Frontline care workers bridge racial divide, close widening trust gap | Cheryl Rucker-Whitaker

Managed Medicaid can be a powerful vehicle for health equity. But it succeeds only if health plan members are engaged in their care plan.

Cheryl Rucker-Whitaker

In under-resourced communities, information is in short supply and a dialogue with health plan members can’t be established in a phone call.

Think about the healthcare system as a car. If you toss the keys to people who get little or no time behind the wheel, how do they know what’s under the hood? Can they select fuel at the pump, check the oil and plan a safe trip? And what prompts them to see the mechanic?

Changing the trajectory of care requires an approach that provides more than access to affordable care. The U.S. Department of Health and Human Services recently injected $226 million in its Community Health Worker Training Program. These community-based grants provide outreach to under-resourced groups from people in the community who have their trust.

To remove health disparities, a health plan must make an investment to meet members in person where they are, then get each of them on a more equal footing. Some members will need extra help to navigate an inequitable environment.

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Outreach diversity gains patient trust

This starts with building trust between plan members and trained outreach workers, known in our organization as community connectors.

In meta-analyses and large-scale studies, minority patients report higher satisfaction with minority physicians and a diverse workforce, and providers report higher patient compliance. Our experience indicates that plan members are more apt to respond to community connectors because they believe the health information being provided is important and unbiased.

Outreach workers from the community share a lived experience, a visual connection and a level of empathy learned from experience. They already know about the community and its struggles.

Some obstacles may not be documented. For example, one hospital emergency room may treat stable patients while another turns them away. A primary care provider might not provide a truly full evaluation or might send patients out with a prescription without explaining why or when they should take it.

The pandemic challenged this outreach role. The Medicaid population rose as people lost their jobs. Phones were disconnected. Members moved or lost their homes, and their physical and emotional needs grew. Even with interruptions in field work, fully vaccinated community connectors engaged new Medicaid members in health risk assessments and built relationships with high utilization patients that allowed them to establish a basis for medication adherence and discharge follow-up.

Many health trust issues still need to be sorted out. Vaccine hesitancy has been an issue even in recruiting community connectors who have been vaccinated.Yet when connectors knock on doors and tell plan members, “I’m vaccinated. It was not an issue,” it’s an opportunity to establish trust.

Connectors ask questions to get members comfortable and thinking about their care. The managed care ecosystem is hollow without the patient at the center. Filling that hole means taking time to engage members in their health.

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To serve members, find them first

Before getting these discussions started, community connectors must find these members who have lost or not initiated contact with their primary care physician.

Our team works to get addresses, talks with neighbors and visits under-resourced communities. By knocking on doors and walking the streets in the community, the connector becomes a trusted face. At homeless shelters, connectors point people to providers to complete health risk assessments.This essential health-equity bridge role deserves wider healthcare industry support.

During the visits, the minority and multilingual providers spend time with patients to make sure they understand medical instructions and bring patients into the discussion. By engaging with clients, they adjust care plans to fit that member's situation, move them toward primary care and ultimately avoid unnecessary ER visits and hospitalization.

Questions asked during a meeting draw out vital information: Are you taking your medicine? When was the last time you visited your primary care physician? Are you aware of the services that Medicaid offers to support good care for you?

A lot of members we have encountered don’t know that they can see a doctor at no cost, that they have dental benefits, or that we can arrange help with transportation or medicine costs. It’s important that a member feels at ease. Empathy combined with motivational interviewing techniques creates a safe space for deeper discussions about their well-being.

Trust is something that’s not going to happen overnight with everyone, and it’s about getting the small wins now that lead to bigger wins over time. Community connectors earn patient trust as members of the care team.

There’s no health equity without equity.Members must be able to participate in a meaningful way in the improvement of health in their communities.

Frontline community engagement brings provider organizations and members together to decrease morbidity and mortality and better manage chronic conditions. As trusted partners they help bridge the health equity gap that plagues under-resourced populations.

Dr. Cheryl Rucker-Whitaker is founder and CEO of Complete Care Management Partners, an Illinois-based care management company that addresses health disparities in under-resourced communities.