From Health Plan Weekly: Census Data Underscores Plans’ Need to Diversify Engagement

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Census Data Underscores Plans Need to Diversify Engagement

Reprinted with AIS Health permission from Health Plan Weekly, September 10, 2021

In mid-August, the U.S. Census Bureau released additional results from the 2020 Census that underscored just how diverse the country has become. While people identifying as white remained the largest ethnic group in the U.S., that population has decreased by 8.6% since 2010. Meanwhile, the Hispanic or Latino population grew 23% over the last decade and the multiracial population ballooned from 9 million in 2010 to 33.8 million in 2020.

With all that demographic change, industry observers say it’s more crucial than ever for health care organizations — especially health plans — to tailor their member engagement strategies to connect with enrollees from a wide variety of backgrounds. But they caution that doing so requires more than just lip service and cursory efforts.

“The plans that are doing the right thing are the plans that are moving away from their old approach to how they engage with their members and build a relationship with their members. That old approach, I would describe it as the ‘one size fits all’ approach,” says Abner Mason, the CEO of ConsejoSano, a health equity-focused engagement company that personalizes health plan member experiences through culturally and linguistically aligned preferences.

Historically, much of the content health plans designed to engage their members was written by English speakers and for English speakers, “and then they translate it into many other languages because it’s a regulatory requirement, but also this is their way to try to serve what they know is an increasingly diverse member population,” Mason tells AIS Health, a division of MMIT.

That approach, he says, “sends a clear signal to the member that who they are really doesn’t matter. Their life journey, their experience with the health care system, their level of trust of the health care system, how the social determinants of health uniquely affect them — everything that makes that person who they are and really determines how they’re going to engage in health care — the old approach, the one size fits all, says, ‘We don’t want to know any of that stuff that makes you who you are….we’re just going to send you the same message.’

“What we’ve found is that just doesn’t work very well — when you treat people like who they are doesn’t matter, we shouldn’t be surprised that they’re not eager to engage with us and that they’re not going to trust us.”

Alternatively, his organization is working with health plans to chart a new approach, with the goal of cultivating “a more personalized, customized experience for the member, to treat that member like who they are does matter,” Mason says. To do that, ConsejoSano collects reams of data — including public data, private data and claims data — which its technology platform analyzes in order to divide member populations into much smaller groups based on culture.

“The data is a big part of it, but we’ve also built a team that comes from the communities they serve, and the combination helps us to craft that messaging so that it feels like it’s coming from a neighbor or a family member,” Mason tells AIS Health. That said, “we don’t always get it right,” he admits, adding that his company therefore conducts tests to ensure messages are “hitting the right tone for the folks that you’re trying to engage with.”

Friso van Reesema, who works for the health care analytics company Cotiviti and is board director of the Health Equity Initiative, makes a similar point.

“The increased diversity of a plan’s membership drives them to invest in additional communication channels — whether it be from the plan or their contracted providers — to effectively reach and earn a member’s trust,” he tells AIS Health. “But it’s not enough to just translate from English. Diversity in ethnic groups includes more than language differences. Cultural distinctions are that next level of trust. When a health plan understands a group’s traditions, values and beliefs, then these diverse groups appreciate and respect the plan more.”

Efforts Need to Be at Program Level

He also recommends that health plans take a “community-based approach” to addressing diversity.

“When your average company talks about diversity, it’s usually referring to its board of directors and executive committees. But to truly align with a diverse community, diversity needs to happen at the program level,” van Reesema says. “To attract and care for those diverse member groups, they need to participate in the health plan activities by helping design the programs. Participatory community engagement is just that: Hire people from diverse communities to tailor benefits, provider networks, and medications and therapies that align with their languages and cultures.”

Health plans, he adds, have incorporated this approach “in their partnerships with community health workers and community-based organizations. Additionally, social determinants of health initiatives become more effective with a participatory community engagement approach.”

Jerry Vitti says health plans that serve Medicaid populations offer plenty of examples for other insurers that want to strengthen their diversity efforts.

“When I think of Medicaid managed care organizations, I think of all the lessons that everybody else can learn from what they’ve done,” says Vitti, founder and CEO of Healthcare Financial, Inc., a firm that connects low-income, elderly and disabled populations with public benefit programs. Those efforts include “outreach, engagement in a culturally competent way [and] working with social determinants of health issues that are much more prevalent in minority and low-income communities,” he adds.

Firms of All Sizes Can Lead the Way

While not-for-profit, community-based health plans often provide the best examples of how to engage with members in a culturally competent way, larger insurers can play a key role too, according to Vitti.

“Folks with the analytics and the resources to make business cases for these investments are the ones that really can lead the way,” he tells AIS Health. “We all know that addressing someone’s transportation needs or giving someone nutritious food are good things and promote [better] health outcomes, but where’s a comprehensive set of data that demonstrates that?” When larger firms can make that case, “a plan with maybe fewer resources can say, ‘This is where I target my scarce dollars.’”

Medicaid-focused plans are not the only organizations focused on diversity, equity and inclusion (DEI), however. According to Willis Towers Watson’s newly released 2021 Benefits Trends Survey, “nearly three in four respondents (73%) cite an increased focus on DEI as driving their benefit strategy” going forward. And in April, the Blue Cross Blue Shield Association unveiled a far-reaching initiative that aims to “change the trajectory of heath disparities and re-imagine a more equitable healthcare system.”

Mason, for his part, says that in addition to connecting with members on a “deeper cultural level,” health plans also need to move toward using members’ preferred forms of communication, such as two-way text messaging.

“Health plans in the past and today are using the U.S. Postal Service to communicate with their members, and I’m just telling you, this is not the way America communicates today,” he says.

Granted, “there are some regulatory constraints on plans that they’ve had to deal with” that can tie insurers’ hands, he acknowledges, “but I don’t think plans have been aggressive enough in insisting that they have the ability to engage with their members in the way the member prefers.”

Contact Mason, Vitti and van Reesema via Joe Reblando at joe@joereblando.com.

by Leslie Small