Increasingly, safety net health plans are pursuing member advisory councils to incorporate member perspectives into health equity strategies and programs. These plans have a vested interest in improving health equity because they serve Medicaid enrollees, including many with complex health conditions. Member engagement helps health plans gather feedback on plan strategies and programs, and understand members’ assets and strengths. Member feedback on access, outcomes, and experiences of care can enhance a plan’s understanding of the key supports needed to address health inequities. State managed care contracts may require health plans to establish member advisory councils, reflecting federal priorities, such as the recent regulations from the Centers for Medicare & Medicaid Services requiring that state Medicaid agencies establish more robust beneficiary advisory councils.
Banner University Health Plans (BUHP) is a managed care plan in Arizona that serves more than 338,000 Medicaid, Medicare, and dual-eligible members. To design and implement health equity initiatives, the health plan has established advisory councils and committees to engage plan members, community providers, and key stakeholders, including non-contracted providers and community members who aren’t necessarily plan members. The Better Care Playbook recently spoke with two BUHP leaders about how the plan has promoted and sustained member and community engagement through its committees and councils. Colleen McGregor serves as an Administrator for BUHP’s Office of Individual and Family Affairs (OIFA). Kurt Sheppard serves as Director of BUHP’s Complete Care plan and oversees their Neighborhood Advisory Councils.
Q. Could you describe key member and community engagement initiatives at BUHP and your roles in them?
C. McGregor: BUHP’s OIFA amplifies plan member and community voice through a comprehensive committee engagement and participation strategy. This approach not only meets a contract requirement with the state of Arizona to ensure we have membership representation on all committees and councils to inform strategic planning and decision-making, it also encapsulates our mission to make health care easier so life can be better.
One key engagement strategy, that is also contractually required, is regular community engagement. How we execute that requirement is our secret sauce. As a local plan, we can engage very intimately. Specifically, every six months we organize “Community Conversations“ to understand the health and social concerns of the communities we serve (not limited to plan members). A recent convening brought community members together with local leaders and community services groups, like the chief of police and a peer-run organization, and we served food from the local peer-led program. Through that rich local conversation, we've been able to activate local solutions. For example, we work with the Community Reinvestment program, funded by BUHP, which invests in projects that provide local responses to public health needs, such as local food banks.
K. Sheppard: Two other BUHP engagement platforms specifically recruit plan members. The Cultural Competency Committee consists of plan members who help to ensure we're providing services in a culturally competent manner. And our Neighborhood Advisory Committees reach members in their neighborhoods, not just their regions. These committees consist of plan members as well as non-contracted community providers, who are important to health-related social needs, like food banks and shelters. We talk about what's working in their communities to address member needs. Their responses become a vehicle for our Community Reinvestment planning where we can explore what we might be able to help with financially, since those providers are non-contracted.
Q. What inspired BUHP to deepen member and community engagement?
C. McGregor: When I came to BUHP in 2018, we had recently responded to an RFP to provide Medicaid services. As a public health practitioner – and as a person in long-term recovery who has touched homelessness and substance misuse – I was excited to blend my community public health background with my lived experience to support amplifying member voice and choice. And the most inspiring part of the RFP was about establishing robust member and community engagement mechanisms. Our leadership recognized this is as fundamental to executing on our mission, as a non-profit managed care organization responsible for vulnerable lives.
But the plan is also not the whole equation, and we strive to nurture local partnerships for communities to take action on their own behalf. BUHP provides funding to local organizations through our Community Reinvestment program. We are also physically present in communities in different ways. For example, we join housing councils. Housing is not a defined plan benefit, but it’s a related social need.
Q. How is BUHP measuring the progress of these initiatives? Can you share any successes?
K. Sheppard: As a health plan, we collect and measure a lot of data. In doing this, sometimes the focus on what is important to communities gets lost. We went to our members and said, “We want to look at the data that is important to you.” And they looked at measures across both physical and behavioral health for kids and adults. We conducted a poll to come up with the eight measures to track. Out of this, we created a Healthy Communities Dashboard. We can slice data by neighborhood and work with the Neighborhood Advisory Council members to address local care needs, including looking at disparities by age, gender, race, and ethnicity.
We also collect “Z codes” to understand our members’ health-related social needs. We discuss the data with Neighborhood Advisory Council members to understand their communities’ needs, which in turn helps us develop programming. For example, we partnered with Food Smart, which provides online nutrition counseling and delivery services to individuals who lack access to healthy groceries. Around 8,000 members have been engaged in that program this past year. Of those, 74% of them reported improved nutrition.
Q. How does BUHP recruit and prepare people to participate in these initiatives?
C. McGregor: We have a formal recruitment, retention, engagement, and incentivizing approach. A contracted consumer-led provider organization that works regionally helps us push out the advertisement and application to join our committees across all 10 counties, from places like Tucson to much smaller, rural communities. We also compensate committee members for their participation.
Informally, we use our member, community, and provider partnerships to recruit members through advertising in their own councils and committees. There’s no cap or limit on the number of people involved in our committees, so we're constantly recruiting through every avenue we can.
Q. How has BUHP prepared its own staff to manage the member and community engagement initiatives?
C. McGregor: It's teamwork and cross-departmental collaboration. So even though my role is dedicated to community outreach and engagement, the responsibility is shared across departments. My team is made up of individuals with lived experience, including people who have navigated public systems. Coming from the lens of lived experience we have been able to design cross-departmental trainings to help the whole organization engage more effectively with those we serve. Last year, we offered anti-stigma training, trauma-informed training, person-first language training, and health literacy training.
K. Sheppard: Ultimately, BUHP funds this work because engaging the community is important. As an example, this year, the Cultural Competency Committee wanted to increase the cultural humility of our plan staff and provider network around the autism community. Colleen and committee members used the evidence-based World Cafe format to conduct community dialoguing with staff and providers that will aid our understanding of the need for additional training or programming.
Q. How did you overcome a significant or unexpected challenge that arose from offering these engagement initiatives?
C. McGregor: Recruitment and retention can be challenging. We're contractually charged to have members and/or family members sit on our Member Advocacy Council and Governance Committee. These two committees inform strategic planning and decision-making and often interface directly with our health plan leadership. One challenge for the committees is consistency in attendance. Our members and/or family members often face real-life complexities – from managing their behavioral health needs, childcare, employment, or their justice system obligations, etc. They’re also balancing life, which doesn't always allow them to stick with the committee for its full annual term.
K. Sheppard: We have learned two things that helps with engagement. The first is that you must make it something they think is valuable. That's where constant engagement and asking for input on what are we doing comes in. The second thing is when you ask those questions, you must show them they are valued. You value their input by addressing the health and social needs in their communities that they care about. The only thing worse than not asking people their opinion is asking them their opinion and ignoring it.
Q. What’s next for BUHP’s member and community engagement initiatives?
C. McGregor: A critically important strategic objective is system navigation and stigma reduction. Working with our Member Advocacy Council Committee Ambassadors, we will be launching a comprehensive multi-modal system navigation initiative and a member-driven, community-focused #StigmaStopsHere Campaign. Our goal is to have both print materials and an electronic consumer-centric toolkit to support navigation, health literacy, and self-care management practices. We’re also in creating a recovery and resiliency toolbox informed by SAMHSA’s 8 Dimensions of Wellness and built by our MAC Ambassadors with the support of community stakeholders.
K. Sheppard: We’re also pursuing NCQA health equity accreditation. We created a Health Equity Committee, consisting of staff from various departments within the health plan, and we will recruit plan members to it this year. Through this committee, we want to demonstrate how developing strategies to address health equity involves our community engagement work and show how it’s helping us be able to achieve health equity for our members, and in the communities we serve.