Payers benefit from community involvement

The sum truly is greater than its parts when insurers partner with community and faith-based organizations to provide services to socially disadvantaged members. For insurers, it’s as much about gaining community capital as health improvement.

“Working with community groups is an efficient way of expanding our services because so many of these programs are extensions of what we do,” says Howard Kahn, chief executive officer of L.A. Care Health Plan, a not-for-profit health maintenance organization that serves more than 1 million low-income Los Angeles County residents.

There are clear advantages when insurers partner with the locals, says Andrew Mackenzie, chief marketing officer for UnitedHealthcare. He says:

• Members receive education, as well as needed services and support;

• Organizations receive financial and other support for their programs; and

• Insurers educate and improve the healthcare and lives of their members, as well as retain membership.

Rules covering Medicaid plans prohibit direct selling, so insurers have to find ways to establish their brand, and collaborating with organizations enables them to make a positive impression in the community.

Another area of collaboration is in promoting coverage and the insurance exchanges. The health reform law calls for navigators to assist consumers in understanding the law and signing up for coverage with multilingual services and in-person interaction when needed. Exchanges can also use grant money to pay organizations-such as advocacy groups, not-for-profit providers or local public health departments-to help new enrollees in their local neighborhoods.

Plans will clearly benefit when the grassroots advocates draw in new members that the plans themselves might not be able to reach.

“It is important that we are active in the partnership and building relationships,” Mackenzie says. “We want to be seen as a positive provider of support and knowledge so that when decision time comes, the member feels good about UnitedHealthcare.”

To provide health education is an obvious reason for these collaborations and all of the insurers support programs that achieve that aim. Education helps members understand that their health can be affected by lifestyle choices and that they should play an active role in their health, not just be passive recipients of healthcare services.

For instance, UnitedHealthcare launched a national program to help fight childhood obesity. They collaborated with the Y of the USA and YMCA of Greater Providence, R.I, to deliver a pilot program called Join for Me, a weight-management and lifestyle intervention for children ages 6 to 17 years old and their families. They held classes that got people up and moving and showed them how to manage their weight.

After the pilot program, 10% fewer of the children who participated were obese. Six months later, 84% of the original 155 participants in the pilot completed the full program and achieved, on average a 3.5% reduction in excess weight.

It’s who you know

Working with community and faith-based groups establishes trust because they know the people, the culture, and the language of that community. They also have a good handle on the obstacles facing the residents. By supporting their programs, insurers can take advantage of that community capital.

“The community groups that we partner with often have deep cultural competence, linguistic capabilities, and are staffed with people from these communities. They have a real credibility, connection to and understanding of the population they serve,” says Debbie Gordon, chief marketing and external affairs officer for Network Health, a not-for-profit health plan serving low and moderate income residents of Massachusetts. “And many community organizations are focused on the same population we are.”

Reaching the socioeconomically disadvantaged can be difficult, however. Some are homeless or lead transient lives-they bounce from family member to family member, from rooming house to rooming house, from rental to rental.

Others are distrustful of the medical establishment because of negative past experiences. There are language barriers, disabilities, transportation issues and a host of other obstacles to care. Community groups can help insurers find current and potential members, educate them and develop a trusting relationship with them, Gordon says.

There are many social determinants of health: culture, environment, socioeconomic status, education, etc.

“The more you can affect these social determinants, the healthier people are, the less healthcare that needs to be delivered, the lower the cost and the better the quality,” Kahn says.

L.A. Care found that some of its pediatric members had severe asthma, which led to an increase in emergency department visits and hospitalizations for those patients. They partnered with QueensCare Family Clinics and Long Beach Alliance for Children with Asthma to provide home visits that helped parents and children learn about asthma self-management. Among members who received at least two home visits during 2012, L.A. Care saw a 52% average reduction in asthma related ED visits from 2011 to 2012.

Using the Asthma Control Test, a validated 27-point tool for measuring asthma control, those with at least two home visits saw a 31% or seven-point increase in scores.  And better asthma self-management can translate into lower overall costs.

“Doing this right isn’t just about good PR” Kahn says. “It is about a win for the members because you bring services closer to them and present them in a way that they can understand and are more likely to use them. It is a win for their doctors because the services they render are being supplemented by the community based organizations, and it is a win for the health plan because it improves our outcomes and hopefully improves the cost of care.”

Many programs have a direct affect on chronic care and self-management, but insurers also support social programs that improve the quality of life of members: legal groups, housing groups, recreation centers, transportation services, etc., because they realize that a person’s emotional well-being affects his or her physical health.

For instance, Network Health partners with Healthcare Financial to assist members applying for social security or disability and assure they have access to all the benefits for which they are eligible.

“We as a society and as an industry understand that people’s health is not just about what happens in the doctor’s office. As a matter of fact, it is rarely about what happens in the doctor’s office. It is about addressing the challenges they face, what choices they make in their everyday lives,” says Gordon.

Business effort

At times, it might seem as if the healthcare system isn’t responsible for social and socioeconomic issues, but for a not-for-profit organization, its members’ overall health and wellness is part of the mission and the expectation.  

“Some people think of community outreach as just a feel-good activity, but done well, community outreach can be just as valuable a business effort as any other,” she says.

The one clear downside to community partnerships is that the need is greater than the available resources, experts say. And these collaborations will become more important as the country moves forward on healthcare reform and access issues come to light. Industry observers predict that primary care will be in high demand, especially with the newly insured and Medicaid’s newly eligible enrollees.

“With Medicaid expansion and exchanges being developed, we are going to see a lot of growth,” Kahn says. “This is good news and bad news. This is good news because even a nonprofit wants to see expansion, but it’s bad news because demands on the providers will be higher.”

When insurers can involve community groups in members’ healthcare they are taking a big picture view that will not only increase and maintain membership, but could potentially decrease the use of costly medical services.