Leadership Interview: Sheila Wise, PhD, social/cultural anthropologist, Rocky Mountain Health Plans

Sheila Wise, PhD, senior analyst and manager of Rocky Mountain Health Plans’ customer experience program, is a social/cultural anthropologist. She describes her role at Rocky as giving a voice to members and tracing people’s experiences and interactions with the health care system. She gathers insights to better understand their point of view, allowing Rocky to make changes members need. Wise’s most recent project is the Health First Colorado* Member Journey, a project that allows users to follow the health care experiences of three composite Medicaid clients. Months of research and more than 60 interviews with Medicaid members support the work.
The Ascent: Very briefly, what are some of the challenges your research revealed?
Wise : Confusing, time-consuming paperwork is a burden. When I visited members, I asked them to take pictures of where they keep their papers: They had plastic bins full of correspondence. It’s time-consuming, they don’t know if they are doing it right, and the various letters and notices often contain mixed messages. The pre-authorization process is often seen as a “roadblock” to getting needed care. Equally important: Many don’t understand the link and relationship between Rocky and managed Medicaid here, which adds to the confusion.
Provider access is also a big issue, specifically access to specialists. The participants definitely have an allegiance to a primary care physician. They want to stick with their doctor. But sometimes those doctors don’t have an opening for several weeks, so they wait months to see them. And when they do get an appointment, they often don’t feel heard. Even with a trusted primary care physician, you can only talk about one health issue and you only have 15 minutes. There’s not time to get to root causes, and patients aren’t satisfied.
The Ascent: And on the positive side?
Wise : Members are grateful for Medicaid. In particular, they appreciate the role of the care coordinators. Although members don’t necessarily understand the official role or title, they know the care coordinator on a first-name basis. That person is a lifeline. Members don’t understand how the different pieces work together, but they are happy to have someone who can help them--not just with health care, but with everything from getting a driver’s license to a mattress the patient needed. These coordinators go above and beyond connecting patients to resources for physical health.
The Ascent: What would you like visitors to learn from these journeys?
Wise : The voice of the patient, of the member, matters. This is the journey from the member’s perspective, and it allows you to put yourself in their position and understand how convoluted and frustrating it can be. In developing these journeys, we went to where people live, work and play so we could really understand all the factors that shape their lives: transportation, health, children, food—all of these things are connected. We hope that those who follow along on these journeys will begin to look at Medicaid members differently. And if they’re in a position to effect change, to do so.

*Health First Colorado is the state's Medicaid program.