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4 things Medicaid members need from a health plan experience

More than 3 in 5 Medicaid members have felt overwhelmed by managing their health. The healthcare system can be confusing enough to navigate. For Medicaid members, it can be even more challenging in the face of financial, transportation, and social barriers. To better serve Medicaid members, health plans have to uncover and understand their key concerns.

Based on the results of Wellframe’s recent survey, we compiled a list of 4 services Medicaid members need most from their health plans.

1. Assistance navigating the healthcare system

Any member new to health insurance might have trouble understanding how to access the benefits and services they need. Health plans have the opportunity to educate these members on important topics—like why they need a PCP, how to get reimbursed for health services, or understanding the healthcare system.

By helping members navigate the healthcare system, health plans and care teams can build member trust and maintain long-term relationships. Giving members a positive health experience can also help improve plan loyalty and retention—and make it easier for them to take control of their own health and wellness.

2. Support for managing chronic conditions

Nearly 3 in 4 Medicaid survey respondents are living with at least one chronic condition. The most common conditions included mood disorders (22%), arthritis (14%), asthma (13%), and diabetes (9%). Managing a long-term condition can be exhausting and expensive—and many members live with more than one. As state Medicaid programs increasingly include beneficiaries with complex needs in MCOs, health plans will have to develop comprehensive strategies to treat members’ whole health needs.

3. Access to health interventions wherever they are

For high-need and high-risk members, it can be difficult to get timely health support. Many health plans offer nurse hotlines to make it easier for members to get in touch with a provider when they need it. However, more than half of Medicaid members didn’t know they have access to a no-cost nurse hotline.

About 54% of Medicaid members are already using at least one app to manage their insurance benefits or communicate with healthcare providers. To make it easier for members to reach out to their providers, health plans can make nurse hotline information and text-based messaging available through a mobile app.

4. Clear communications from their health plan

Health plan documents and communications can be confusing—especially if they include a lot of healthcare-specific terms. Your plan can help avoid member confusion by removing healthcare jargon from your member communications whenever possible. When removing industry terms isn’t possible, you can include an explanation in the text. Using plain language in your member-facing information can help improve members’ health literacy and increase benefits utilization. In turn, this can help prevent care gaps and lower member care costs.