Improving the Medicaid member journey means removing barriers to care

Making the best Medicaid programs doesn’t happen overnight. It takes time to research how members access services and what might be a barrier to care.

November 18, 2019

Understanding challenges along the member journey
Health care can be hard. When we understand the barriers Medicaid members face, we can work to make their experience better. Medicaid members are an extremely diverse group. Their health care needs and challenges are equally diverse and constantly evolving. To keep up with these constantly changing needs, we put the focus on the members and their unique circumstances.

Identifying the pain points
Through in-depth research and interviews with Medicaid experts and members, we’ve developed a profound understanding of the Medicaid member experience. This has helped us create distinct member profiles that outline the barriers they face. From children to healthy adults, people with disabilities and the elderly, Medicaid membership reflects the most diverse population in managed care.

Anybody can face barriers to accessing health care. Typical barriers can include locating a clinic nearby, fitting into a clinic’s limited office hours, or finding reliable transportation. But a Medicaid member often has more barriers that keeps them from using their Medicaid benefits. These barriers might include:

Language and cultural differences
Little schooling and/or lack of basic health care knowledge
Addiction and its negative health effects
Poor access to information/communication
Lack of access to affordable, reliable housing
Childcare/eldercare (cannot leave them unattended)
Poor access to affordable, nutritious food
Mental/physical disabilities
Unsanitary living conditions
Keeping up with the changes
Understanding Medicaid members, their journey and the challenges they face along the way has helped guide our Medicaid program designs. While we know who these members are, their needs are always changing. To make sure our pharmacy benefit design continues to meet the needs of Medicaid members, Prime has put together a Medicaid Product Council. This is a standing series of interactive meetings with Medicaid representatives from our health plan clients. These meetings help us fine-tune our existing Medicaid program suite. It helps us come up with new ideas. And it helps us better integrate with our clients’ Medicaid programs to give their members the support they need.

Better results through better understanding
At Prime, we have a lot of Medicaid knowledge and expertise. And we invest more time and resources through research, collaboration and knowledge sharing. We align our strategies to better understand Medicaid members, remove barriers to care and get them the medicine they need to feel better and live well.

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