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. Context: 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. Methods: 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. Findings: 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. Conclusions: 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.
Bibliographical noteFunding Information:
: Jane M. Zhu and David Grande received a grant from the Robert Wood Johnson Foundation to support this work (RWJF #76242), and Sarah Gollust received consulting fees from Oregon Health & Science University. Funding/Support
Funding/Support: Jane M. Zhu and David Grande received a grant from the Robert Wood Johnson Foundation to support this work (RWJF #76242), and Sarah Gollust received consulting fees from Oregon Health & Science University. Acknowledgments: The authors appreciate the time and expertise of the state Medicaid Directors and other key Medicaid staff and stakeholders who participated in this study. We also thank Tricia McGinnis at the Center for Health Care Strategies; Ann Hwang at Community Catalyst; Lindsey Browning and Hilary Kennedy at the National Association of Medicaid Directors; Heather Howard and Dan Meuse at the State Health and Value Strategies Program at Princeton University; and anonymous Milbank Quarterly reviewers for their feedback. Conflict of Interest Disclosures: All the authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest. No conflicts were reported.
© 2020 The Authors. The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Millbank Memorial Fund
- consumer engagement
- program design
- state health policy
- vulnerable populations
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't