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Becker’s Healthcare Podcast
Kelli Tice, MD, Vice President of Medical Affairs and Chief Health Improvement Officer at GuideWell and Florida Blue
00:21:37
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- [00:01]
A
Hello, everyone. This is Jacob Emerson with the Beckers Payer Issues podcast. Thrilled today to be joined by Dr. Kelly Tice, who serves as the Vice President of Medical affairs and Chief Health Improvement Officer at Guidewell and Florida blue. Dr. Tice, thank you so much for taking the time to be with me on the podcast today.
- [00:19]
B
Thanks for having me, Jacob.
- [00:20]
A
Absolutely. It's a pleasure. And before we dive into everything we want to talk with you about today, Dr. Tice, can you first tell us a little bit more about yourself, your background in healthcare, and what it is that you do today at Guidewell Florida Blue?
- [00:34]
B
Sure. Thank you. So I am a family doctor. I was a National Health Service Corps Scholar, which means I made a commitment to practice in an underserved area while I was still a medical student. And after completing my residency in family medicine, I completed my service commitment at a local health department here in Jacksonville, Florida. And I stayed for 17 years. And during my time with the Department of Health, I had the opportunity to work on all aspects of solution design which were intended to meet the needs of communities. And so that, you know, it was a wide range of efforts and activities that really taught me a lot about, you know, the needs of communities and how often we miss the mark. And then seven and a half years ago, as you mentioned, I came to Guidewell and in 2022 was named to this position, its first ever. And my role really has been to ensure that the work we do in managing the health needs of our population appropriately includes and addresses the needs which may drive health disparities. So things that which might be overlooked, that might actually, if not addressed, would prevent us from producing intended outcomes. So I've had the wonderful opportunity to work across the organization to ensure alignment for all of our efforts and activities.
- [02:05]
A
Understood. And it really is such a unique background, I think, given your current role. I talk to individuals at health plans around the country and it's sometimes a bit rare to hear somebody coming from such an extensive public health background. And that's really one of the first things I wanted to ask you about is coming to the pear world after almost two decades in public health in Florida. You're talking to health plans all over the country right now. And so I wonder what you would tell them in terms of maybe what the industry misses or under invests in because they don't have that public health lens that you do and where you then have tried to close that gap
- [02:46]
B
at Florida Blue, Certainly, I think the major issue is that there are many leaders and executives across the pear industry that don't have a great understanding of what public health is. And as a result, we tend to sort of craft solutions that ignore or under emphasize the public health infrastructure that does exist in all communities. And what I mean by that is, you know, very often we're building our own sort of systems and solutions. We are creating our partnerships, partnerships based on just our own industry knowledge versus a knowledge of the things that are actually at work in the community. You know, here in Florida, every county has a community health needs assessment completed, and from that is created a community health improvement plan. And typically your local health department is the convener of all of those conversations, and so is the keeper of a lot of that information. And we contribute to the siloed efforts that work against us by not understanding those systems. The other mistake that I find is made very often is to relegate the work of community improvement to philanthropy and to rather than mainstream those efforts and use our business infrastructure, our roles as anchor institutions in the communities where we exist and where our own employees live, work play. Rather than leverage that as a way to positively impact communities, we sort of donate our way toward community health solutions. And while philanthropy is important, it won't be the thing that drives sustainable change.
- [04:46]
A
Sure, that makes a lot of sense that the community work has been set where into the philanthropic arms versus into the core business operations. And I think in that vein, I was researching a little bit about what's gone on at the company under your leadership. Kelly and I know there's been dashboards built when we're talking about infrastructure dashboards built that surface social determinants and clinical risk data for you all at the member level. And so can you detail that for us a little bit how long that has been in place and how you're translating all of that data into actual plan design, care management decisions? If you could offer our audience just a little bit more details on that.
- [05:29]
B
Absolutely. So, and it's actually work I'm very proud of. It isn't as if we weren't using data prior to my position existing. Right. And in fact, there were teams across the company that had either specific data sets that they were familiar with and accustomed to using, but during the pandemic, as we tried to work on a process for identifying our members that were going to be at greatest risk. Right. Those are folks we needed to get information to and from, you know, we need to direct them to care and services and testing and all of the things. And we did not have immediate line of sight to those that that had, you know, conditions that would put them at increased risk, be those social or, or clinical conditions. We, we first created a dashboard to try to address that need. And you know, what we've done in the years since is build upon that. So we begin with the, the data we have on members. And you know, and let me stop here and say that we still have significant underreporting of some of the demographic information that would, that would be really useful to us from our members. And so we are, you know, we still have to work on that part of it, but we take the member data we have and in most instances we then co locate publicly available data to paint the picture, if you will, of the, of what surrounds the members. So what do we know about members, claims, needs, our interactions with them, you know, the current state of their health and then what based on their environment can we infer? Because there are things, there are regional and local influences on health that should sort of shape our decision making. And we have expanded this work to produce a number of dashboards that give us the ability to sort of double click on certain conditions, you know, certain drivers of disparate impacts, again to give us an idea of where to begin. And this is the most important thing, like you can build the dashboard, but if you only use them to sort of admire your problem, then you really, it really hasn't benefited you. Right. These are interesting information, interesting data points, but we now use those dashboards to allow us to direct our resources in a way that improves our impact. So if we've got limited resources, as most do, we want to be sure we're directing time, attention and resources to the members of our population that are in greatest need.
- [08:03]
A
Absolutely. So admiring that problem, where do you think then health plans who can say they're able to do similarly? Where do they commonly fall short in terms of closing that loop industry wide? Not talking about Florida Blue specifically, but where do you think other plans struggle in this space, Kelly, in terms of tracking these kinds of social determinants?
- [08:25]
B
Sure. So, you know, I think it starts and ends with data. And so, you know, being consistent in the data that you collect, being sure you've built an appropriate use case for that data and that you are leveraging relationships of trust in order to make members comfortable in sharing that data. So I think that that's where it begins. Right. We find that even as we have integrated, for instance, social drivers of health screening tools into, you know, our care management tools and, you know, other systems, very often our members are reluctant to report their needs unless the information is Gathered in a setting in which they feel comfortable and have trust. So I can't sort of overemphasize that. I also think that the place that payers tend to fail is in ensuring that they have a consistent approach to applying that data. So we can have dashboards and things that provide us the appropriate information, but if we only refer to those dashboards when we're talking about health disparities, then we miss the opportunity to apply that lens when we are talking about total cost of care or when we are developing new products for the market. Right. So it really has to be the lens we look through consistently. Because unless you're looking for it, you will miss it. And often and I think this is the biggest problem, you will have unintentional impacts on at risk populations because you haven't sort of sliced the data. The appropriate way to identify the disparate gap or the disparate impact that you were hoping to avoid?
- [10:21]
A
Absolutely. No, it makes a lot of sense and I think the natural follow up question to that is how do you maintain continuity on these long term population health clinical improvement initiatives that take much longer than singular quarters obviously to shift show results but people don't, people don't necessarily stay at companies long enough for these to see those results. So how do you make sure that this work continues beyond, beyond just yourself
- [10:51]
B
so that, that's such an important thing? You know, I, I, anyone who does work like this understands the, the conundrum of, you know, having leaders who expect, you know, a report out on ROI and progress toward, you know, the return on investment and they want it by third quarter of this year. Right. And so we've had to provide a lot of support across the industry for leaders like me to share with their respective leaders the, the longevity of this work and the value of that. And I would encourage folks that are making decisions related to this to look at this as systems change. You know, this is the role that payers can play in addressing these long term impacts. These things are going to impact cost or they're not, you know, because they're going to be, they're going to be mitigated by the solutions we put in place today. And so as we look down the road in what is a, an unsustainable cost environment, these are actually investments in long term cost mitigation. And you know, we are working together across the health disparities industry to better identify the leading indicators like what are the things we can begin to hang our hats on that do sort of forecast the savings that we expect to see, and I would hope that we will begin to recognize that these are collective savings because of what we're doing with costs across the industry.
- [12:34]
A
It's almost like you've had to bring in a different metrics reporting perspective into a business environment that maybe wasn't used to that kind of thing in the past. It sounds like.
- [12:47]
B
Absolutely. And that's what public health systems do. Right. That is a public health approach to managing the health of populations. And we don't expect that needle to move very rapidly. And in fact, when it does, we should fully expect it to move back the other way. Right. Because those quick changes don't tend to be sustainable. We should see a slow, gradual improvement and be satisfied with that.
- [13:12]
A
Absolutely. And it seems like an even more pertinent message right now or strategy right now, Kelly, given what's going on across the industry, especially when we're talking about managed care and taking care of more vulnerable populations, taking care of seniors. You know, it's no secret that insurers across the country are facing very significant financial pressures right now. And so does this become an even more important message on, on making that case for investing in more upstream health improvement programs? Like with what we talked about, when these investments take much more than, than singular quarters or even year to, to
- [13:50]
B
materialize, that's exactly the message it should send. You know, that upstream investment makes, makes for significant gains. You know, a great example of that is the work we're doing in the, in the maternal health space while we're doing a lot of things to support our birthing moms during their pregnancies, but the work we do with chronic illness prevention and management also influences maternal health outcomes. For because the state at which a birthing person finds themselves in terms of their health at the time of conception really does influence their outcomes to a great extent. So the upstream work of creating a healthier population and addressing the things that keep people sick are all investments in what we really want to see, which is more people with the opportunity to achieve their highest level of health.
- [14:47]
A
Absolutely. Absolutely. Well, let's stay on the topic of maternal health, because I know you all just announced an expansion of your maternal health support program for high risk members. So can you walk us through what's driving this decision and ultimately what it means for your members on the ground?
- [15:06]
B
So this is one of my favorite things to talk about for a myriad of reasons, not the least of which is that this program actually came to be because of needs that were brought forward by our own employees. We had three Employees who were participating in an employee innovation challenge, who themselves were recently postpartum, who collectively sort of, you know, talked about their postpartum experiences and their desire for more support or easier access to the supports that are required to help through the postpartum period. And from that, we built this program that we've now expanded in a number of ways. You know, initially it was postpartum only, and, you know, to our earlier point about the need to intervene further upstream, we would find that we'd have members who were in need postpartum, that if we had identified them a bit sooner, we could have wrapped services around them, we could have built community around them and actually prevented some of the significant complications we were seeing. And so we expanded the program first to do the screening and assessment for social needs and for depression or anxiety early in pregnancy. And we initially tested this with a small population. But as we built our dashboards and recognized that what was being reported nationally in terms of maternal health outcomes, we were seeing reflected in our member data, we were seeing reflected in our employee data, it was time then to expand access to the program to our highest risk moms across our population to ensure that at least those needs could be met. And so, you know, this is a wonderful time to be discussing a solution like this because it is not, it's not just focused on the clinical aspect. You know, we do point our members back to their delivery provider, their obstetrical providers, but it really is about having having a member feel heard, having them have a place of. Of community where they can share fears, concerns, experiences where they can feel supported, where they can engage in educational activities around pregnancy. But I think really, the, the, the magic sauce is that it's a community. You know, there's this shared experience of pregnancy that actually is improved when you can share ideas with others, when you recognize that there, there are others out there who are experiencing what you've experienced, who have the questions you have. Right. It's what, what it does is, is magnify that. You know, when I was in practice, I did group visits, and so I would bring my chronic disease patients sort of all into one visit. We talk about sort of the general issues related to the particular condition, and then one by one, I would pull them back to exam rooms to see them. It's that concept, but scaled so that we can reach thousands of members with these solutions versus the 10 or 20 that I was able to do in my group visits.
- [18:30]
A
Wow. Your passion for this is really coming through just hearing you talk about this.
- [18:34]
B
Yeah, it's amazing work.
- [18:36]
A
Yeah. And it's amazing that this all stemmed from hearing what Florida Blue employees were reporting and then you all had the channels to funnel that up to, then filter it down to other members. That's an amazing story. So I really appreciate you sharing that with us.
- [18:52]
B
I'm proud of it.
- [18:53]
A
Well, before we go, Kelly, what else are we missing? You've got the ears of a lot of other health plan leaders from all over the country right now facing very similar challenges. So what would you want to share with them or any final bits of advice?
- [19:08]
B
Thank you, Jacob. You know, the most important thing, you know, everyone needs has to step into this work for all the reasons we've outlined right there. Disparate outcomes are a significant contributor to cost of care. Right. And so unless we begin to solve for these things upstream. Right. We're going to be telling the same stories. You know, those of us who've been doing this work, we've been having these conversations really for decades because we haven't shifted. We haven't changed the way we solve. You've got to intervene upstream. You've got to consider more than the clinical. You've got to consider all of the social drivers that influence health outcomes. You have to be aware of and address the policies that keep barriers in place, all of those things. But if we as payers, as we are going about the work of being payers, don't operationalize efforts to examine what we do for disparate impacts, then we'll continue to get this wrong. And what, what that means is your best program, your. Your. Your initiative which drives the. The greatest amount of cost savings. If you don't hold those programs up to the light and ask yourself the tough questions. Who in my population do we leave behind with this? Who gets excluded because of this decision? And how do we mitigate the impacts on those who may be transportation challenged or, you know, not have broadband access or, you know, are unable due to health literacy to log on and access these services or products or tools, then we haven't delivered a complete solution. So you must know as you're doing this work, this is our intended goal. These are the potential unintended impacts, and this is how we mitigate that.
- [20:57]
A
It's fantastic advice. I cannot thank you enough, Dr. Tice, for taking the time to be here with us and for sharing your expertise with our audience. We really appreciate you doing so, so thank you.
- [21:09]
B
Much appreciated.
- [21:10]
A
Ticket and to our audience, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.