How to Serve Medicare and Medicaid Populations in the New Normal

CG Adams: Hello everyone and welcome to the Payer Principle, a Salesforce healthcare podcast created exclusively for payers. I'm your host, CG Adams. Today's episode focuses on how payers can better serve Medicare and Medicaid populations and the importance of how to address social determinants of health that can negatively affect these groups. I'm joined today by Dr. Sindhu Pandit. Dr. Pandit is a practicing physical medicine and rehabilitation physician with over 10 years of clinical experience and currently is a clinical advisor on the Healthcare and Life Sciences Go To Market team at Salesforce. Dr. Pandit, welcome to the podcast. It's great to have you here today.

Dr. Sindhu Pandit: Thank you for the invitation and happy to be here.

CG Adams: So according to the Centers of Medicare and Medicaid Services, there are over 62 million Medicare and 64 million Medicaid beneficiaries respectively. That amounts to almost one third of the US population, which is not a small number. What exactly are we seeing Medicare and Medicaid members struggle with during the COVID- 19 crisis?

Dr. Sindhu Pandit: This is a pretty diverse population, but behavioral health really is what comes to mind when I think about this population. We're seeing large increases in those battling depression and anxiety. And right now, it's incredibly imperative that we address this for all of our population, but especially our vulnerable.

CG Adams: And seniors are especially vulnerable during this time?

Dr. Sindhu Pandit: Senior loneliness is a big deal. People are being isolated. They hear in the news and among their loved ones that they're considered to be high risk. It's causing increased anxiety and fear. 26% of our Medicare beneficiaries live alone. So they are having challenges going out and getting their errands done. And the way they were accomplishing them before, they're possibly afraid to go out to public spaces, or maybe their support system isn't there to help them get their groceries in the way they used to. Maybe they used to have an aide, but that aide no longer is visiting with them. They used to go to their pharmacy in person, but now they are trying to shift that and they may not understand how to opt for mail order, mobility considerations.

CG Adams: All of these things are really exacerbating the situation for our senior population. What else?

Dr. Sindhu Pandit: Among our Medicaid population, we're seeing changes in employment and maybe some challenges with affordability. So this is a widespread issue, and really, we have a huge opportunity, especially payers, to engage their members in a way that's preventative, and also perhaps proactive, to meet them where they are and offer support. Virtual care, for example, grief counseling services, behavioral therapy.

CG Adams: I think that everyone can relate to this concern, right? We all have a parent or a grandparent or potentially a loved one or a friend that's elderly and may potentially be sheltering in place by themselves. So it's definitely very important that people are made aware of some of the different issues or challenges that vulnerable population may be dealing with as they're sheltering in place. Let's jump to social determinants of health, a hot topic for healthcare payers. The US Department of Health and Human Services define social determinants as health conditions in the environment in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality of life outcomes and risk. What social and economic considerations are impacting Medicaid and Medicare members as they're sheltering in place, aside from some of the behavioral health considerations that you just informed us of?

Dr. Sindhu Pandit: Yeah. Social determinants of health has become a lot more commonplace in terms of conversations when we're discussing general healthcare. And right now, we are definitely having to address many of those aspects of a person's sort of larger environment, as you well- described, that supports their healthy or their ability to live healthy. A couple come to mind that are a little bit more top of mind right now, not to say that any is less important, but access, access is a big deal for many of our seniors, especially with mobility issues, and as I mentioned earlier, those that had aides and others that were supporting them in order to access the different points of care in order to maintain that healthy life. Transportation is one consideration, but maybe they don't understand where they can go because they're now sheltering with their loved ones in a different state. With the Medicaid population, they may have other challenges such as having to support their children who are now at home with them and in a virtual learning environment. And so they're not able to leave their home to access the care they once were potentially doing, or maybe they're afraid to go to the hospital or to the clinic that they were going to because the number of patients that are being seen there have increased and they're afraid of exposure. So that topic is coming up a lot because, A, can they get to where they need or are they avoiding where they need to go? And we need to be ahead of that conversation with these patient populations.

CG Adams: Affordability comes to mind as well. There's been huge economic implications from this pandemic.

Dr. Sindhu Pandit: And that is affecting this vulnerable population in a pretty profound way. Can they afford what they were doing to support their healthy life prior? If someone is making the decision between obtaining food or obtaining other needs such as for their own health, that's a really difficult decision for families to make. I think that's where the payers can really help sort of meet the patients where they are and help them come up with the solution or options rather to meet this need that has become a lot more top of mind than ever before.

CG Adams: So how can payers help to educate members during the pandemic so that they can be more informed and live healthier lives while we're sheltering in place?

Dr. Sindhu Pandit: Yeah. When talking about educating members, one is actually health literacy, making sure that when education or information is disseminated to a member, that it accounts for their understanding of information around their health. So if you can personalize that messaging, they can probably have a better comprehension of what it is that is trying to be communicated to them. So you can personalize the information for that member based on their ability to comprehend the information. The second is actually digital literacy. There's a misconception that this population doesn't have a device or maybe they're not comfortable using options such as a portal or mobile apps. It's interesting because Pew Research has showed that 96% of adults in the US actually have a cell phone. That might not be a smartphone, but they do have a cell phone. And there's another survey that recently came out by MediaLogic that showed 94% of seniors use the internet every day.

CG Adams: Wow. That's a pretty large number.

Dr. Sindhu Pandit: Yeah. I was surprised as well. And I think it's important to kind of keep in mind that if you're able to figure out what channel is most appropriate for the person you're reaching, and then also cater the message to the way that they can consume it in the best manner, then I think you'll really resonate with that person and have a better outcome. So I think there's a lot more we can do in customizing the information, if you will, individualizing the messaging.

CG Adams: And so, one of the things with customizing the messaging, if we're thinking about members that may have learning disabilities or accessibility issues, can payers also look to create materials that cater to those individuals?

Dr. Sindhu Pandit: Oh, absolutely. In fact, that's such an important point that you bring, I mean, large print, for example, if that's appropriate, braille. If physical materials are being sent out, what is the primary language that your member speaks? Those types of things are now, not only is the information available, but we can actually leverage tools out there in order to disseminate information in the most appropriate and the most successful manner for that member to consume and to act upon.

CG Adams: It sounds like there's a really large opportunity for payers to really think about personalizing and customizing information to help educate members from a health literacy and digital literacy perspective and really think about what is the best channel to engage these individuals on and how can I tailor the information in a way that's going to resonate with them and educate them on how to live a healthier life, right? And stay informed with real- time information.

Dr. Sindhu Pandit: Yeah. It's not only cost- effective and efficient, but it's going to result in better outcomes.

CG Adams: Absolutely. And so knowing that health literacy and digital literacy are very important when it comes to educating members, you also touched upon some tools that health plans can leverage as they're looking to engage members during this time. Can you tell us a little bit more about that?

Dr. Sindhu Pandit: Yeah. Payers can create tailored communications that are personalized for the members according to their status and their condition, as you mentioned, but also create journeys that allow for continuous engagement regarding their health, and appropriately opt in or disseminate educational information as appropriate via that journey. You can leverage assessments, questionnaires, so that you can gather more information to understand what is the situation that your member is currently managing. Are they quarantining, for example. If the survey or the assessment yields a positive answer to that or an affirmative answer to that, then you can offer more assistance to that individual around quarantining. Do they have access to their medications? Do they have food? And then you can help fill those gaps as and when they're presenting themselves versus after the fact.

CG Adams: Are there other considerations, especially in times of impending crisis, where members may be impacted by hurricane season, wildfires, et cetera?

Dr. Sindhu Pandit: You know, there are ways that we could get ahead of issues as well. In some areas where you can predict natural disasters, for example, you can plan in advance with those members to fill prescription medications in advance or to switch them from pharmacy pickup to mail order. In a case like this in this pandemic situation, we can do the same. If you see a lapse in refills, we can certainly help by asking that member via survey, via a question or a phone call out if that's what they prefer, if they're having trouble getting their medications.

CG Adams: So from portals to assessments, to questionnaires, to omni- channel communications and thinking about medication delivery services, there are a multitude of already existing tools that health plans can basically look to today to engage members in the Medicare and Medicaid populations to stay healthy during the crisis.

Dr. Sindhu Pandit: Yeah, I think it's not so much that we need to discover new ways to communicate or to engage, I think we will need to look at the tools that we have and optimize and improve and to customize so that we meet the patient or the member where they are. For example, portals are very common for payers to offer access to for their members, but 47% of Medicare beneficiaries feel that their plan's portal are rarely or never useful to them. And I think that's a pretty telling statistic. And so having a tool, if we're not optimizing it, doesn't really speak to the power that the tool has in order to meet the needs of your member.

CG Adams: That's a really great call- out. Dr. Pandit, you've given us an amazing insight today on the Payer Principle podcast and we are very thankful for you sharing all of your insights. Thank you for being here today.

Dr. Sindhu Pandit: This is such an important conversation and I really appreciate you asking me to be on. Thank you for the time.

CG Adams: Thank you. To learn more about our payer solutions, visit salesforce. com/ healthcare. I'm your host, CG Adams. Thank you for listening and make sure to check out the rest of the podcast.