Advancing Culturally Competent Medicare Advantage with Karen Walker Johnson of Clever Care Health Plan

Summary

Podcast Summary

Episode Overview

Podcast: Becker’s Healthcare Podcast
Episode: Advancing Culturally Competent Medicare Advantage with Karen Walker Johnson of Clever Care Health Plan
Guest: Karen Walker Johnson, CEO, Clever Care Health Plan
Date: March 3, 2026
Host: Scott King

This episode dives into the critical importance of cultural competence in Medicare Advantage plans, featuring insights from Karen Walker Johnson. She shares how Clever Care integrates cultural beliefs and practices into care delivery, addresses current challenges with provider relationships and cost pressures, and highlights strategic initiatives for bridging gaps in healthcare equity.

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Key Discussion Points & Insights

Karen Walker Johnson’s Background & Clever Care’s Mission

• Pediatric Nursing Roots: Karen began her career in pediatric nursing in Detroit, witnessing firsthand the harm caused by lack of cultural understanding in healthcare. (01:03)
• Clever Care’s Focus: Clever Care is a Medicare Advantage plan emphasizing culturally sensitive care—incorporating patients’ beliefs, behaviors, backgrounds, and language needs.
• Growth: The plan has grown to ~46,000 members, emphasizing access to care in members’ primary languages and honoring cultural traditions.

  “We are a Medicare Advantage plan ... delivering care from a culturally sensitive and competent perspective.” – Karen Walker Johnson (01:13)

• Blend of Medicine: Uniquely, Clever Care blends Eastern and Western medicine (acupuncture, herbal treatments).

Provider Partnerships in a Pressured Environment

• Trust & Reliability: Karen underscores that building reliable and transparent relationships with providers is essential, especially during cost pressures and workforce shortages.

  “Trust is so critically important between a health plan and its providers.” – Karen Walker Johnson (02:53)

• Supportive Collaboration: Clever Care helps providers by ensuring claim accuracy, timely payments, and stable benefits, reducing provider administrative burden. (03:20)
• Shared Accountability: Clever Care employs outreach teams to assist members, benefiting both patients and providers through shared resource dedication.

  “They may not have that person ... but we do. We are sharing the responsibility ... making sure that member and their patient gets the best outcome.” (04:45)

Gaps Between Strategy & Execution in Payer Organizations

• Cultural Needs as Essential, Not Optional: Karen identifies that many plans see cultural sensitivity as an “extra” rather than fundamental.

  “Not viewing the cultural needs of their membership as something more than just an extra.” (05:33)

• Examples at Clever Care:
  • Large provider network with bilingual clinicians and direct-contracted acupuncturists.
  • Culturally tailored supermarket benefits (via Nations Benefits), enabling access to culturally meaningful foods and herbs at national and local chains (e.g., 99 Ranch Market). (06:27)
• Vendor Alignment: Close alignment with vendor partners on culturally relevant benefits is crucial.

Key Investments & Initiatives for the Future (07:56)

• Member Engagement: Engagement “drives everything.” Key focus is on enabling access to care in members’ languages and aligning care delivery with members’ lifestyles.
• Community Centers: Clever Care operates four community centers to promote holistic health, offering activities like tai chi, dental health courses, book clubs, and birthday celebrations.

  “Those community centers ... are built around cultural competence. They help connect our members with the communities ... so they can stay in control of their health.” (08:13)

• Alignment with Providers: Strategic partnerships with Blue Zones Health and CareMore Health, both of whom share a holistic, culturally competent philosophy.
• Holistic Health: Emphasis on lifestyle medicine and whole-person care.

Regulatory & Industry Changes to Advance Equity

• Missing STAR Metric: Karen urges that CMS STAR ratings should include a quality metric for cultural competence, recognizing the additional resources needed to serve diverse, linguistically isolated populations.

  “STAR programs don’t measure cultural competence ... I’d like to see a quality metric in STAR ratings that accounts for the additional resources that a plan like ours uses.” (11:08)

• Bilingual and Culturally Tailored Health Education: Advocates for incentivizing plans to maintain bilingual providers and provide relevant community education.

Pressures on Health Plan Margins & Clever Care’s Response

• Industry-Wide Cost Growth: Recognizes rising industry costs and margins pressures. (12:24)
• Cost-Effective, Preventive Approach: Invests in strong provider relationships and programs for high-risk member engagement, focusing on stable benefits rather than cost-cutting (i.e., not narrowing networks or reducing benefits).

  “We’re able to maintain our commitment to those stable benefits ... we want to provide access to culturally appropriate care.” (13:17)

• Population Health Management: Moves to population-level strategies rather than individualized, myopic approaches.

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Notable Quotes & Memorable Moments

• On Provider Trust:

  “Trust is so critically important between a health plan and its providers.” – Karen Walker Johnson (02:53)

• On Cultural Competency:

  “Not viewing the cultural needs of their membership as something more than just an extra.” – Karen Walker Johnson (05:33)

• On Member Engagement:

  “Engagement really drives everything.” – Karen Walker Johnson (07:58)

• On CMS Ratings and Cultural Competence:

  “STAR programs don’t measure cultural competence ... I’d like to see that be something that’s measured.” – Karen Walker Johnson (11:08)

• On Resisting Benefit Cuts:

  “Rather than cutting our benefits or narrowing our network ... we’re able to maintain our commitment to those stable benefits.” – Karen Walker Johnson (13:09)

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Key Timestamps for Important Segments

• 01:03: Karen’s background and Clever Care’s mission
• 02:41: Strategies for maintaining strong provider relationships
• 05:30: Biggest gap between payer strategy and execution—meeting cultural needs
• 07:56: Investments and initiatives — community centers, member engagement
• 10:32: Regulatory changes to support culturally competent care
• 12:24: Margin pressures and Clever Care’s adaptive strategies

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Conclusion

Karen Walker Johnson articulates a compelling case for embedding cultural competence at every level of the Medicare Advantage member experience. By prioritizing community engagement, stable provider relationships, and linguistically and culturally appropriate care, Clever Care positions itself as a leader in health equity and innovation. Johnson’s vision for changing regulatory metrics and maintaining community focus offers actionable insights for health plan leaders facing the demands of a diverse and evolving Medicare population.

Transcript

[A]

This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you here in Chicago.

[B]

Hello, everyone, and welcome to the Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by a very special guest, Karen Walker Johnson, Chief Executive Officer of Clever Care Health Plan. Karen, how you doing today? Thanks so much for joining us.

[C]

Thank you. Good morning, Scott. And it's a pleasure to be here.

[B]

Thank you. It's a privilege to have you. And you know, we have a lot of big topics to get to with health plans and, and health care, as always, of course. But before do that, Karen, I was wondering if you just kind of tell us a little bit about your background and your career.

[C]

Well, I'm happy to do that. First of all, I'm Karen. I'm the Chief Executive officer here at CleverCare. I started my career actually in pediatric nursing back in Detroit and at that time had the opportunity to see firsthand a lot of the systemic barriers and just the lack of cultural understanding that was unfortunately harmful to families. And so since that time, I'm now leading Clever Care. And we are a Medicare Advantage plan which is delivering care from a culturally sensitive and competent perspective. And for your readers who may not be as familiar with that, basically what that is is that we really take into account understanding how patients beliefs and their behaviors and their background really influence how they seek health and ultimately what their health outcomes look like. As a growing plan we've got right now, it's got approximately about 46,000 members. We just had some pretty significant growth. We are giving our members access to care that's delivered in their own language. We honor their unique cultural traditions. It's all from a value based care model. So we're blending Eastern and Western medicine.

[B]

Well, appreciate you sharing your background info there, Karen, and it's great to hear about Clever Care's growth. That's outstanding. The first, the first topic I want to get your perspective on is I want to ask how do you think relationships or how is CleverCare's relationships with providers changing, you know, as both sides kind of face cost pressure and workforce shortages?

[C]

You know, we realize, and I Realize that our providers are managing quite a bit right now, Scott. So the best way for us as a health plan really to think about our relationship is really to do it from what we've always done. And that is really showing up for them by being reliable, by being transparent, and at the end of the day, really being a trustworthy partner. And I've been in this business a very long time and one of the things that I know my experience has borne out is that trust is so critically important between a health plan and its providers. And so we are doing everything we can to continue to build upon the trust we've already established. We are doing things like making sure that the benefits that we offer are stable and they're reliable and that our providers can count on them being that way. We know that it's really important that we make sure that they get paid on time, that they're paid accurately, that we are adjudicating claims appropriately. All of those things really build and just continue to build upon that trust. And for us, that's what it means to really help our providers manage through a lot of the cost pressures that you mentioned. And some of what we're seeing just around workforce. If we're one less thing they have to worry about and they can rely upon us, we believe that that's very helpful.

[B]

Well, do you think on the other side of that relationship, do you think that providers also feel like health plans have a lot going on right now too and they're, they're kind of understanding of that? Is that a two way street right now?

[C]

Yeah, I do believe that. And again, I think that's based on developing that trusting and mutual, respectful relationship. And so my providers, you know, they say, sit down with us and say, what can we do collaboratively to address some of these, these, these, you know, headwinds that we all see? One of the examples would be we employ people on our teams who reach out and do outreach to our members. You know, what we're trying to do with our providers and our providers recognize that that's a benefit for them. Right. That we're reaching out to their patients. We're doing it in collaboration with them and we're doing it in alignment with what the physician thinks is important for their patient. But that's one way that we are helping each other. And so they may not have that person, if you will, on their payroll, but we do. And so we are sharing the responsibility and the accountability all within mind, making sure that that member and their patient gets the best outcome.

[B]

Yeah, I Think that collaboration and understanding goes a long way right now with both sides. Karen, I also wanted to ask you, where do you see the biggest gap today between payer strategy and operational execution?

[C]

Well, one of the ones that I would identify is just goes back to the core of what clever care is, and that is not viewing the cultural needs of their membership as something more than just an extra. For example, our members have access to providers who speak their language and they understand their cultural traditions. That's essential for them to get the care. And so it's fundamental to our model of care. We have this very large network that includes the top provider facilities and hospitals. We have bilingual physicians, we've got acupuncturists that we directly contract with. And so all of that is something that is addressing that gap where plans that are not viewing the cultural needs of their members as something that's essential. Another example, I would say is the partnerships that you have with your vendors. In our case, I'm going to use nations benefits as an example. That's one where we are able to, through our work with nations, we've added culturally tailored supermarket benefits. And that's important because it supports the needs of our local communities. When they think about the foods that they want to cook and the herbal medicines, et cetera, that they want to take by us. Enhancing the access through nation's benefit with these national stores like a Costco or 99 Ranch Market, which may not be as familiar to your listeners, but it is a very big national chain for us in our communities. And so those are the types of things that we're focused on. Again, when you get back to your question about what is a gap that we're seeing with payer strategies in their operational excellence, it is thinking about those benefits that are key to meet their members, where their members are, and it's also making sure that that strategy that you're doing is aligned with how you execute in practice. And for us, again, it is being able to offer things like the foods that are important to our membership because we're recognizing those cultural needs that they have.

[B]

What's one investment or initiative you believe will most reshape how health plans operate over the next two to three years.

[C]

I think it's how we continue to engage members and knowing and recognizing that engagement really drives everything. So for us, it means that members are able to access their care in their own language. It means that they're able to be engaged in a way that that they are getting that care that coincides with the way they're actually living. We've got, for example, these community centers. We've got four community centers. And those community centers, Scott, are in communities that we're serving. But those community centers are built around cultural competence. They help to connect our members with the communities so that those members feel that they can stay in control of their health. Those centers they have and offer a blend of Western approaches to wellness as well as Easter. And so our members can go into those, into those centers and they can do things like take a tai chi class, for example, participate in a course on dental health. We do things that build the community. So we invite people to come in for things like a book club or a birthday celebration. All of that again is tied to engagement. And that's an investment in an initiative that's really important for a health plan. It allows that health plan to continue to grow, but more importantly, it allows them to continue to help their members get the best health outcomes. We recently, as I think about it, we recently brought on two new provider partners, one being Blue Zones Health, and the other is Care More Health. And the reason we did that is because both of those groups really align with our philosophy around the blend of Eastern and Western medicine around holistic care. Blue Zones, for example, is really focused on lifestyle changes and longevity practices, and that's fairly important in our membership. CareMore, for example, is a very large primary care practice, but they really are committed to some of the core values that clever Care is, that is caring for people from a whole person perspective and not just whatever their ultimate condition is. And so our members are benefiting by these initiatives and these investments that we're making in the community. And I think that's something that other health plans will have to do as well.

[B]

Yeah, I think they might have to adjust. Now, Karen, if you could change one regulatory or industry, industry practice tomorrow to improve affordability and access, what would it be and why?

[C]

Wow, that's a great question. You know, I, I guess I would say that if, if, if I only had one thing, you can throw out

[B]

two if you want, but yeah, let's, let's hit one first, if you can.

[C]

Well, if I go back to my, you know, my start in my career as a nurse, you know, one of the priorities that I found, and I was a public health nurse as well, Scott, One of the things that was really important was what could we do to help keep our patients healthy even when they had lots of challenges. So when I think about something that would be, I think a really beneficial change, it would be, you know, we have the STARS program. And it's really a helpful way to help ensure that health plans are delivering on the promise to focus on the right thing. But those STAR programs don't measure cultural competence. What I'd like to see would be a quality metric in STAR ratings that accounts for the additional resources that a plan like ours uses. For example, our community centers. I'd like to see that be something that's measured so that we could ensure that resources are there to serve diverse and linguistically isolated populations like ours, that we have the ability to continue to make sure that we have bilingual providers in our network, that we can offer health education that really is tailored to populations that have maybe different needs. So if I could have a crystal ball and say that's something that could be a change or an ad, that would be it.

[B]

Okay, I think that's a good one. And the last, the last question I have for you, Karen. What issue do you think is putting the most pressure on health plan margins right now? And how are you responding differently in 2026?

[C]

Well, I can't speak for the industry as a whole, but I can say that, you know, we've seen costs, excuse me, grow up across the industry. You know, everyone is, is aware of that. And the way we've been able to deal with that since Scott is by doing what we've been doing best and that's providing cost effective care. So we work very closely with our members, making sure that they're getting the right care, that they can stay healthy. And all of that will help to reduce cost. And it also, more importantly, I think, improves health outcomes. This year we're investing in strengthening our provider partnerships. We think that's a really important investment. We're investing in clinical programs that help us to identify and engage our high risk members. That gets back to population health and really looking at populations, as opposed to just looking at your membership from a very myopic way. We're also really keeping in mind that rather than cutting our benefits or narrowing our network in response to some of those margin pressures, we're able to maintain our commitment to those stable benefits. Gets back to what I said to you earlier about the trust that we've established with providers, we've also established trust in the marketplace as a whole. Despite the fact that we know that there are some, you know, some pressures around cost and margins, but we're still maintaining and staying true to, you know, our North Star. And that being that we want to be able to provide stable benefits, we want to make sure that we can continue to expand so that we can provide access to culturally appropriate care. And ultimately, we think that gives and fosters healthier communities.

[B]

Absolutely. I think that focus will go a long way and hopefully others can adapt like that. Karen, thank you so much for joining the podcast and for a great conversation. I look forward to working with you again soon.

[C]

Thank you as well, Scott. And you have a really good day.

[B]

You too.