Build communities to improve the health care experience for dual-eligible members

While dual eligibles are individuals with a wide range of financial resources and diverse backgrounds, as a whole, this population does face a higher rate of health care and lifestyle challenges.

According to Kaiser Family Foundation, no less than 12.5 million of our fellow Americans are dually eligible, meaning that they rely on both Medicaid and Medicare for their health care.^[1] This growing population now represents 34 percent of the spending in Medicare and 19 percent of our total Medicare beneficiaries.^[2]

Importantly, more dual eligibles (more than four in 10, according to the Kaiser Family Foundation) were in fair or poor health, compared to the 17 percent of the general Medicare population. And, nearly twice as many dual eligibles reported having at least one limitation in activities of daily living (ADL)s.^[3] Taken all together, while dual eligibles are individuals with a wide range of financial resources and diverse backgrounds, as a whole, this population does face a higher rate of health care and lifestyle challenges.

Serving dual eligible beneficiaries is at the heart of what we do at Wider Circle. We believe that if you connect people to each other, it will lead to better health. Second, if we can help spark these connections, the real power comes not from what we do for our members, but what they will do for each other. Third, at the core of our offering is a fastidious focus on creating and maintaining trust among our members. And finally, better health is not just good for the members, it is value created for our health care system. That’s why as a company we are focused on fostering community connections that create trust between us and our members, and among our members.

LESSONS LEARNED ON NURTURING DUAL-ELIGIBLE COMMUNITIES

Since our inception in 2015, we have built, tested, torn down, and rebuilt our model to foster these connections between individuals. At each step, however, we sought to stay true to the core principles above. It’s also why we remain committed to making sure that we track, measure, and study our impact. We strive not only to ensure that we are demonstrating value to our sponsors, but that we can enhance and refine our program over time and as needed. Along our journey, we have learned a few key lessons, some the hard way:

• Trust is hard to win, and easy to lose: For successful engagement, we have to make sure we are upfront about what we are trying to accomplish and do what we say we’re going to do.
• It matters who you are: Our communities are local, and we make every effort to ensure that our engagement specialists are from the neighborhoods and communities where our members live. It’s very easy for members to spot an outsider.
• Put yourself in the members’ shoes: It’s easy for us to imagine we know the answer and for us to tell members what we think they should do. To create true connection, we have to listen first.

MEASURING IMPACT

Today, more than 30 percent of the members we serve across the country are dual eligible. That’s an important metric for us. But just as important is whether we’re helping improve the lives of our members.

• Creating communities with positive social pressure in health care works as is demonstrated by the results from one of our sponsors:
  • +9 percent primary care visits for prevention (AWV).*
  • 44 less inpatient visits per 1,000 participants.*
  • 14 percent less emergency visits in Wider Circle participants.*

* Compared to a propensity matched control group.

[1] KFF (https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/)

[2] MACPAC (https://www.macpac.gov/topics/dually-eligible-beneficiaries/)

[3] KFF (https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/)