What Do Medicaid Members Want From Their Health Plan? Insights From a Qualitative Study to Improve Engagement in Case Management

Amy McQueen; David Von Nordheim; Tess Thompson; Kayla Manley; Albert J Pool; Matthew W Kreuter

doi:10.1097/NCM.0000000000000716

What Do Medicaid Members Want From Their Health Plan? Insights From a Qualitative Study to Improve Engagement in Case Management

Prof Case Manag. 2024 Mar 1. doi: 10.1097/NCM.0000000000000716. Online ahead of print.

Authors

Amy McQueen^{1

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6}, David Von Nordheim^{1

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3

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6}, Tess Thompson^{1

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6}, Kayla Manley^{1

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6}, Albert J Pool^{1

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6}, Matthew W Kreuter^{1

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6}

Affiliations

¹ Amy McQueen, PhD, is Professor of Medicine and Co-Director of the Health Communication Research Lab. She primarily designs and tests behavioral interventions to prevent cancer and improve self-management of chronic conditions. She also has experience using mixed methods with diverse samples. She can be reached at amcqueen@wustl.edu.
² David Von Nordheim, MA, is a data analyst in the Health Communication Research Lab. He contributes to projects investigating health and social needs in underserved populations. His focus is on applying the best statistical methods for analyzing survey and health claims data. He can be reached at dvonnordheim@wustl.edu.
³ Tess Thompson, PhD, is an Assistant Professor at the University of North Carolina-Chapel Hill. She studies health promotion, cancer prevention, and cancer survivorship. She can be reached at tess.thompson@unc.edu.
⁴ Kayla Manley, MA, is an Evaluation Coordinator at the Evaluation Center at Washington University in St. Louis. She has expertise in conducting qualitative interviews, coding, and analyzing qualitative data. She can be reached at kmanley@wustl.edu.
⁵ Albert J. Pool, MPH, is a Research Project Coordinator in the Health Communication Research Lab. He assists in the management of research projects, especially data collection and data management. He can be reached at a.pool@wustl.edu.
⁶ Matthew W. Kreuter, PhD, is an endowed professor and founded the Health Communication Research Lab. He is an international leader in designing and testing tailored communications and novel interventions to improve the health of low-income and minority populations. He can be reached at mkreuter@wustl.edu.

PMID: 38421729
DOI: 10.1097/NCM.0000000000000716

Abstract

Purpose of study: Managed care organizations (MCOs) provide case management services to address unmet health and social needs among their members. Few studies have examined factors influencing members' decision to participate in these programs. The purpose of the present study was to describe the life circumstances of Medicaid members offered case management, what they wanted from their MCO, and their perceptions of case management and barriers to participation. Results will inform practice to raise the awareness, engagement, and impact of case management programs.

Primary practice settings: Case management offered through a Midwestern Medicaid MCO.

Methodology and sample: Adult members who had been offered case management services in the 6 months preceding the study were eligible for the study. Fifteen people from each strata were recruited: members who engaged with case management, declined it, or declined it initially but later engaged (N = 45). Participants completed a qualitative interview by phone and a brief health survey online.

Results: Across strata, only 22 participants recalled engagement with case management. Members described a variety of life challenges (e.g., chronic health conditions, caregiver responsibilities, and limited finances) and services they desired from their MCO (e.g., stipends for over-the-counter health expenses, improved transportation services, and caregiver assistance). Participants identified direct communication, emotional support, and referrals for resources as benefits of case management.