Copays to Cab Rides: How a Local Health Plan Helps Members Access Health Care

A few years ago, I was invited to take a tour of a homeless shelter in one of the most impoverished neighborhoods in Albany. Interfaith Partnership for the Homeless is located in the heart of Sheridan Hollow, a community I normally drive over – not through – to get to work. Curious as to what I might see, I graciously accepted the offer.

While touring the facility and meeting with the individuals who called this shelter “home,” I learned a couple of important things. The first was that none of us knows what it’s like to struggle until we’ve walked a day in the life of a homeless person’s shoes. The second, and maybe most striking fact, was that many of these individuals were CDPHP members.

It was at that very moment that I realized that health care needed to change.

As a doctor and health plan CEO, I often talk to our members about the importance of connecting with a primary care provider, getting immunized, and staying up to date on screenings. But the homeless man or woman is not thinking about scheduling their annual well visit. They’re thinking about where they are going to sleep that night or where they will get their next meal.

How can a health plan, like CDPHP, expect these folks to access health care in the same way as you and me? The short answer is that we cannot.

CDPHP covers the majority of Medicaid enrollees in the Capital Region. Most of these individuals are not homeless, but they do present a host of challenges for a health insurance company. Those challenges include cultural and linguistic differences, low health literacy, poverty, and high rates of substance use and depression. Armed with a new perspective on our evolving membership, I encouraged my staff to get creative in their approach to treating our growing and increasingly more complex Medicaid population.

The team started by partnering with community groups, like faith-based organizations, community centers, and homeless shelters to identity members who are “off the grid” or have gaps in care. We offered to meet these members face-to-face at various community-based sites. Once a sense of trust was established, the case managers helped the members connect with a doctor, sometimes even accompanying them to appointments and arranging transportation. In addition to meeting members in the community, CDPHP also partnered with a local hospital, where our nurse case managers began meeting with members at their bedsides. The nurses talked to patients about their health and discharge plans, made sure they understood their medications, and helped coordinate any follow-up appointments. One story in particular reminds me of how critical this type of “boots on the ground” approach is.

A 59-year-old Medicaid member with diabetes had been admitted to the hospital several times in just a few short weeks. Curious as to what was going on, a CDPHP nurse case manager went to see the gentleman. After spending some time talking to the man, he opened up and told the nurse that he was single, had no family, but has two dogs. The dogs, he went on to explain, are his family, and every time he is admitted to the hospital he worries about them. Who will take them outside? Who will feed them? The gentleman admitted that he had checked himself out of the hospital every time against doctors’ orders to take care of his “family.”

The nurse told the member not to worry. She called a local foster program and arranged for his dogs to be watched whenever he needed care. Knowing that his dogs were in good hands, the man spent a few days in the hospital and got his diabetes under control.

Today, health plans around the country have hundreds of stories like this—stories where the lines between medical care and social work have become blurred for all the right reasons.

This type of work is not easy, but for CDPHP, it’s paying off. Since 2013, engagement rates for our Medicaid members have jumped 36 percent. In fact, engagement rates for our Medicaid members have since surpassed our commercial population.

For years, doctors – like myself – have taken a very proscriptive approach to medicine. But the more we learn about the social determinants of health, the more we put ourselves in our patients’ shoes, and the more we are able to help our members live fuller, healthier lives.

Photo by Flickr