School of Medicine, Oregon Health & Science University.
Center for Health Systems Effectiveness, Oregon Health & Science University.
Milbank Q. 2021 Mar;99(1):99-125. doi: 10.1111/1468-0009.12492. Epub 2020 Dec 15.
Policy Points As Medicaid programs grow in scale and complexity, greater consumer input may guide successful program design, but little is known about the extent to which state agencies are engaging consumers in the design and implementation of programs and policies. Through 50 semistructured interviews with Medicaid leaders in 14 states, we found significant variation in consumer engagement approaches, with many common facilitators, including leadership commitment, flexible strategies for recruiting and supporting consumer participation, and robust community partnerships. We provide early evidence on how state Medicaid agencies are integrating consumers' experiences and perspectives into their program design and governance.
Consumer engagement early in the process of health care policymaking may improve the effectiveness of program planning and implementation, promote patient-centric care, enhance beneficiary protections, and offer opportunities to improve service delivery. As Medicaid programs grow in scale and complexity, greater consumer input may guide successful program design, but little is known about the extent to which state agencies are currently engaging consumers in the design and implementation of programs and policies, and how this is being done.
We conducted semistructured interviews with 50 Medicaid program leaders across 14 states, employing a stratified purposive sampling method to select state Medicaid programs based on US census region, rurality, Medicaid enrollment size, total population, ACA expansion status, and Medicaid managed care penetration. Interview data were audio-recorded, professionally transcribed, and underwent iterative coding with content and thematic analyses.
First, we found variation in consumer engagement approaches, ranging from limited and largely symbolic interactions to longer-term deliberative bodies, with some states tailoring their federally mandated standing committees to engage consumers. Second, most states were motivated by pragmatic considerations, such as identifying and overcoming implementation challenges for agency programs. Third, states reported several common facilitators of successful consumer engagement efforts, including leadership commitment, flexible strategies for recruiting and supporting consumers' participation, and robust community partnerships. All states faced barriers to authentic and sustained engagement.
Sharing best practices across states could help strengthen programs' engagement efforts, identify opportunities for program improvement reflecting community needs, and increase participation among a population that has traditionally lacked a political voice.
政策要点
随着医疗补助计划规模和复杂性的不断增长，更多的消费者投入可能会指导成功的计划设计，但对于各州机构在多大程度上让消费者参与到计划和政策的设计和实施中知之甚少。通过对 14 个州的 50 名医疗补助计划领导人进行 50 次半结构化访谈，我们发现消费者参与方法存在显著差异，存在许多共同的促进因素，包括领导层的承诺、灵活的策略来招募和支持消费者参与，以及强大的社区合作伙伴关系。我们提供了关于州医疗补助机构如何将消费者的经验和观点纳入其计划设计和治理的早期证据。
在医疗保健政策制定过程的早期让消费者参与，可能会提高计划规划和实施的有效性，促进以患者为中心的护理，加强受益人的保护，并提供改善服务提供的机会。随着医疗补助计划规模和复杂性的不断增长，更多的消费者投入可能会指导成功的计划设计，但对于各州机构在多大程度上让消费者参与到计划和政策的设计和实施中知之甚少，以及它们是如何做到的。
我们对 14 个州的 50 名医疗补助计划领导人进行了半结构化访谈，采用分层有目的抽样方法，根据美国人口普查区域、农村性、医疗补助计划参与人数、总人口、ACA 扩展状况和医疗补助管理式医疗的渗透率选择州医疗补助计划。访谈数据进行了音频录制、专业转录，并进行了内容和主题分析的迭代编码。
首先，我们发现消费者参与方法存在差异，从有限的、主要是象征性的互动到更长期的审议机构，一些州调整了其联邦授权的常务委员会，以让消费者参与。其次，大多数州都是出于实际考虑，例如为了确定和克服机构计划的实施挑战。第三，各州报告了一些成功的消费者参与工作的共同促进因素，包括领导层的承诺、灵活的策略来招募和支持消费者的参与，以及强大的社区合作伙伴关系。所有州都面临着真实和持续参与的障碍。
在各州之间分享最佳实践可以帮助加强计划的参与工作，确定反映社区需求的计划改进机会，并增加传统上缺乏政治声音的人群的参与。
