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Medicaid Redetermination, another reason Healthcare needs a good CRM.


today in health, it why healthcare needs a good CRM? My name is bill Russell. I'm a former CIO for 16 hospital system and creator of this week health. So Charles dedicated to keeping health it staff current and engaged. We want to thank our show sponsors who are investing in developing the next generation of health leaders, short test and artists. I check them out at this week.

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All right. Today's story may not seem related, but I'm going to. Talk about Medicaid, redetermination and the need for a CRM. In healthcare and this from modern healthcare health systems, nervous as Medicaid redetermination threatens shaky bottom lines. Let me give you some excerpts. Health systems are nervously awaiting Medicaid redetermination. As the process will remove millions of people from government backed insurance plans and shrink provider's bottom lines because these people will show up in the ed without insurance.

Through the COVID-19 pandemic. The federal government allowed people to remain on Medicaid, even when their income should have excluded them from the program. The decision benefited providers, which saw fewer uninsured patients and insurers that have large contracts with states to administer Medicaid coverage.

Stay started reading, determining Medicaid eligibility, April 1st. As a result up to 14.2 million people where 13% of all enrollees. Are expected to lose benefits according to the estimates. From, , let's see, Kaiser foundation. , about a third of those will turn to the affordable care act exchange, marketplaces, the left-leaning think tank urban Institute projected.

Others may transition to employer based plans or remain uninsured altogether to dull the impact. And this is where we get into this CRM to tell the impact healthcare systems are creating strategies to reach effected enrollees before coverage runs out, particularly the most vulnerable populations. And debating what the changes could mean for reimbursements and safety that it support.

Even if everything goes perfectly, we're going to have patients who are going to lose insurance coverage. That's unavoidable said Matt Harvey, interim executive director of integrity, community care network, part of the care new England health system. Then, of course there's the unknowns. How many and when, and what's going to go wrong.

Okay, so getting the word out here we go. Health systems are putting together a communications plans to inform patients. Of possible changes to their coverage. However systems have limited information on whose coverage may end. And much of the re-enrollment process is ultimately up to the patients.

Okay. So the first thing, if you were going to reach out to a population, the first thing is you have to know. Who the population is, and we can do that somewhat in the EHR. But then you have to know how to reach them. Right. How are you going to communicate with them? What is their preferred communication method?

What is the way. To get in front of them, get the message in front of them. Are you omni-channel can you go in multiple paths to get in front of them? All right. So certain states automate parts of their re enrollment so forth. , let's see, let me move down a little bit with so many unknown systems are forced to stick with general messaging instead of tailoring messages to make them more effective for particular groups.

Maintaining the same level of urgency with communications will be another challenge as months pass. Harvey said. Addressing a patient's coverage. Loss is often reactionary at Providence, Rhode Island based care. New England employees can see. When a patient loses coverage via a provider portal. But by that point, coverage has already ended.

Harvey said care. New England is hoping to partner with health plans to obtain a list of patients who are up for reenrollment, somehow systems such as Duluth, Minnesota base Ascensia. And it's 14 hospital network across Minnesota, Wisconsin, and North Dakota are hiring third-party companies to help them contact patients about the changes and streamline the re enrollment process.

Okay. So. Even in this case, 14 hospital system, Duluth, Minnesota, they're hiring a third party. When they go to that third party, first question they're going to say is who do you want us to reach? Well, who is the population? What are they? , what are the fields we're going to look at and essentially.

Looked through that population and identify the people we need to, to talk to. So they say we have hired a vendor to help us with outreach and additional vendors to help us in our proportionate share hospital reporting and data scrubbing. Wilson said every little bit helps. So. They're essentially.

, They're essentially asking a third party to help them go through their data, to figure out who they should be reaching out to. , that's another level of sophistication that could be. , driven by having the right processes in place, having the right tool sets in place for where healthcare is going and where it's going is consumer facing consumer centric.

It is meeting them where they're at is communicating with them where they're at. It's digital first kind of engagements is what we're seeing. , start to evolve from the major players were seeing it from Optum or seeing it from. The CVS, Aetna, as we're seeing it from Amazon. We're seeing it even from some of the smaller competitors.

That don't have as much legacy equipment. We're seeing it from the telehealth providers. Digital first. , multi-channel omni-channel. , communication with the patient on their terms. In ways that they can understand it. MetroHealth a safety net system based in Cleveland has been meeting weekly with representatives from the Ohio department of job and family services and fellow Cleveland based Cleveland clinic and university hospitals to get Medicaid beneficiaries.

Re-enrolled. There is a running list of so-called fallout files, comprised of Medicaid beneficiaries to get the picture. That's what Metro health is doing systems, including Renton, Washington based Providence and Oakland based Kaiser Permanente have also reached out to Medicaid patients during their visits digitally, via phone and through letters.

Now you're looking at two organizations that probably are a little bit more advanced. Did you just hear the difference? Right. They're reaching out to those Medicaid patients. , during their visits. So they've identified them when they actually come in for a visit. There's some aspect that's showing up on the screen. That's telling whoever's either checking them in or seeing them, Hey, have you considered right.

So you have those kinds of alerts showing up on the systems. And then you also have, you know, they're reaching out for your phone. They're reaching out through letters. They're reaching out in a lot of different ways because they have systems and they've been tracking that. They've been moving in this direction of really understanding their patients as consumers. The process though is tricky for health systems that span multiple states, especially when the patient directories aren't updated with current contact information, Providence, for instance, designed social media campaigns for each state.

Medicaid programs such as Denali care, Alaska state Medicaid program. Let me ask you this. If your health system was asked to create a specific social media campaign. For a specific market. , let's assume it's in the same state, but you want to have a different program in Philadelphia then you want to have in Pittsburgh, then you want to have in rural Pennsylvania.

Could you create that? Could you reach that group? Do you, do you have that level of sophistication within your marketing group to create those messages and reach just those subsets? Do you know how to use the social media tools to reach those groups? Do you have the ability and this is where CRM comes in.

Do you have a. At an, an ability to essentially look at your population. To dissect that population to do identify the right messages for the right people. This is where the CRM comes in, but this is also where Mindshift, , comes in at a change in the way you approach the consumer in healthcare. First of all, calling them a consumer, but second of all, treating them like a consumer, what are their preferences?

How do they like to be communicated to where do they like to receive care? , you know, w what's their current insurance and will that insurance. Not be around after Medicaid return redetermination. So Kaiser Permanente expects about 195,000. I have it's 1.3 million Medicaid beneficiaries covered under its health plan to lose eligibility.

Or have trouble re-enrolling it is working with the eight states to. , that it operates in and their respective Medicaid agencies, each of which reviews, Kaiser's messaging to ensure that they are using the right language to meet certain regulatory requirements. Said Shannon McMahon. It's executive director of Medicaid.

You know, I use this. This article really to highlight. The need for a CRM and the need to have the right tools. To reach people. Yes. You're still gonna work with the state. Yes. You're still gonna work with your legal and your regulatory, , aids in order to craft the right messages and use the right language to approach that.

Population in the right way. But at the end of the day, do you have the tools. Do you have the tools to look at your lists of patients? Do you have consumers who are going to show up at your hospitals or do they have to be patients already? What data sets do you have, do you have any data sets outside of your existing datasets that are going to help you with this effort?

So I'm just using this as an example of having the right tools. And I think a CRM is going to be critical moving forward.

There's a lot of different directions you can go in. Some can get very pricey, very quick. And some are much more effective. , cost-effective solutions. But consider when you're going in the direction of a CRM. Where else will it get utilized? So it'll get utilized in your call centers for sure. I'll get utilized in your marketing departments.

And it'll get utilized potentially in your population health group. Unless you have some population health tool, which does some aspect of the CRM. There's a lot of places that can be utilized. I know that epic has their. , cheer. I think it's called cheer. That's just coming out. And that will be a very small subset of what a CRM is, but it is a piece of what the CRM is. And for those who are really.

You know, being cost-effective, I guess you could look at your EHR as a, doing some of the work of your CRM,

but at the end of the day, if you're going to be interacting with your consumers directly, which all of your competitors are. , outside of health systems, but all your competitors, new competitors, new entrance in the market are, , you're going to want a CRM. All right. That's all for today. If you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week.

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