medicaid sometimes carries. Virtual care eases that vulnerability because they are receiving care in a safe place—their own home.
Q: Not everyone is comfortable with virtual care yet. How do you work through that with Medicaid members?
Munson: First and foremost, it’s vitally important that we meet Medicaid members where they are. We need to accommodate their needs and make it convenient for them to get services. Getting patients into care early reduces the likelihood that they will use the emergency room (ER) for their health care, which is very costly. So convenient care is in everyone’s best interest.
Also, virtual care offers an option for those who otherwise may not engage a health care provider. Research shows that Medicaid members are more likely to use virtual care than those covered by a commercial plan. If some of our members are not using virtual care because they don’t have Internet access or enough phone minutes, we’ve provided a dedicated hot-spot room in some CVS stores. If our members have the technology at home, our care managers will visit and teach them how to connect to care. And, of course, we still reach out in communities through face-to-face initiatives.
Q: Any other digital technologies that are helping?
Munson: I’ve seen very good results from our pilot programs with home-monitoring tools. These can help deliver better care for diabetes, congestive heart failure and high-risk pregnancies. The tools might identify, for instance, when blood sugar is too high or a heart rhythm is abnormal.
Members submit their data to nurse health coaches, who contact the primary care provider when a problem is picked up. I think their real value is preventing an event that would lead to an ER visit or hospitalization. We’ve seen a strong reduction in ER use and a 23% decrease in hospital admissions using these digital tools.
Q: What about Medicaid patients who can’t—or won’t—make the leap to virtual care?
Munson: In underserved communities, we do what it takes to increase access. At Aetna, for instance, we’re rolling out social care teams. These connect Medicaid users to social services—transportation, food, community-based organizations. These can help eliminate physical barriers that prevent people from getting care.
For people that aren’t plugged into the virtual care revolution, we go to underserved areas with our mobile clinics and partner with Federally Qualified Health Centers to bring health services directly to our members. And our Workforce Innovation and Talent Centers provide employment services to underserved populations, along with health clinics, food pantries, and daycare, so people can achieve greater economic stability, which puts them in a better position to focus on their health.
In our communities, virtual care is a big step forward and a tremendous opportunity. But the benefits aren’t universally enjoyed yet. In the near term it will call for education, patience and a lot of flexibility as we bring everyone on board.