Medicaid managed care provides health care and long-term services and supports (LTSS) to more than 92 million people in the U.S. Medicaid and dual eligible members are vulnerable, hard-to-reach populations who often have a myriad of factors that affect access and outcomes, and drive healthcare costs.

Disparities in health and healthcare among underserved populations have led to higher rates of chronic disease, lower life expectancies, and poor health outcomes.  

Six in 10 Americans have at least one chronic disease and 4 in 10 have two or more. Chronic diseases are leading causes of illness, disability, and death and drive the $4.9 trillion in healthcare expenditures.  

32% of Medicaid enrollees rate their physical health “fair” or “poor.” 

How to Improve Engagement Among Medicaid & Dual Eligible Populations  

Finding effective engagement strategies to improve quality, close care gaps, and drive better outcomes among Medicaid and dual eligible populations has been a challenge for plans.  

These populations have unique needs and engagement isn’t one-size-fits-all, yet there are certain approaches that can start to move the needle on closing care gaps.  

Improve Care Coordination and Support

Gaps in access to care are an ongoing challenge in Medicaid populations. Provider shortages in low-income communities, lower physician payment rates, and participation in Medicaid are among the many barriers.  

Those who live in rural areas are also disproportionately affected. Compared to urban areas, rural communities have fewer primary and specialty care physicians. In fact, only 10% of physicians practice in rural areas, and over 65% of primary care Health Professional Shortage Areas (HPSAs) are located in rural or partially rural areas, according to the American Hospital Association.

Engagement solutions that combine digital health technologies, as well as human interaction, can help to improve access and close care gaps. These solutions include phone outreach and 2-way voice communication through Personal Emergency Response Systems (PERS) and provide members with support in identifying primary and specialty care providers, scheduling preventive care and screenings, medication adherence, and follow-ups.  

Identify and Address Social Determinants of Health (SDoH)

Between 80 and 90% of health outcomes are attributed to social determinants of health (SDoH)—non-medical factors such as economic stability, food insecurity, and health literacy. SDoH are linked to health disparities, inequities, and poor health outcomes such as increased hospital readmission rates.

While SDoH has been an increased focus in recent years, plans have more work to do. Among Medicaid and dual eligible members, 60% are less than fully satisfied with their care manager’s ability to provide access to essentials such as housing, food, utilities, or transportation, one survey found. 

Engagement platform solutions that conduct SDoH screenings to identify an individual’s factors and connect them to community resources such as medically-tailored meals can help close gaps in care and improve outcomes. These solutions may provide member education and support for those with low health literacy and limited English proficiency (LEP). 

Some solutions also have teams of wellness advocates who conduct proactive outreach to facilitative preventative care, ensure devices are working properly, and provide high-touch engagement and support, for example. 

Adopt Digital Health Solutions 

More than one-third of healthcare executives (36%) say that investments in technology platforms are a priority this year, a recent Deloitte survey found.

The adoption of remote patient monitoring (RPM) technology, in particular, is on the rise.  Between 2019 and 2021, remote patient monitoring (RPM) use among Medicaid members increased by more than 1,300%, a study in Health Affairs found.

Research shows RPM can improve patient engagement, adherence, and access to care, and reduce costly ED visits and hospital readmissions.

RPM, when integrated with personal emergency response systems (PERS), can monitor vitals, gather real-time data insights, and engage members in their care. Some platforms combine human and AI interactions to identify fall risks, provide preventative guidance, close care gaps, and allow members to manage their conditions. 

Implement a Multichannel Communication Strategy

Health plan executives are increasingly using multi-channel communication strategies to engage members and improve quality and outcomes. In fact, more than half of health plan executives (55%) have increased their member engagement budgets and about 75% say they have placed more attention on these departments, one survey found. 

A multichannel communication strategy can be an effective way to reach and engage members, meet them where they are in their journeys, build trusted relationships, and provide tailored communications and education that address member needs and preferences— boosting satisfaction and HEDIS scores.

Provide Proactive Care and Support For Older Adults  

Most older adults want to age in place, with 75% who say they want to live in their homes and about the same (73%) in communities, a recent AARP survey found.  

Many, however, are living alone and are at risk of hazards and falls around their homes. In fact, one in 4 older adults falls each year, but less than half tell their doctors. This drives up ED visits and hospitalizations. Each year, Medicaid pays $9 billion for medical costs related to non-fatal falls.  

Digital health solutions that include PERS devices monitor older adults 24/7, provide 2-way voice communication with operators, and include fall detection for members who cannot send an alert during an emergency. With round-the-clock monitoring and timely interventions, members have peace of mind knowing they have support when they need it most

Boost Member Engagement With Medscope

Engagement is the key to closing care gaps, better outcomes, and member satisfaction that boosts HEDIS scores and drives retention and loyalty. MedScope is a leading provider of RPM and PERS, allowing care managers to deliver patient-centric care. Our AI-powered solution in combination with our highly-empathic wellness team connect and build trusted relationships with members to close care gaps and drive engagement. To learn more about our solutions and schedule a demo, contact us today.  

Care management agencies and Managed Care Organizations (MCOs) face the challenge of efficiently managing Personal Emergency Response System (PERS) referrals and ongoing member support. CareManager360, a proprietary platform developed by MedScope, simplifies this process, offering a seamless, all-in-one solution for managing member populations and optimizing care workflows. 

A Smarter Way to Manage PERS Referrals 

CareManager360 revolutionizes the referral workflow, eliminating inefficiencies and providing a streamlined experience from start to finish. With its intuitive interface, care managers can: 

• Add New Referrals effortlessly, ensuring prompt enrollment of members. 
• Check Referral Status in real-time, tracking progress and required actions. 
• Monitor Installation Updates to stay informed about deployment phases. 

Comprehensive Member Management Tools 

Beyond referrals, CareManager360 offers robust capabilities for monitoring and managing active members: 

• View Active Members at a glance, providing instant visibility into member status. 
• Agency-Level Dashboard with key metrics, including button presses and dispatch trends. 
• HIPAA-Compliant Data Management, ensuring secure handling of member health information. 

Actionable Insights and Data-Driven Decisions 

One of CareManager360’s key strengths is its ability to provide deep insights into member engagement and PERS utilization. The platform generates valuable data to help care managers make proactive decisions, including: 

• Trends in Member Activity: Identify patterns in button presses, device activations, and emergency dispatches. 
• 7-Day No Signal Alerts: Receive early warnings when a device has gone inactive, allowing timely intervention. 
• Low Battery Notifications: Ensure that members’ devices remain functional by monitoring battery levels. 
• Monthly Utilization Reports: Track member participation and overall program engagement to assess effectiveness.

Enhanced Care Coordination & Efficiency 

By integrating CareManager360 into their workflows, care teams can enhance communication, improve efficiency, and reduce administrative burdens. The platform’s streamlined approach enables care managers to: 

• Improve Member Outcomes: Faster processing of referrals ensures that members receive their PERS devices promptly. 
• Optimize Staff Productivity: Automated tracking and reporting reduce manual data entry, allowing care teams to focus on delivering quality care. 
• Enhance Compliance & Security: With HIPAA-compliant protocols, CareManager360 ensures that all member data remains protected. 

Why Choose CareManager360? 

CareManager360 empowers care teams by offering an efficient, data-driven approach to PERS management. By integrating advanced reporting and tracking features, the platform enables care managers to make informed decisions and provide better member support. 

As a proprietary solution from MedScope, CareManager360 is uniquely designed to support the needs of care managers, ensuring that PERS referrals, installations, and monitoring are handled with precision and ease. 

Experience the Future of Care Management with MedScope 

MedScope has been a leader in personal emergency response systems and healthcare technology, developing solutions that enhance safety, efficiency, and care coordination. 

Discover how CareManager360 can transform your approach to care management—schedule your demo today!

Navigating Medicare options can be overwhelming for both case managers and the individuals they support. Understanding the basics of Medicare coverage is essential in helping clients make informed decisions about their healthcare. This guide provides an overview of Medicare, its different parts, and how case managers can assist in ensuring patients receive the benefits they need. 

What is Medicare? 

Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as younger individuals with certain disabilities or end-stage renal disease. It is funded through payroll taxes, premiums, and the federal budget. 

Medicare consists of four parts, each covering different aspects of healthcare: 

• Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. 
• Medicare Part B (Medical Insurance): Covers outpatient medical services, doctor visits, preventive care, lab tests, durable medical equipment (DME) like wheelchairs and walkers, and mental health services. 
• Medicare Part C (Medicare Advantage): Offered through private insurers, these plans combine Part A and Part B benefits and may include additional coverage such as vision, dental, and hearing services. 
• Medicare Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications, with plans varying in covered drug lists and associated costs.

What Does Medicare Cover? 

Medicare provides comprehensive health coverage, but understanding its limitations is key. Coverage includes: 

• Preventive Services: Annual wellness visits, screenings for conditions such as cancer and heart disease, vaccinations, and chronic disease management. 
• Medical Necessities: Doctor visits, outpatient surgeries, hospital stays, emergency services, and rehabilitation. 
• Durable Medical Equipment (DME): Medicare Part B covers medically necessary equipment such as walkers, oxygen supplies, and alert systems that support independent living. 

What is Not Covered by Medicare? 

Medicare does not cover all healthcare needs. Excluded services often include:

• Routine dental care and dentures 
• Hearing aids 
• Vision care (eye exams and glasses) 
• Long-term custodial care in nursing homes 

Some Medicare Advantage plans may offer coverage for these services at an additional cost. 

How Case Managers Can Help 

As a case manager, your role is crucial in guiding patients through the Medicare system. Here are some ways you can support them: 

• Assess Coverage Needs: Help individuals evaluate their medical conditions and determine the best Medicare plan to fit their needs. 
• Identify Provider Participation: Confirm that doctors and specialists accept Medicare to minimize out-of-pocket costs. 
• Navigate Enrollment Periods: Educate clients on Medicare’s Initial Enrollment Period (seven months surrounding their 65th birthday) and Special Enrollment Periods for qualifying events. 
• Advocate for Additional Benefits: Assist in identifying supplemental insurance options or Medicare Savings Programs for low-income individuals. 
• Coordinate Durable Medical Equipment Access: Ensure patients receive necessary medical equipment, such as Personal Emergency Response Systems (PERS), that enhance their safety and independence. 

For case managers, a strong understanding of Medicare ensures that clients receive appropriate healthcare services without unnecessary financial burdens. Staying informed about Medicare coverage options and changes can help facilitate better health outcomes and improved access to essential services. To explore specific coverage details, visit Medicare.gov for up-to-date information.

Case managers play a critical role in ensuring their clients receive the right tools and resources to live safely and independently. One essential tool that can make a significant impact is a medical alert device. These personal emergency response systems (PERS) are not just for older adults or those with mobility challenges—they provide peace of mind for anyone at risk of falls, medical emergencies, or other safety concerns. 

If you’re working with clients who want to maintain independence while staying protected, here’s why a medical alert system is a valuable recommendation. 

Supports Aging in Place Safely 

Many older adults prefer to remain in their homes rather than transition to assisted living. However, living alone can pose risks, especially in the event of a fall or medical emergency. A medical alert system empowers clients to stay in their homes longer while ensuring they have quick access to emergency assistance when needed. 

How it helps case managers: 

• Reduces the risk of delayed medical attention for clients living alone 
• Provides an added layer of safety without requiring in-home caregivers 
• Offers GPS tracking for mobile users, ensuring help can find them anywhere 

Enhances Safety for Clients with Chronic Conditions 

Clients managing chronic health conditions—such as diabetes, heart disease, Parkinson’s, or epilepsy—often face an increased risk of sudden health complications. Medical alert devices provide immediate access to trained emergency responders, ensuring they receive timely medical attention when symptoms arise. 

Key benefits: 

• Clients receive immediate help, preventing minor symptoms from escalating 
• Reduces unnecessary ER visits by providing access to trained response teams 
• Allows case managers to coordinate care more effectively by monitoring emergency incidents 

Fall Detection for High-Risk Clients 

Falls are one of the leading causes of hospitalization for older adults. If a client has fallen before or expresses concerns about balance and mobility, fall detection technology can provide automatic emergency response, even if they are unable to press the help button themselves. 

Why case managers should recommend fall detection: 

• Automatic fall alerts ensure help arrives even if the client is unconscious 
• Reduces fear and anxiety about falling, increasing confidence in daily activities 
• Supports preventive care by minimizing hospital stays and complications from delayed response 

Provides Reassurance for Family and Caregivers 

Family members of high-risk clients often worry about their loved ones living alone. Medical alert systems bridge the gap between independence and safety, ensuring clients receive 24/7 support while reducing stress on caregivers. 

How this helps case managers: 

• Provides care coordination tools for families through online care portals 
• Reduces caregiver burden by offering an extra layer of emergency support 
• Strengthens client care plans by addressing safety concerns proactively 

A Simple Solution for Case Managers to Recommend 

Medical alert devices are a low-cost, high-impact solution that can help case managers improve client safety and quality of life. With customizable options, including in-home and mobile devices, GPS tracking, and automatic fall detection, there’s a system suited to every client’s needs. 

At MedScope, we partner with healthcare professionals and case managers to provide reliable, easy-to-use medical alert solutions. Whether your clients are at risk of falls, managing chronic conditions, or simply need peace of mind, we can help you find the right device for their needs. 

Get Started Today 

If you have clients who could benefit from a medical alert system, explore MedScope’s solutions. Contact us today to learn more about bulk orders, referral programs, and customized options that fit your care plans.

As a case manager, ensuring the safety and well-being of your members is a top priority. Personal emergency response systems (PERS), also known as medical alert devices, can play a crucial role in helping individuals remain safe and independent in their homes. These devices provide quick access to emergency assistance, reducing hospitalizations and improving overall quality of life. 

How Do Medical Alert Systems Work? 

Medical alert devices connect members to a 24/7 monitoring center, providing immediate access to trained emergency response professionals. Depending on the system, medical alerts can function via a landline or cellular network. 

Landline Systems 

Traditional at-home medical alert systems include: 

• A base unit that connects to a telephone jack and wall outlet 
• A wearable help button (neck pendant or wristband) that syncs with the base unit 
• A two-way speaker system that enables direct communication with the monitoring center 

Mobile Systems 

For members who are more active or do not have a landline, mobile medical alert devices offer increased flexibility: 

• Operate via cellular networks, eliminating the need for a landline 
• Include GPS tracking to pinpoint a member’s location during an emergency 
• Often feature built-in fall detection technology

Medical Alert Devices in Action: A Simple 3-Step Process 

1. Press the Button – The member activates the device by pressing the help button, sending an alert to the monitoring center. Some systems offer automatic fall detection, which triggers a call if a fall is detected. 
2. Speak with a Trained Operator – A professional responder assesses the situation, determining whether emergency personnel, a caregiver, or a case manager should be contacted. 
3. Receive the Right Help – The appropriate assistance is dispatched, ensuring members get the support they need quickly and efficiently. 

Key Features of Medical Alert Systems 

PERS devices are designed with features that enhance safety and peace of mind for both members and care teams: 

• 24/7 Monitoring – Round-the-clock emergency response services 
• Help Buttons – Wearable, waterproof devices with extended range for in-home or mobile use 
• GPS Locating – Ensures rapid response by pinpointing a member’s exact location 
• Fall Detection – Automatically triggers a call if a fall occurs 
• Care Coordination – Monitoring centers can notify caregivers, case managers, or emergency services as needed 

Who Benefits from a Medical Alert Device? 

PERS devices can be an essential tool for Medicaid beneficiaries who: 

• Are at risk of falls or have a history of falls 
• Have chronic conditions such as diabetes, COPD, or heart disease 
• Live alone or have limited caregiver support 
• Need an added layer of safety while aging in place

Choosing the Right Medical Alert System for Your Members 

As a case manager, recommending the right PERS solution means considering the member’s needs, lifestyle, and budget. Here are some factors to keep in mind: 

• Monitored vs. Unmonitored Systems – Monitored systems connect to a 24/7 response center, while unmonitored devices dial a pre-programmed number, such as 911 or a family member. 
• Company Reputation – Look for a trusted PERS provider with strong customer reviews and transparent policies. 
• Device Features – Ensure the device meets the member’s specific needs, such as GPS tracking, fall detection, or mobile connectivity.

MedScope: Your Trusted Partner in Member Safety 

MedScope is a leading provider of PERS solutions for Medicaid beneficiaries, offering reliable, affordable, and easy-to-use medical alert devices. Our dedicated team ensures seamless implementation and ongoing support for case managers and their members. 

For more information on how MedScope’s PERS solutions can support your members, contact our team today!