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Why Segmentation is a Must for Treating Medicaid Patients

medicaid-expansion-c2b.jpgFor 74 million low-income Americans—men and women, seniors and young adults, individuals with physical or cognitive disabilities—Medicaid represents a critical lifeline to better health. Often these medically underserved patients face complex healthcare needs, driving the need for hospitals, Medicaid Managed Care Organizations (MCOs) and other healthcare providers to improve patient engagement. Proper psychographic segmentation of Medicaid patients can help ensure they receive the best care.


The Impact of Medicaid Expansion

Some anticipated that the physician shortage would be exacerbated by Medicaid expansion, but this issue has not been as pronounced as feared thus far. A recent data note from the Kaiser Family Foundation shows that 70 percent of doctors accept new Medicaid patients, which is close to the 85 percent of doctors that accept new Medicare or privately-insured patients. Safety-net organizations for medically underserved populations, such as community health centers, tend to have even higher rates of Medicaid acceptance.

Healthcare access does vary from state to state, however—from a high of 97 percent in Nebraska to a low of 39 percent in New Jersey. Still, says the KFF data note: “Twenty-five states have significantly higher rates of Medicaid patient acceptance than the national average.”


Spending as part of total U.S. healthcare spending (public and private). Percent of gross domestic product (GDP). 

Another positive sign: more than 50 percent of Medicaid beneficiaries are enrolled in MCOs, which must ensure access to care within their provider networks. As a result, only 11 percent of adult Medicaid patients have trouble finding a primary care physician, though this is still nearly double the rate for privately-insured patients.


Moving from Healthcare Access to Patient Engagement with Segmentation

Improved access to screening and preventive care can lead to earlier diagnosis of chronic conditions, but other factors hamper effective engagement, leading to higher costs. Addressing the National Academy of Medicine, The Commonwealth Fund revealed its rationale for the use of segmentation with high-need, high-cost population. Their research included a review of empirical analysis, segmentation literature, program-related information such as case studies, and interviews with health system leaders, payers and others. During the presentation, The Commonwealth Fund said that “Segmentation can help target and tailor care to high-need patients.”

But the segmentation needs to go beyond traditional demographics. Among high-need, high-cost patients, behavioral health—along with poverty and social determinants to health—need to be part of the segmentation framework. For example, mental illness or drug or alcohol abuse issues struggle to manage health conditions, leading to higher costs.

When patients have mental illness and substance abuse issues in combination, the costs go even higher:

  • 3x higher costs for asthma
  • 4x higher costs for diabetes
  • 2x higher costs for hypertension


For its research, The Commonwealth Fund classified similar populations into subgroups based on c2b solutions’ five psychographic segments to better understand how individuals approach health and how they can be motivated to drive greater engagement.


  • Direction Takers. These patients believe that physicians, as medical experts, are the most credible source for health advice. They tend to go to the doctor at the first sign of a problem. While they do listen to their physicians’ advice, they often struggle to follow it. Follow-up communications can help discover the barriers—perhaps a patient doesn’t have transportation to pick up a prescription—to help keep engagement on track.

  • Balance Seekers. These patients have an independent streak, so they prefer to gather health advice from multiple sources—not just physicians. They will search online, as well as check with friends and family. Rather than giving directions, physicians need to present options and choices, along with the consequences of each, so they can make informed decisions.

  • Willful Endurers. These patients are the most challenging to engage. They live in the moment and are resistant to changing habits. Willful Endurers go to the doctor only as a last resort. To effectively engage these patients, healthcare providers need to devise wellness or chronic disease management programs that are easy to implement and offer immediate gratification.

  • Priority Jugglers. As the name suggests, these patients lead busy lives and are less invested in health and wellness. Priority Jugglers only address health concerns when begin to interfere with work or family responsibilities. The exception? They are typically very proactive when it comes to their families, however, so appealing to their sense of responsibility can motivate them to engage in their own health.

  • Self Achievers. Proactive and task oriented, these patients listen to medical advice and respond to health education, as well as measurable goals and the tracking tools to capture progress.


The c2b Consumer Diagnostic, a national study of healthcare consumer attitudes and behaviors, identified the psychographic segment distribution among the Medicaid population:


Forty percent of Medicaid patients belong to the Willful Endurer segment, which can pose a challenge as they are the most difficult segment to activate against desired health behaviors. However, even Willful Endurers can be motivated to change behaviors with the right message and incentive. It is critical that clinicians understand the nuances among the segments to maximize patient engagement.

Medical care alone is not enough to improve outcomes and lower costs for patients. To drive positive health outcomes, hospitals and other healthcare providers must move away from treating patients based only on their similarities—whether in diagnosis, in payers, or as members of a medically underserved population. Psychographic segmentation of Medicaid patients can help physicians align their approach to better suit patient attitudes and keep them engaged.  

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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