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Case Study - Qualitative Research to Uncover and Resolve Root Causes of Perceived Barriers to Care

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Summary: As a result of lower-than-desired CAHPS ® scores, a large regional health plan wanted to first understand the root causes of the low scores by engaging in more detail with its members, and then apply strategies to fix the uncovered problems. The Health Plan partnered with SPH Analytics to conduct focus groups with members of the plan from throughout the state. The goal of the focus groups was to uncover and better understand member perceptions and concerns about their access to care, the quality of the care they receive, as well as about the plan itself. The final report yielded many enlightening insights and encouraging news to the health plan, including how satisfied their members are with their primary care physicians, their customer service representatives, the appointment reminders received, and the overall coverage the plan provides for most health care expenses. The focus groups also exposed a general confusion related to awareness and branding of the health plan versus the awareness and branding of the state Medicaid program – a distinction that while on the surface might seem a peripheral branding issue, could actually inhibit future efforts by the plan to improve CAHPS scores, if members continue to confuse the two organizations. From an actionable perspective, information gleaned from the focus groups led to the conclusion that if the Health Plan enhanced its communication methods and increased its telehealth offerings, they would increase the access to care that members both want and need, and ultimately also improve the members' experience and perception of access and quality. Background: The Health Plan is one of several large state-wide Medicaid plans contracted by their state's Medicaid program. The Health Plan covers approximately 400,000 lives, scattered across nearly 100 counties. All the state Medicaid plans interact and collaborate with each other, often sharing the same tools and processes to serve the Medicaid beneficiaries in the state. The Health Plan has worked with SPH-administered focus groups in past years and has often incorporated the resulting voice and opinions of the customer into its processes and workflows. Qualitative Research to Uncover and Resolve Root Causes of Perceived Barriers to Care Population Engage ™ Case Study

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