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Becker’s Healthcare Podcast
Affordability, Access, and Operational Excellence at MetroPlusHealth with Lila Benayoun
00:10:18
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- [00:02]
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.
- [00:34]
B
Hello, everyone. This is Elizabeth Casillow with the Becker's Payer Issues podcast. I'm thrilled today to be joined by Lila Benighoun, Chief Operating Officer at Metro plus Health. Lila, thanks so much for chatting with us today.
- [00:47]
C
Thank you so much for having me. Very excited to be here. Thank you. Great.
- [00:51]
B
So before we jump into the conversation, I would love to hear a bit more about you and your healthcare career background and just an overview of your current role at Metro plus Health.
- [01:01]
C
Sure. I'm Lila Benny and as you mentioned, I'm the Chief operating officer at MetroPlus Health. We are a health plan that services approximately 700,000 members in New York City in all five boroughs. I have been in the healthcare space for over 20 years, very specifically in managed care. And so it has been very interesting to see the managed care environment evolve over the span of 20 so years. And so it's pretty exciting to see the different regulatory environments shifting and changing and how that plays out to our members. I joined MetroPlus Health in 2021 and we really focus on various products to service our members, and I really focus on operational and service excellence, just always keeping the members and our providers at the center of everything that we do.
- [01:48]
B
And today we wanted to have you on because your team recently released the Care Crunch Index. So what are some of the biggest takeaways for insurance leaders to take note of from this research?
- [02:00]
C
Yes, and so thank you for that question. One of the clearest takeaways is that healthcare affordability is no longer an abstract concern. It is actively reshaping household decision. So what we found was that 42% of New Yorkers told us that they have to cut back on leisure or lifestyle spending because of healthcare costs. And nearly half of them said that they could not afford $1,000 medical bill without going into debt. So it is a major concern in terms of cost and the impacts of the New Yorkers. Another important signal for insurance leaders is that affordability pressure is widespread. So it's not just limited to the lowest income bracket, but it's also we're seeing that blend over and bleed over to the middle income earners, which is telling us that it's really important for us to consider the benefit design, making sure that the information that we deliver to our members have clear and concise and that we are mindful of any out of pocket cost expenditures so that the predictability is there, so that when our members are budgeting, they know how to better budget. And finally there is a disconnect between confidence and clarity. Many people feel that they understand insurance, but when push comes to shove, they still struggle with a very basic time sensitive moments like open enrollment. And so that was eye opening to us as well.
- [03:25]
B
So to follow up, you know, based on your role as coo, how do you translate survey data showing these affordability concerns into concrete changes?
- [03:34]
C
So for us, for measure plus, we use data like a roadmap and it sort of illuminates a path forward to us and making decisions on how we can better service our members and making sure that we are true value to them. And so when we see that people are worried about unexpected costs and we look at where we can reduce that friction and that surprise, meaning we look at the way we design our plans, making sure it's low to no premium, predictable co pays and benefits that support everyday needs and not just clinical care. Where health plans often fall short is assuming that access equals understanding coverage can be technically affordable. But if members do not know how to use it, when to enroll or where to go with questions, the system will still fail them. And so we have to be very, very aware of who our members are and just making sure that we're meeting them at their level so that they understand certain important events like open enrollment so they get the health insurance that they need. Operationally, we focus on simplicity, high touch support. We try to go to where members are, Right. We have community offices throughout the five boroughs where we're at facilities, we're one phone call away. And so we really want to make sure that our members know that we are there to support them and their life changes.
- [04:57]
B
That makes a lot of sense. And speaking about knowing your members, the survey did highlight racial and ethnic disparities with affordability. So what are the biggest operational challenges in delivering truly low cost care to populations that are more likely to face these concerns.
- [05:12]
C
Right. So one of the biggest challenges is that cost pressure does not exist in isolation. Communities that are more likely to report affordability concerns are also navigating language barriers, work schedules that limit flexibility, transportation challenges, and just a lower Trust and confidence in the healthcare system overall, making sure that they have access to care when they need the care. From an operations standpoint, delivering low cost care means investing beyond the traditional insurance model. It means culturally competent outreach, multilingual support and benefits that address social needs like food and transportation. So we want to make sure that a good portion of our workforce speak various languages so that when a member calls, we could really communicate with them at their level. That's such an important way that we operate. It also requires sustained engagement. So you cannot solve disparities with a single enrollment period or campaign. We need to continue to be a presence in the, in the communities, making sure that our members know that we're available and there, and letting them know where they can, where and how they can reach out to us. And so that's very important to us.
- [06:25]
B
How have you built out, just as a follow up, how have you built out those community efforts in recent times and what languages are you placing the most investment in Right now? You're seeing a lot of your members needing those resources.
- [06:39]
C
Sure. So we are trying to have Spanish speaking individuals, Mandarin and Chinese, Urdu, so we identify the top five or so languages are commonly spoken in our population and then also those individuals that are in the community. We have community office locations throughout all five boroughs and we let our members and consumers know that we are there for them. And we also let the language speaking individuals there as well, so that they're not timid or intimidated to come over to MetroPlus and ask the questions. And that we are a valued partner in their life and that we want to make sure that they can rely on Metro plus and supporting them in their times and needs, healthcare, whatever the case may be.
- [07:27]
B
So another thing you mentioned earlier with the general findings was the Survey found that 79% of respondents feel they understand insurance, but only 60% know when open enrollment happens. So what's the hardest part about that simplification you talked about earlier with open enrollment, especially when it comes to younger and lower income populations?
- [07:47]
C
Yeah, that's a really good question. So open enrollment is one of the most important moments in the insurance experience, but it's also one of the most complex. You're competing, you have all this information coming at you and it's very hard to decipher which one would be the best fit for the individual. Also, timelines vary, terminology is confusing. The process often assumes people have the time and the bandwidth to navigate this on top of their day to day activities. Right. And so for younger and lower income populations, competing priorities are a real barrier. Health insurance may not feel urgent until something goes wrong. Adding in the digital fatigue or lack of clear reminders. It's very easy to miss the open enrollment period and so crucial that that individuals select their insurance carrier during that open enrollment period. So we really have to set the reminders, making sure that the individuals understand this very important event. The hardest part is cutting through the noise with clear, repeated and human communication. So at metraplus, we focus on making enrollment feel approachable, not intimidating, and ensuring members know there is a real person that they can talk to whenever they need and get their questions answered.
- [09:03]
B
Absolutely. I love the point about digital fatigue. I think that's something that we see so often, especially with those younger populations. I was just wondering if you have any final thoughts or advice for industry leaders and how you recommend translating these findings beyond the New York market.
- [09:21]
C
Yeah, so it's really important to know and remember that our members are the center of everything that we do. And so we need to listen and pause and recalibrate our approach and service offerings so that we are meeting the needs of our member at that point in time. And so, and that, and that we need to consider not just the demography of the members, the income level of members, but also the various life stages of the member. And we have to meet them there. And so that's an important, I think, an important lesson that we've learned and that we carry through in our day to day operations. And so I just think in general, it's important for us to take pause and really listen to what our members need.
- [10:02]
B
Well, Lila, thank you so much for joining us today. It was great having you.
- [10:05]
C
It was a pleasure. Thank you for having me.
- [10:07]
B
Awesome. Well, to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit beckershospitalreview. Com. Thank you.