RIC Event: Locating and Engaging Hard-to-Reach Members During COVID-19: A Panel Discussion

Event Start Date: December 14, 2021 - 12:00 PM EDT
Event End Date: December 14, 2021 - 1:30 PM EDT

Video Recording:



This webinar is also available as a podcast on SoundCloud and iTunes.


This webinar features speakers from health plans serving individuals dually eligible for Medicare and Medicaid, who share strategies related to engaging hard-to-reach members during the COVID-19 public health emergency.

As a population, individuals dually eligible for Medicare and Medicaid have a higher prevalence of chronic medical conditions, co-morbidities, and serious mental illness (SMI) than Medicare-only beneficiaries, and also experience a disproportionately large number of negative social drivers of health.1,2,3 The COVID-19 public health emergency, which has made in-person engagement much more difficult and exacerbated health and social needs, has made reaching these members both more pressing and more challenging.

In 2021, RIC launched an Integrated Care Community of Practice (ICCoP), a learning community of outreach and care coordination staff from 20 national and local health plans focused on sharing promising practices for reaching and engaging members in primary and specialist care, social services, and long-term services and supports.

This panel discussion offers promising practices that emerged from the ICCoP and elsewhere for locating and engaging these members, especially in light of the COVID-19 public health emergency. Panelists share challenges and innovative strategies for engaging members in care coordination, addressing social needs, and providing education and outreach related to the COVID-19 vaccine. By the end of this discussion, attendees should be able to:

Identify strategies for:

  • Locating members that are hard-to-reach, including through the deployment of community health workers (CHWs) and through partnerships with community-based organizations;
  • Addressing unmet social needs and building trust through tangible supports for members;
  • Developing information system approaches to contact members that are hard-to-reach;
  • Reaching members with limited English proficiency, those experiencing homelessness, or those with SMI; and
  • Providing COVID-19 vaccine outreach and education to hard-to-reach members.

Featured Speakers:

  • Lauren Easton, VP–Integrative Program Development and Clinical Innovation, Commonwealth Care Alliance
  • Tashau Asefaw, Manager, Community Programs, Community Health Plan of Washington
  • Jen Klopstein, SNP Administrator, Health Services, Viva Health

Intended Audience:

This panel discussion is intended for providers serving hard-to-reach populations including individuals that are isolated, individuals experiencing homelessness, and individuals with behavioral health considerations. This includes outreach and care coordination staff of Medicare-Medicaid plans (MMPs), dual eligible special needs plans (D-SNPs), PACE organizations, Medicaid managed care organizations, and other health plans.

1 Center for Health Care Strategies. (2020). COVID-19’s Effect on Dually Eligible Populations. Retrieved from https://www.chcs.org/covid-19s-effect-on-dually-eligible-populations/.

2 Kaiser Family Foundation. (2010). Chronic Disease and Co-Morbidity Among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Sending. Retrieved from https://www.kff.org/health-reform/report/chronic-disease-and-co-morbidity-among-dual/#:~:text=The%20health%20reform%20law%20contains,most%20severely%20disabling%20chronic%20conditions.

3 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. (2016). Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs. Retrieved from https://aspe.hhs.gov/system/files/pdf/253971/ASPESESRTCfull.pdf.


Webinar Slides

Webinar Transcript

Questions and Answers

Key Considerations in Engaging Hard-to-Reach Members Brief