Medicaid, Medicare, and exchange health plans wield an outsized influence on the U.S. healthcare landscape. Their challenges, needs, and decisions reverberate across the healthcare ecosystem. This year, to understand the factors shaping health plans' strategies in two of the fastest-growing states, Texas and Florida, we conducted a short in-person survey at the Texas Covered Conference + Expo (TAHP) and the Florida Association of Health Plans Annual Conference (FAHP).

The findings from 32 distinct respondents revealed interesting insights.

Collaborative partnerships are driving health equity

When we asked, "What is your health plan’s most impactful initiative to reach state health equity goals or measures?" collaborative partnerships with local healthcare providers and community organizations emerged as the top choice, securing 35% of votes across both conferences. Targeted outreach and education programs for vulnerable populations claimed the second spot with 28% of the votes, while data analysis and reporting to identify disparities garnered some favor, claiming 23% of the votes across both conferences.

These three top initiatives—collaborative partnerships, targeted outreach, and data analysis—are foundational for improving access to care, fostering cultural sensitivity, and building community trust. Collaborative partnerships enable community-centric approaches, leveraging local expertise to tailor interventions for specific needs and build trust. Targeted outreach and education address accessibility challenges, empower communities with knowledge, and inform evidence-based interventions. While data analysis allows interventions to be deployed to the highest need patients at the appropriate time.‍‍

‍Member outreach dominates concerns in Florida, Texas reveals dispersed challenges‍

In exploring the challenges faced by health plans outside of redetermination, a regional divergence became apparent. In Florida, member outreach dominated concerns, with 26% of respondents highlighting issues related to having accurate member contact information. The popularity of this concern in Florida aligns with nationwide difficulties in securing updated contact information for Medicaid enrollees through the end of the public health emergency. Interestingly, according to the Kaiser Family Foundation Medicaid Enrollment and Unwinding Tracker, Texas and Florida have two of the highest disenrollment rates in the country. Other challenges, such as access to care, behavioral health, engagement, and member/plan growth, were also represented among the respondents at FAHP, each accounting for 9% of the mentions. 

In Texas, challenges reported were more dispersed, with utilization, retention, medication cost, and care management, each leading with 13% of mentions and adherence/compliance securing 7% of the mentions. This diverse spread of issues illustrates the complex interplay of challenges in the Texan healthcare ecosystem.

The regional divergence in identified challenges outside of redetermination between the two states emphasizes the need for tailored and context-specific approaches to address the unique healthcare needs of each state's population.

Improvement in access to care is a top criteria for external resources

When examining the criteria for selecting external resources to address challenges, a similar hierarchy emerged at both conferences. Improvement in access to care took precedence, with 15% of the votes across both conferences, emphasizing the universal recognition of its fundamental role. 

Return on Investment (ROI) closely followed at 13.2%, reflecting a pragmatic emphasis on cost-effectiveness and long-term sustainability. Notably, impact on member satisfaction also held significance with 12.9% of the votes across both conferences, underscoring the commitment to patient-centered care and acknowledging the vital role of member experience in overall health plan success. 

A call for deeper exploration

The sentiments unveiled by our survey are sure to resonate across health plans nationwide, sparking a call for deeper exploration into the unique regional strategies shaping health equity, the challenges faced by health plans by state, and the opportunities for external resources to bridge crucial gaps. There is much to glean from both successes and failures, and we look forward to delving into the health plan challenges, best practices, insights, and strategies that future conferences will undoubtedly bring to light.

About Scene Health

Scene Health's 360° model of care enhances Directly Observed Therapy through video technology to address the $500B medication nonadherence problem. Scene currently delivers programs for Medicaid and Medicare MCOs, public health departments, and life science organizations covering multiple chronic and infectious conditions, including diabetes, asthma, cholesterol, opioid use disorder, hepatitis C, tuberculosis, hypertension, and solid organ transplants.

To discover how our MedEngagement program contributes to improved outcomes for diverse populations, contact us.