The Patient Perspective: Utilizing Focus Groups to Inform Care Coordination for High-Risk Medicaid Populations
Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination.
We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA.
Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs.
Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.
Overview of article
- This article focuses on understanding the barriers to care Medicaid patients experience and what supports will be most effective for providing them care coordination
Methods of article
- The research team conducted 2 focus groups and thematic analyses to assess outcomes drivers and preferences of Medicaid patients enrolled in the study sites integrated care management program (iCMP)
- The focus groups illuminated 6 key themes categorized into 3 groups where the iCMP care coordination efforts were either having a positive impact or not addressing needs:
Group 1: Enabling resources
1) Traditional medical care coordination efforts – many participants viewed this as a strength but noted more face-to-face communication as an area for improvement; and
2) Provider communication – participants reported positive accounts of assistance, and good relationships with providers, though also pointed to areas where these efforts fell short, such as frustration with automated reminder from unfamiliar staff
Group 2: Predisposing characteristics (and their effect on care)
3) Trauma histories – includes loss of a loved one and domestic violence;
4) Mental health challenges – includes anxiety, and feelings of claustrophobia in waiting rooms and;
5) Executive function – participants described challenges, such as navigating social and medical benefit programs, they face that would likely require redress through additional programmatic supports;
Group 3: Need for care coordination
6) Peer-to-peer support tendencies – includes a sense of comradery and connection among focus group patients because of experiencing similar challenges
- Given the differing needs of the Medicaid patient population, utilizing other types of providers for patients, in particular community health workers, with more socially driven needs, might be a better allocation of resources to improve provider communication
- Motivational interviewing techniques by all care team members may be helpful in helping patients navigate tasks that require more executive function
- Social workers may also be enlisted as to help with behavioral health integration and care coordination, especially with trauma-informed care
- Medicaid patients themselves may be an untapped resource. Communication with other Medicaid patients can provide peer and emotional support
- Limitations to the study include nonrepresentative sample size (primarily older, white and female), lack of generalizability, use of English in focus groups (excludes non-English speakers), and the fact that younger patients were likely to be working and thus not able to participate