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Inside One Startup’s Approach to Improving Medicaid Members’ Outcomes and Patient Experience

In July, Roseville, California-based Adventist Health began a three-year partnership with Emcara Health, a primary care provider group focused on meeting patients where they are by deploying community health workers into the places people live. Five months later, Emcara is announcing that the program is seeing significant engagement and improving patients’ ability to keep up with their care plan.

Emcara is a national provider group that serves about 50,000 patients using value-based primary care models. It launched last year out of PopHealthCare, GuideWell’s population health analytics subsidiary. Emcara’s care teams reach patients in their homes, in shelters or on the street and help coordinate other in-person care as needed. 

The startup’s partnership with Adventist’s was designed to advance the work the health system is doing through its participation in the California Advancing and Innovating MediCal (CalAIM) program, which gives providers state funds to improve health outcomes among Medi-Cal enrollees by broadening care delivery models.

Through the partnership, Emcara serves as an extension of Adventist’s capabilities. There are some populations, such as the unhoused, that brick-and-mortar healthcare providers will never be able to reach. And there are some patients who need extra guidance as they may be navigating complex treatment plans and personal circumstances at the same time with little assistance, said Ernestine Hill, Emcara’s lead care manager.

Having been out in the field working with patients, Hill said she has learned it’s crucial to provide “active effort.” This is a concept she first became familiar with when she was doing advocacy work for a Native American tribe — the term refers to the fact that timely, hands-on support is needed to reunite Native foster children with their families. Similarly, Hill found that some patients need thorough and active help in order to maintain their treatment plan.

“I took that concept and said that when I meet with my members, I’m not just saying ‘Hey, here’s a phone number for housing — call it and let me know what happens.’ No, it’s making the call with them and walking them through it step by step until they’re confident enough to do these types of things on their own,” she said.

For an example of a patient to whom she provided active effort, Hill talked about a man named Bryan. When they met, Bryan had been diagnosed with stage three bladder cancer and said he was “having a horrible time navigating” the healthcare system. He had visited seven urologists and three oncologists in less than a year, and he felt like these providers weren’t listening to him.

By stepping in as Bryan’s designated community health worker, Hill could attend doctor’s appointments with him as an advocate. In one case, Bryan was at home in great pain after a doctor’s visit during which his physician refused to prescribe him antibiotics for a urinary tract infection. After telling Hill, she convinced the physician to write the prescription. She has also helped him get transportation to medical appointments and found caretakers for his dogs when he needed to travel for surgery, Hill said.

To measure the impact of their partnership, Emcara and Adventist will track metrics such as the number of patients who graduate (no longer need Emcara’s services) and whether emergency department utilization and hospitalizations go down among Medi-Cal members. Emcara will also look at the number of patients it is able to engage, as well as metrics associated with patient outcomes, such as medication adherence rates or the number of patients who have follow-up appointments with Adventist specialists, said Chris Dodd, the startup’s chief medical officer.

While it’s too early in the partnership for Emcara to report back on how these numbers have changed, Dodd and Hill said the program is off to a nice start because the care teams have already been able to engage with patients and conduct successful outreach, which is often one of the toughest part of community health programs.

With health systems undergoing major financial pressures and workforce shortages, they don’t necessarily have the resources to deploy community health workers of their own into the field. But health systems still need to make sure that vulnerable patients are able to continue their care journeys, and that’s why partnering with community health workers is so important, Dodd said. Emcara gets paid through its value-based agreements with payers.

“Ultimately, you would want the ethical motivation to do the right thing for our fellow community members who are most in need to be enough. But we know things are more complicated than that. So from an economic perspective, hospitals received the least amount of reimbursement from Medicaid. The ability to deliver better care to that Medicaid population to keep them healthy and outside of the ER and hospital allows hospitals not only to do the right thing, but also help their bottom line,” he said.

Photo: Rawpixel, Getty Images

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