According to the Centers for Disease Control and Prevention (CDC), rural Americans have a higher risk of premature death from heart disease, cancer, respiratory disease, stroke, and unintentional injuries than urban residents. Challenges related to social determinants of health (SDOH) such as poverty, lack of healthy food options, and poor transportation contribute to the problem.
Access also remains a key hurdle. One in five Americans lives in a rural area, where provider shortages account for two-thirds of primary care health professional shortages. These areas are also burdened by a scarcity of mental health providers. Even when telehealth is an option, many rural members can’t use it. Between 22.3% to 50% of rural Americans have poor access to high-speed internet.
Improving health outcomes for the rural population facing these challenges may seem like a daunting task, yet health plans can employ several communication strategies to help members receive the care they need. By doing so, plans can also boost their quality metrics and improve their Healthcare Effectiveness Data and Information Set (HEDIS®) and Star Ratings performance, which directly impact revenue and future enrollment.
Better Communication Strategies for Rural Members
Improving care for members requires their engagement, which may be difficult to secure given the sense of mistrust that many vulnerable populations feel toward healthcare institutions. Plans that take time to build trust and carefully curate their outreach, however, can make strides towards achieving better outcomes and relationships with rural populations.
Amid these challenges, health plans should consider adopting the following strategies for more effective communication with rural members:
1. Send digital surveys to gather members’ contact information, communication preferences, and other insights. Welcome calls and health risk assessments can help plans identify the best ways to connect with their rural members: via voice, text, email, and even direct mail, especially when broadband is limited.
To reveal potential care gaps, plans can survey members to get a better sense of provider wait times or distance traveled to reach a provider. This can also uncover opportunities to improve their Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan Survey results, which query members on the ease of getting care, among other measures.
2. Use analytics to identify members most likely to engage. Using predictive models, plans can refine their outreach and curate a target list with the most engageable members. Then, they can launch campaigns to improve high-weight quality measures. For example, a plan might target rural members in a certain geography who haven’t had a provider visit in the past 12 months and may be at risk for an inpatient admission based on clinical endpoints like A1C values.
3. Employ text messaging, interactive voice response (IVR), and other technology to support targeted campaigns. Multichannel communication can connect members with plan resources to address SDOH factors that contribute to poor health outcomes. Using engage-and-transfer approaches, plans can reach out to members via IVR or text and connect them to live agents who can schedule appointments for health screenings. Plans can also employ IVR outreach to connect rural members with community resources, such as transportation providers.
One large regional plan sent a secure digital survey on SDOH factors combined with an IVR call to 200,000 members. Of the 90% of targeted members reached, more than one-third provided key SDOH data that care managers used to provide personalized support to members. Such multichannel strategies could also be more narrowly focused to the needs of rural members.
For rural and nonrural members, visually driven content like educational videos can increase the likelihood of engagement. Prior to launching their campaigns, plans should ensure they have adequate call center resources to triage calls and direct members to the appropriate services quickly.
4. Ensure messages convey empathy, not judgment. Plans should craft reminders about missed screenings or immunizations with empathy and behavioral insights so they are less likely to be misconstrued as “member shaming.” Pairing a reminder with an added support, such as transportation assistance, will also help cultivate trust among members.
While rural America remains predominantly English-speaking, more native Spanish-speakers are moving to these areas. For these members, plans should ensure that translations are culturally sensitive, relevant, and not word-for-word translations. This also promotes trust between the plan and member.
Whatever the language, all digital communications should be easy to understand and designed to ensure the security of health information, such as by using text messages linking to secure digital portals.
5. Establish a calendar for year-round engagement. Thousands of deaths in rural America could potentially be prevented, and making sure rural members receive their annual exams, screenings, and immunizations should promote better health outcomes for many rural members. Outreach calendars can detail opportunities for member engagement, such as flu shot reminders each fall or annual exam reminders for member birthdays, delivered at the right cadence and through members’ preferred channels. Each outreach presents an opportunity to drive better clinical outcomes by helping members schedule the care they need.
6. Communicate and connect through local partnerships. In areas where hospitals and provider offices may be farther away, local pharmacies often serve as vital hubs for health screenings and other interventions. Plans should consider building partnerships with pharmacies to deliver relevant health information or close gaps in care. For example, pharmacists can deliver vaccinations as well as medication management services to improve compliance. Working with faith-based and other community organizations to deliver important health messages can also help build trust.
Improving the Experience for Rural Members
Plans that aim to reduce the health risks of their members can take advantage of resources like the CDC’s toolkit on preventing deaths in rural communities. Beyond developing messages that motivate members to be more active and eat healthier, communications could promote the plan’s resources to quit smoking, the leading cause of preventable death in the U.S. Other outreach could help promote seat belt safety and the use of child car seats.
By taking a proactive approach to rural member outreach, plans can demonstrate their commitment to improving rural health outcomes and delivering culturally competent care while simultaneously securing better metrics to protect their HEDIS and Star Ratings performance. Such efforts can also help improve the member experience by providing a more personalized approach to an overlooked population.
About Leah Dewey
Leah Dewey is Vice President of Clinical and Consumer Engagement Operations at Cotiviti. She is focused on improving healthcare outcomes by leveraging data and insights to close care gaps, improve consumer quality, and move population health across various cohorts and cultures.
