Carrie Kozlowski: Enhancing Patient Access Amidst Rising Medicaid Disenrollment

Carrie Kozlowski, OT, MBA, chief operating officer and cofounder of Upfront Healthcare, explained how the company emphasizes personalized engagement to overcome technological, cultural, and social barriers. This is especially crucial while Medicaid disenrollment rates are increasing.

Transcript

With health systems facing financial difficulties, motivating patients to seek care becomes crucial. How does Upfront Healthcare's omnichannel approach address this challenge, especially considering the barriers such as technological, cultural, psychological, social, and health literacy?

It's a great question I appreciate you asking. [At] Upfront our mission is to guide every patient to get the care they need, and fundamental to doing that is access. And access, we talk about in 2 ways in this country: one is access to financial coverage that empowers me to get care, makes me feel confident that I can get care, and the other is access to providers. And so in either case, what we're really focusing on is how do we help patients get care and remove those barriers that you highlighted, across the board?

Our belief is the key to that is personalization. And what we do that no one else does is we combine both behavioral science with a health care psychographics model to deliver highly personalized, very relevant engagement outreach. And this is orchestrated all the way across, whether it's enrollment, helping patients get into a new provider because they've been attributed and paneled, etc, all the way through then, "What is the care I need? How do I make sure I come to my visits? And how do I make sure I'm connected to the referrals after my visits" across the board. And we really think about personalization in a framework.

I'll highlight a couple of things I think are really important. The first is capturing a moment that matters when we're engaging a patient sending a message on a Tuesday in March, we'll catch a few people, but we're really looking for moments when people might be interacting with their health system, or interacting with medical, or thinking about their health care. Maybe they've gone to urgent care, maybe they've been to an emergency room, maybe they haven't seen their primary care [physician], and their enrollment, for example, in Medicaid isn't due for a few months and so we want to get ahead of that. But we're looking for opportunities where we have patients in the behavioral science thinking of like a little bit of mindshare around the issue.

Another area where we really think about personalization is delivering on equity, and this is fundamental to everything that we do. But we think about language, we think about health literacy, we think about culturally relevant imagery, words, etc. And then the other piece is driving and addressing social barriers in real time. So, do we understand what the social barriers are? In some cases, people are inquiring about that from patients, and they're starting to gather that data, but it's point-in-time and maybe not in the context of care so people don't really think about if that's a problem for them. But in the context of helping people get care, we're asking if they have a barrier, and we're providing the solutions that our clients offer them to overcome those barriers. And so we're taking potential obstacles and reasons for not taking action on the patient side and we're removing them in real time, in context, and in a highly supportive way.

The other side of that coin is it's not just technology. I've been in technology for 20 years or more now. Before that, I was a clinician, I was an occupational therapist. You can't take technology and install it and solve the problem. Right? When we're thinking about our partnerships with our clients, what we're really focusing on is, what are the strategic goals? What are the workflows associated with achieving those goals? Who's going to be involved? And how are we going to facilitate or change management that is going to lead to sustained improvements in a patient experience, patients getting the care they need, and really the team around them hopefully finding greater operational efficiencies in their work?

Our goal is to bring in experts in health care who have been on the delivery side, some on the consulting side, and create strategic partnerships with our clients where we're serving as a guide over time. And when we think about the combination of those 2 things, that's where we start to see really exciting results because what we're doing is not forcing in technology, but it is layering in technology in the context of work.

We have another health system that is working specifically in this case on Medicaid re-enrollment. We've done a number of things with them. And so the fact that we've been working with them over time to create these digital experiences and patients have really formed what I think is a trusted digital relationship with this health system. The engagement for patients around messaging them, encouraging them, understanding what their needs are for enrollment, we're seeing over 35% engagement. Of those, I would say over 50% of their respondents are indicating that they do need to re-enroll, 40% are saying they've done it already, and less than 10% are saying that they don't qualify.

But I think what's really telling is of the 50%—or I guess a little more than 50%—that are saying they need to re-enroll, over 70% are saying they need help to do it. And I think that's where we're trying to [say], "OK, what are your needs? How can we help you?” And then together between technology, people, process, we're able to actually create a supportive system environment where patients can get that care. And then again, that builds greater trust, right? Because you're solving a problem that they have, you're helping them get health care, and that's going to continue to create a more activated patient over time for all their care needs.