HJNO Jan/Feb 2021

42 JAN / FEB 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS COLUMN INSURANCE FOR MANY of our patients, however, this landscape becomes even more complex due to factors such as low health literacy and social determinants of health (SDOH) like food insecurity, unemployment or in- adequate shelter – issues that are most prevalent across Medicaid member pop- ulations. All too often, patients experi- encing these issues feel overwhelmed by the information they receive from their physicians, in turn making it difficult for them to adhere to care plans, to partic- ipate in healthcare decision-making and to be proactive in their own care. Yet, we are increasingly seeing evidence that patients who are more actively involved in their healthcare experience have bet- ter outcomes – a body of evidence that credits these improved outcomes to phy- sicians who are achieving meaningful pa- tient engagement. Defining Patient Engagement A February 2013 Health Policy Brief from the Robert Wood Johnson Foun- dation perhaps defined it best: “Patient engagement is a broad concept that com- bines patient activation with interven- tions designed to increase activation and promote positive patient behavior.” A November 2014 brief by the Institute for Patient- and Family-Centered Care (IPFCC) took it a step further, calling it “an active partnership among individu- als, families, health care clinicians, staff, and leaders to improve the health of in- dividuals.” “Research shows that engaged indi- viduals and families actively working with their health care teams have better outcomes, often choose less expensive options when participating in shared de- cision-making, and express greater satis- faction with their healthcare experienc- es,” the IPFCC noted. The organization further clarified that this engagement occurs at four levels: in the clinical encounter, at the practice level, at the community level and at the policy level. Across each of these levels, collaboration and behavior change – for patients and healthcare professionals – are required. “Engagement is a complex phenom- enon and requires the health care pro- grams, as well as the individuals and families served by the programs, be open to creating a trusting relationship based on shared goals,” according to the IPFCC brief. Engaging Medicaid Members: The Challenges The Medicaid program provides health insurance to nearly 69 million Ameri- cans, including low income children and families, elderly individuals, disabled persons and adults without dependent children, reports the Centers for Medi- care and Medicaid Services (CMS). Here in Louisiana, nearly 1.5 million residents are enrolled in Medicaid. As much as 60% of these Medicaid patients fall within the lower levels of patient activation and engagement, the IPFCC reports. Among the patient en- gagement roadblocks for Medicaid mem- bers are healthcare system barriers, a lack of evidence-based interventions and practice styles that discourage active en- PARTNERING WITH PATIENTS: Engaging Medicaid Members for Better Outcomes Healthcare, even for those of us who work in it, is a complex and constantly evolving landscape.