posted by AHIP
on September 4, 2019
There are numerous health-related challenges facing rural areas of the United States, including geographic isolation, an aging population, and a shortage of providers and hospitals, especially as rural hospitals close at unprecedented rates. People living in rural communities experience higher rates of chronic conditions, such as diabetes, obesity, and mental and behavioral health disorders in children, and residents are at higher risk of injury and complications from substance use disorder (SUD). These and other challenges prevent patients from consistently getting the care they need – and it creates opportunities for health insurance providers to innovate and coordinate care delivery for rural residents.
California Health & Wellness, a wholly owned subsidiary of Centene Corporation, began serving Medi-Cal members in California in 2013 in 19 rural counties. To best serve members in geographically isolated areas, California Health & Wellness created a comprehensive rural health program that uses local community health workers. The California MemberConnections program is an integral part of the company’s care management program, where local MemberConnections Representatives, also known as health plan navigators, serve as liaisons between the insurance provider and its members.
This program engages rural members in new ways, with targeted outreach for members who may need services like post-discharge from the hospital or following the delivery of a baby, for example. The program targets high-risk, vulnerable populations and helps members navigate the health care landscape more easily.
California Health & Wellness emphasizes cultural connections and recruits people from the communities it serves – recognizing the importance of working with people who understand the challenges members face. Health plan navigators speak the same language, hail from the same regions, and understand the communities based on lived experiences.
Focusing on a whole person approach to care also helps members address issues beyond traditional health care needs – the social determinants of health. When a member meets with a MemberConnections Representative, they’re asked about housing needs, transportation issues, and food insecurity – and resources are delivered where appropriate.
California Health & Wellness’ MemberConnections program has created a blueprint to address rural member needs and can serve as a model for care delivery in rural communities.