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Key Insights from Nationwide Survey: Understanding Your Medicaid and Dual-Eligible Members as Consumers

Tuning In: Recent HealthEdge Webinar Reveals Healthcare Consumer Study Results

During the recent webinar, Understanding Your Medicaid and Dual-Eligible Members as Consumers: What Matters Most Today, HealthEdge released the findings from its nationwide survey that gathered the opinions and perspectives of more than 2,800 healthcare consumers. Presenting exclusively to Association for Community Affiliated Plans (ACAP) members, the speakers focused their interactive discussion on the survey findings from the nearly 500 Medicaid and Dual-eligible plan members who responded.

The results shed light on member satisfaction, communication preferences, the role of social determinants of health (SDoH), and the trust today’s consumers have in health plans. Understanding these aspects is crucial for health plans to meet the evolving needs and expectations of their members. Here, we summarize the discussion.

Member Satisfaction: A Top Priority for Health Plans

Member satisfaction has become increasingly important, driving health plans to seek modern, digital transformation that facilitates a more connected, consumer-centric healthcare marketplace. Factors influencing the growing importance of member satisfaction include:

  • Consumer buying behaviors being shaped by retail experiences,
  • New market entrants setting standards for consumer-friendly experiences and driving the need for increased health plan agility,
  • Increasing availability of data sources and maturing interoperability standards,
  • Growing participation in Medicare Advantage, Medicaid, and individual marketplaces.

By keeping a pulse on what matters most to consumers, health plans cans can more effectively adapt, prepare for the next generation, and remain competitive in the evolving market.

Consumer Preferences and Expectations: Summary of Survey Results

The study revealed meaningful insights about Medicaid and Dual-eligible members:

  • Medicaid and Dual-eligible members tend to be more satisfied than their counterparts in Medicare and employer-funded health plans, but significant gaps remain.
  • Good customer service has emerged as a top priority for members.
  • Adhering to members’ communication preferences significantly impacts overall member satisfaction.
  • Consumers expect health plans to leverage SDoH data to deliver more personalized and relevant services.
  • While most consumers trust health plans to manage their insurance, they also hold health plans most responsible for high healthcare costs.

Now, let’s dive into the details.

The survey indicated that Medicaid and Dual-eligible populations show higher levels of satisfaction with 44% and 52% fully satisfied, respectively, compared to other groups. Conversely, the study revealed 44% of Medicare-only members were fully satisfied and 38% of members in employee-sponsored programs. Given this data, there is still ample room for improvement.

The study reveals the vital role care management plays in enhancing member satisfaction, providing a more personalized experience, and improving outcomes. The speakers explained that to scale care management efforts and achieve higher member satisfaction, health plans need modern technology in place. Technology can automate manual, mundane processes and empower care managers to be more productive, reach more members, and provide personalized engagement.

“We need to find ways to reach more members without taxing our nurses. When the right technology is present, payers are able to put the care manager in the center and empower them to be more productive to meet member needs at scale,” explained Jennie Giuliany, RN, Lead Clinician, Client Management, HealthEdge, GuidingCare.

Christine Davis, Senior Vice President, Marketing at HealthEdge also added, “Technology can help plans understand members holistically – medically, behaviorally, environmentally – and allocate the right resources based on populations. The right tools can help care managers scale so more members can receive the personalized engagement that previously could only be given by a care manager. For example, by improving care managers’ access to more real-time data, they have better insights immediately available. Technology can also automate manual tasks that take time away from care managers connecting with more members.”

Connecting with Members: Using Preferred Methods of Communication Improves Satisfaction and Outcomes

Medicaid and Dual-eligible members tend to prefer communication via phone, email and text or mobile app. Technology can equip health plans with the right tools to engage these hard-to-reach members. In addition, the study found that being able to communicate with members through multiple channels – and specifically their preferred channels – has a positive impact on overall satisfaction scores. Adopting an omni-channel communication approach allows health plans to connect with members through their preferred channels, which ultimately helps improve engagement and care plan adherence.

Holistic Inights and Actions: Using SDoH Data to Improve Member Satisfaction

A growing number of state policies now include SDoH. As SDoH data becomes more available, health plans can use this information to address health equity challenges. However, study participants demonstrated they are less than fully satisfied when it comes to their care manager’s ability to provide personalized care based on their personal traits, current economic conditions, and location or community. For example, results indicated:

  • 50% are less than fully satisfied with their care manager’s ability to provide individualized services based on their personal traits, such as race, ethnicity, gender, or religion.
  • 60% are less than fully satisfied with their care manager’s ability to provide access to essentials such as housing, food, utilities, or transportation.
  • 64% are less than fully satisfied with their care manager’s ability to provide services based on the location and/or community in which they live.
  • 69% are less than fully satisfied with their care manager’s ability to provide individualized services based on their current economic conditions such as education, employment, or income level.


To close these gaps in satisfaction, payers can turn to technology to easily identify at-risk populations and build more whole-person care strategies that can make meaningful differences in member outcomes and costs.

Using the right data and workflow tools, health plans can align individuals who have specific needs with more tailored services, such as access to housing, food, utilities, and transportation. Leveraging a care management platform that integrates with SDoH vendors can help accomplish this.

Understanding Member Needs and Gaps

When selecting a health plan, Medicaid and Dual-eligible members prioritize factors such having more services covered; offering benefits that align with service and medication needs; the ability to keep current providers; and in-network providers close to home or work.

However, the survey revealed that gaps exist in health plans’ abilities to address key member needs. Consumers identified the biggest gaps as:

  • Good customers service
  • Easy access to my health records
  • Incentives and rewards for health behaviors
  • Regular communication through preferred channels

Perceptions and Trust in the Health Plan Ecosystem

Medicaid and Dual-Eligible members generally trust health plans over other entities like the government to administer their health insurance. However, the research shows important trends emerging from different generations, such as younger members placing more trust in retail companies and being more likely to assign assigning blame for high healthcare costs to health plans. Understanding individual experiences and touchpoints within the healthcare ecosystem is essential for shaping perceptions and trust.

Actions for Health Plans to Improve Member Satisfaction

To enable care managers to be more efficient and effective, and to enhance current and future member satisfaction, payers can leverage modern care management solutions, like GuidingCare® and Wellframe from HealthEdge. The right solutions to support member experience should include key capabilities that allow health plans to:

  • Remain agile and adaptable to support regulatory changes
  • Automate multiple redundant and inefficient workflows
  • Expand into new markets and business models
  • Manage and support value-based care
  • Personalize member engagement at scale

Following consumer trends and needs allows health plans to improve member satisfaction and health outcomes at a time when the stakes have never been as high. To watch the full webinar, visit the HealthEdge website here.