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Becker’s Healthcare Podcast
Integrating Care and Accountability in Medicaid’s Next Chapter with Erin Henderson Moore
00:16:26
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- [00:02]
A
This is where health insurance leadership comes together. Becker's fourth 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. Hello everyone, this is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Aaron Henderson Moore, who serves as the President and CEO of Fidelis Care of New Jersey. Aaron, thank you so much for taking the time to be with me on the podcast today.
- [00:50]
B
Thank you so much for having me. Really excited to be here.
- [00:54]
A
Likewise Aaron, we're excited to dive into some important topics and hear a little bit about what's been going on under your leadership at Fidelis of New Jersey. But before we dive into that, just want to have you fill in our audience on who you are, what your health care career background has looked like, and if you could give everybody quick overview of what your current role entails.
- [01:16]
B
Yeah, absolutely. So as you mentioned, I serve as the President and CEO of Fidelis Care of New Jersey. Fidelis Care is a centene health plan supporting Medicaid, Medicare and Marketplace. We also are really excited about our large long term services and its population across the state. So you'll hear me refer to that that group as the LTSS population. So here in New Jersey my role is really about aligning access, affordability and accountability for our state, our members, our provider partners and really building teams who can execute against that mission. So excited. I've been here at Fidelis Care of New Jersey of almost three years, but not new to the healthcare space. So prior to to Fidelis Care I was at UnitedHealthcare for six years. I led their dual special needs plans in D.C. and in Maryland and I was really excited to launch the Dual Choice program in D.C. which is an integrated Medicare and Medicaid plan, really aligned and designed to serve duals across the state and that was a really innovative program. Prior to my time at UnitedHealthcare I've been in consulting. I've worked in government programs my entire career. Spent some time at D.C. medicaid, spent some time in consulting and spent some time in nonprofit management. But really excited to continue to be in the government program space where I feel like innovation is really key and you need People that are aligned to the mission and to the goals of those specific programs.
- [03:01]
A
Wonderful. Well, Aaron, like I said, we're excited to get to talk with you today and let's stay on the topic of Medicaid. Like you mentioned, you've been in this space for a bit. You, you've served this population for a long time and you've seen trends come and go in this space. And so I wanted to ask you and get us started by talking a little bit about what we've been hearing from Medicaid managed care plans all over the country these last few years. Of course, in the face of everything going on federally with Medicaid, we're seeing, we're hearing from plans about rate adequacy concerns on the state level, increasing state scrutiny of how these dollars are being managed by companies like yours. So I wonder, you know, just given all the context of what's going on policy wise right now for Medicaid, what's an issue that's, that's keeping you up at night in this space that isn't talked about enough right now in the industry that you don't think the, the media is hitting on enough, that your colleagues don't touch on enough? What do you want to hear more about in Medicaid managed care?
- [04:04]
B
Yeah, absolutely. I would say two things keep me up at night. The first is really integration. I think you're starting to see a lot of integration of programs that are not traditional clinical programs. Two that I'll talk about here, behavioral health and housing. We're starting to see huge increases in spikes of behavioral health in particular. But there is a link between those two programs. And so you are seeing states really work with the federal government to move towards carbons of really making this such an integral part of the managed care experience. Because what we're starting to see is that we've so traditionally focused on physical health, but really where the costs are spiking are in behavioral health. And how do we make sure that people, especially with behavioral health needs, can remain housed and housed long term because that way we, we know where people are located and how to then intervene with all the other parts of the managed care experience to make sure that the people receiving the care that you need. The second is really around support for older adults and individuals with disabilities. So you're seeing states do a lot leveraging the flexibility between their Medicare and their Medicaid. But you're going to start to see and you're going to continue to see a lot of focus on LTSs, modernization and focus for care of those continuity of care and care for older adults and people with disabilities in their homes. You're going to see that for a couple reasons. One, we just have an aging population to the infrastructure is not designed for people. We just don't have the capacity for people to be in facilities. And so you're going to see this move away from people needing different environments to age safely in place. And then thirdly, people just, that's a better experience. So I recently, you know, lost my parents and it was really important that they were able to stay in their homes and die with dignity and care in places that are comfortable for them. And a lot of times that means at home and putting services around them. And so you're starting to see a lot of cost again at behavioral health services and non traditional clinical services to allow people to age in place at home.
- [06:28]
A
Well, I'm very sorry to hear that about, about your parents, Erin, but thank you for sharing that with us, for connecting that back to why it's so important to continue to expand support for older adult for people with disabilities enrolled in these programs. And if we're sticking on this topic in terms of everything going on right now in terms of Medicaid policy, of course, as you know, a lot coming down the pipeline at the federal level, work requirements next year across the country. Nearby in New York, you've got the essential plan rollback, expired ACA enhanced subsidies at the end of last year and you know, stalling of any kind of solution there in Congress. So just a lot going on for, for individuals like yourself to be tracking. So I wonder, given all of that, how are you navigating member retention right now when, when so many coverage pathways are shifting at once?
- [07:23]
B
That's an amazing question. And the, the answer is we're using a multi prong approach. We have not figured this out at Fidelis Care, but we are working, you know, we haven't figured out the bullet like what it, what is the thing that, that keeps people connected to care, especially with all the different things coming at and social media and other ways. But one of the things that I would say is really working with the state partners to make sure that the information that we have is correct. So you know, one of the things is we've traditionally relied on mailing addresses and mailing things to people, but we're finding increasingly across the entire span is that people get their information differently. So one thing that generally doesn't change is email addresses. And so making sure that we have up to date email addresses for, for people. Right. Like stores have gotten this down packed and so figuring out how can we leverage things that are that other part of other retailers or other companies have really figured out email addresses being one of them. How can we leverage text messages? It's one of the things that we found is across our population, regardless of income and regardless of ages, people have phones. And so how do we use text message? And then how do we then work with the data? When we have the data that's better or more up to date than our state partners, how do we figure out a way to make sure that that data is being updated in their systems and not being replaced by daily 834 eligibility files? So those are three things that are just really, really crucial to making sure people stay connected to care. The second is really making sure. And I say second. But another thing is really making sure that the state systems because that's where we get or federal systems, if we're talking about marketpl, Medicare is making sure our data has redetermination date. So right now one of the things that we don't have that date. Right. So the state is kind of re engineering how do they give that date so that we're really always kind of keeping up to date with our members saying don't forget to renew, don't forget. Here's how you do it, here's how you can check the system. So really working with our state partners to figure out ways that we can also have that date. And so that there's not this kind of. I think it's around this time and so that we can really walk our members through the process. And finally one of the things that we would say is we think it's probably a good idea for states to really be thinking much more creatively and how plans can help members get connected to care. There's a lot of really interesting and innovative partners, vendors that are doing really cool, cool work and to use a, you know, more colloquial term of doing really innovative work, leveraging AI, leveraging all the data that we have on our members. And I think we need more flexibility in how we work with those members to keep them connected to care. Because what we're finding is when there's gaps in care, it's more system, more expensive for the entire system. And it doesn't serve people well to be disconnected. Right. So then now you're getting them back to the system, there's more expense and just that muscle, it takes a while to get that kind of muscle back of making sure. People are, you know, taking their medicine and going to their doctor and it causes a lot of downstream impacts to the system, certainly.
- [10:54]
A
And I think that's such an interesting point that you make there, Aaron, in terms of, we're hearing similar all over the country from leaders like yourself in terms of get creative in a time of, of uncertainty for the industry and for some of your members. Think outside the box, meet them where they are and really, I think communicate differently is what we're hearing around the country with the members, with the state and like you said, get innovative with how you're interacting with them. And I think in that vein, kind of going back to what you were saying earlier about thinking outside the box, outside the clinical box and really going to address social determinants. I know that Fidelis last year announced half a million dollars in health equity grants through this year for things like food security, maternity, internal health access, expanding rural care access. So, you know, those things are amazing. Talk to us about the, the business case here for investing in social determinants work during what we just talked about during this period of coverage instability for so many.
- [11:58]
B
Yeah, absolutely. I, I think what it's really about getting upstream, you know, what we are seeing is that a lot of the factors driving cost in the system is not the clinical cost. Clinical is a reactionary, it's a lagging indicator of how people are doing. One of the things that we're really trying to do is really get upstream and really address social determinants of health, housing instability, behavioral health fragmentation and all the caregiving burden on families. If we don't upgrade, address those upstream levers, the system will continue paying downstream in the emergency department and long term care institutional settings. So a lot of the grants that we put up there, both at Centene nationally and at Fidelis Care is really shifting spend upstream and not just lowering rates. Right. Getting really creative, you know, and really getting creative and paying differently to drive affordability in the system.
- [13:04]
A
Well, it's great to hear and I know from our perspective, Centene has certainly been one of the more innovative companies in terms of how and where you decide to use social determinants grants, equity grants. So wonderful to hear about that at the New Jersey level as well. Aaron, before we go, what else are we missing today? You've got the ears of a lot of other Medicaid, Medicare insurance leaders overall all over the country facing similar dynamics as you. So final bits of advice that you'd share with them?
- [13:38]
B
Yeah, I would say two things. I think we really need to focus on integration, I would you're seeing it in large fragmentations of the integration of systems. You know, large systems, Medicare, Medicaid, but also medical, behavioral, social services, how that we operationalize those together. And the second thing I would say is states are being asked, states are being asked for measurable outcomes, not just access metrics or metrics. And so what you're going to be seeing is that what what states are asking, what the federal government is asking of states, what this federal government is asking for providers, what the federal and state governments are asking for their MCO partners, that is changing. And so to me you're going to start to see more data sharing, more outcome based contracting, both with the health plan partners, but also with our downstream partners. I think you're going to see a confluence or a mix of integration plus accountability that will really define the next decade of Medicaid and much larger government sponsored programs. I think you're starting to see that really in the signals at the federal level, but we're seeing it local across the country how states are asking more integration, person centered care and how we think about, how we think about that to be really differently. And that's not just how we pay providers, but really how we drive accountability in the system. So that's really what I would think about. And then the last thing I would just say is really about this population aging. I think you're starting to see that across the book of business, non clinical services are driving the cost to Medicaid. And so you'll really start to see that demand continue to outpace traditional physical health demands. And we're going to see people continue and we're going to need to continue to enable aging at home. So a lot of focus on that in the next decade and I'm really excited to kind of be at the table to see how we continue to change Medicaid and what we expect of the program.
- [15:56]
A
Wonderful. Well, it's some really great advice for our audience before we go. So Aaron, I want to thank you for taking the time to sit down with me today and for sharing your insights and everything about what's going on under your leadership at Fidelis Care of New Jersey. We really appreciate you taking the time, so thank you.
- [16:14]
B
Thanks so much for having me. Look forward to the next one.
- [16:16]
A
Absolutely. And, and to our listeners, if you'd like to listen to more podcasts from Becker Healthcare, you can visit Beckershospitalreview.com.