From AIS Health: Payers See Value in Job Training for Medicaid Members

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Reprinted with AIS Health permission from the December 23, 2020, issue of Health Plan Weekly

The University of Pittsburgh Medical Center is the largest employer in the Pittsburgh area, with hundreds of job openings on any given day. At the same time, the integrated network’s UPMC Health Plan covers nearly one in five Medicaid beneficiaries in the state of Pennsylvania.

So when the health plan launched its Pathways to Work program this July, it made sense for Medicaid members to be a focal point of the program’s workforce development efforts.

“Our mission is to provide job opportunities, training, and education, both to members and the community,” says Dan LaValle, the director of social impact for UPMC Health Plan, which has roughly 1.3 million covered lives in Pennsylvania.

The program aims to help members find jobs with the health plan and health system — about 800 members have been hired in the last three-and-a-half years — but also with employers throughout the area. “The pandemic was a stark reminder that we can make a huge difference here,” LaValle tells AIS Health.

UPMC Health Plan is one of a growing number of insurers offering new or expanded job training and placement programs to Medicaid members. For example, CareSource, which has about 1.4 million Medicaid members in Georgia, Indiana and Ohio, offers workforce development services as part of its Life Services program. This program connects members with a life coach to help them secure employment, including obtaining a high-school diploma or GED if necessary.

Other services include online professional development and skill-building sessions, sample job applications, and interview prep. Support is also available for up to two years after a member has started a job.

In addition, national insurer Anthem, Inc., which has more than 5.5 million Medicaid covered lives across 17 states, has recently partnered with Aunt Bertha, a public benefit corporation that helps connect people to social services programs such as food assistance and job training. Care teams and providers can help members search for services in their area and view contact information, hours of operation and next steps for receiving assistance.

For Anthem, the goal is to emphasize whole-person health and quality of life, according to Leigh Davison, staff vice president of Medicaid strategy and initiatives.

“Perceived job insecurity, downsizing or workplace closure, and underemployment can all have negative implications for physical and mental health,” Davison explains.

Expansion of these initiatives comes at a time when Medicaid work requirements are making headlines. On Dec. 4, the U.S. Supreme Court said it would hear arguments on the legality of work requirements. Under the Trump administration, CMS has encouraged states to apply for waivers that would require certain Medicaid beneficiaries to prove that they are working, looking for a job, or enrolled in a job training program in order to retain Medicaid coverage. Experts say that the Biden administration will likely try to reverse those waivers (HPW 11/13/20, p. 1).

According to the Kaiser Family Foundation, Medicaid work requirement waivers have been approved in 12 states. However, lower courts have struck down work requirements in Arkansas, Kentucky, Michigan and New Hampshire, and some other states with approved waivers have not yet implemented their programs.

According to a 2019 analysis from the Kaiser Family Foundation, 63% of adult Medicaid beneficiaries in the U.S. are working, and only 7% are not working due to an inability to find work. The remainder of beneficiaries are not working due to illness or disability, school attendance or their role as a caregiver.

“It’s such a [misconception] that people on Medicaid don’t want to work,” LaValle says.

UPMC Health Plan’s program is not tied to a Medicaid work requirement waiver. While Pennsylvania’s Republican-controlled legislature has repeatedly proposed bills that would direct the state to apply for such a waiver, Democratic Gov. Tom Wolf has vetoed these bills and indicated that he will not support similar legislation in the future.

Job Placement Yields Results

Instead of work requirements, in January 2020 Pennsylvania launched a program called Medicaid Work Supports, which connects new enrollees in Medicaid plans with employment resources as well as assistance with obtaining a diploma or GED.

“When we get new Medicaid members, they tell us if they’re interested in work support, and we try to help them wherever they are at,” LaValle says. Beyond simply referring members to a job listing website, the goal of the program is to help new members find work regardless of their level of education or previous type of employment. In one recent example, new members who had recently worked in retail roles were hired for customer service roles at UPMC Health Plan, he notes.

“We’re helping people navigate the employment space. What we heard from the community is that people just needed someone to talk to, to bring hope and compassion and action,” LaValle says. “We spend a little more time with people. We have multiple conversations and help people find their way. It’s as simple as communicating with them and building that trust, to help them see where their life experiences have led them.”

Industry experts suggest that insurers’ job training programs offer a broader benefit than just meeting the needs of Medicaid work requirement waivers or filling job vacancies.

“Health plans look at stable employment as just one of the many social determinants of health that they’ve been trying to address. Like access to safe, affordable housing and food security, having a steady job leads to better health outcomes,” says Jerry Vitti, founder and CEO of Healthcare Financial Inc., a firm that connects low-income, elderly and disabled populations with public benefit programs. “Providing job training resources helps plans fulfill their primary goal of keeping their members healthy. That in turn lowers costs and yields a positive ROI for the plan.”

Preventive Indicators Improve

CareSource said in 2018 that it observed an 18% drop in emergency department use and a 15% decrease in outpatient expenditures among members in the first months of participation in the Job Connect program, compared to the six months prior to joining the program. In addition, CareSource has seen a 22% increase in prescription drug spending, which the insurer views as a driver for preventing chronic conditions down the road.

Abner Mason, founder and CEO of ConsejoSano, agrees with this assessment. ConsejoSano provides health plans, providers and employers with engagement tools designed to meet the needs of non-English speakers and multicultural populations.

“The further upstream you go with interventions, the more effective they are, and the more savings we see over time,” Mason tells AIS Health. “Unemployment is a social determinants of health barrier, and it directly impacts, in dollars and cents, when people access health care. If they don’t have cash on hand for a copay or for a prescription, they hold off, and little problems then turn into big, expensive ones.”

For Anthem, it’s important to be able to link newly working Medicaid members with resources above and beyond job training to help remove barriers to employment. These could include transportation, child care and housing, Davison says.

“A loss of any one of those supports could potentially derail completion of training or cause an individual to miss a job opportunity. With steady employment, many social determinants of health supports could be lessened and even resolved,” she says.

The job training programs also help health plans connect with their communities. CareSource’s Job Connect program got its start when the insurer hosted a hiring event on behalf of a glass manufacturing company that wanted to hire 1,000 workers for its new plant in Dayton, Ohio. Anthem has employed 16 college students in its Atlanta-based IT apprenticeship program, Davison says. These students work and obtain a degree in an IT field over the course of five years. The program is part of a larger effort to work with community organizations to train individuals in soft skills and help them obtain professional certifications in high-demand fields such as IT or health care, she adds. UPMC and UPMC Health Plan have recently launched a program called Freedom House 2.0, a grant-funded initiative to recruit high-risk youth and individuals replaced by COVID-19 — including the health plan’s Medicaid members — for emergency medical service (EMS) training and certification. This program takes its name from the initial Freedom House, an ambulance service founded in 1967 by UPMC anesthesiologist Peter Safar, M.D.

Safar drew recruits from the low-income and predominantly Black Pittsburgh neighborhood known as the Hill District and trained them in IV and medication administration. The first program helped set a national standard for paramedics training, according to Dan Swayze, vice president of community services for UPMC Health Plan. Prior to its inception, city police or funeral homes typically provided ambulance services, which led to poor outcomes. The hope is that Freedom House 2.0 will do similar work by pioneering the role of the “community paramedic” who can assess individuals for mental health needs or other social determinants of health when responding to 911 calls.

“We want not only give students and participants a new career trajectory but to also transform the whole EMS industry,” Swayze tells AIS Health.

by Brian Eastwood

Contact Davison via Tony Felts, LaValle via Bill Ries, and Vitti and Mason via Joe Reblando.