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Becker’s Healthcare Podcast
Leading Medicare Innovation and Supporting Dual Eligibles with Michael Carson
00:21:50
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- [00:02]
A
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that Much simpler with Athenahealth. See how simpler is healthier at athenahealth.com.
- [00:44]
B
Hello everyone, this is Jacob Emerson with the Beckers Payer Issues podcast. Thrilled today to be joined by Michael Carson, who's The president and CEO of WellCare, which is part of Centene. Michael, thank you so much for taking the time to be with me on the podcast today.
- [00:59]
C
Thanks Jacob.
- [01:00]
B
And Michael, before we dive into everything we want to talk with you about, can you tell us a little bit more about yourself, your background in healthcare and what it is that you do today at wellcare?
- [01:10]
C
For sure. Pleasure to be here. Thanks for giving me the opportunity to connect so time flies when you're having fun. I can't believe it's been 30 years in healthcare, but it's been a great ride and a great opportunity to work with some great organizations. Over those years I've had privilege of working in and leading a few payer organizations, a few provider value based care type organizations, as well as some population health companies. So the spectrum of administration and financing care delivery mixed in with the care management aspect of things, which has been a great experience. To round those perspectives out. I've also had an opportunity to work across the types of benefits that we offer in our healthcare system. So fully in self insured commercial businesses, ACA business from a marketplace perspective, lots of Medicaid and lots of Medicare background and then thinking across the types of companies that exist, have also had the opportunity to work in nonprofit regional health plans, publicly traded companies, as well as some private equity startup organizations. So again I bring all that up just because of the breadth of experience and breadth of perspective that brings to what we're here to do for our members and constituents and communities. Before healthcare I spent spent seven years in the Air Force. People ask me what kind of planes I flew. I say I flew a desk. So I did like quality assurance standardization work for aircraft maintenance type work and then I spent several years with Anheuser Bush after the military, something called total quality Management. But it was really around performance improvement, helping businesses, helping companies do better. So that's sort of healthcare background. And the things that led me into healthcare itself, which thinking about how to improve businesses and trying to be a change agent, those are the kinds of things that have brought me throughout my career. And today at WellCare where I serve, as you said, as the President CEO of our, of our well Care Medicare business. It's against Centene's Medicare business. We're serving about 32 states across the country with a very strong mission on really serving our communities and improving the health of our communities one person at a time.
- [03:24]
B
Wow. I mean, so clearly you've had a very diverse career background, Michael. And you mentioned you served in the Air Force before really diving into the the healthcare industry. And for our audience who isn't aware, Michael served at organizations like Harvard Pilgrim, Healthcare, Bright Health Plan and Care About. So Michael, talk to us about how all these past experiences brought you, brought you to wealth Care and how that's really shaped approach of leading what. What you just said. The Centene's Medicare division. Such a massive organization.
- [04:00]
C
Yeah. And lots of my colleagues at this stage of our careers, the. The list of companies becomes embarrassingly long to have to run through. But I actually started my healthcare career with a regional blues plan. Colorado, Nevada, New Mexico at the time was a not for profit plan just before Anthem acquired it in the late 90s or so. So I've spent my time, as you said, with Harvard, Pilgrim and Bright and Care about sort of from a provider perspective, but also with Amerigroup serving national Medicaid businesses with Anthem quite a bit helping to build Medicare businesses as well, which again has been a great challenge and an opportunity as I think about, you know, how those things have led me here and how they help shape my approach to, to leading well care today. But really overall I kind of reflect on the combination of my work and healthcare experience with my upbringing and at the risk of sort of getting boring here, I think we all have a background and certain pillars to our foundation. And to me, I was born and raised in Germany, grew up in Europe. Mom was a factory worker. My dinner was the stuff that was left over from the cafeteria. Dad wasn't in the picture, so no silver spoo. A healthy dose of reality of what we have to work very hard for. That coupled with that early military and business improvement experience being, you know, on the ready at any given time to go do what we have to do to fulfill a mission. So those pieces as a foundation combined with my healthcare experience have me focused on WellCare today in terms of what's our vision, where do we need to go, what are opportunities, what plan do we need to put in place? How do we execute on that plan in a diligent, rigorous way? I love the 8020 rule. To what extent can we build an infrastructure that allows us to manage what we have to manage at the 80% level so that we can be ready to react to the 20% of things that sort of punch us in the mouth and then we have to react to with the healthy dose of courage to make a difference. Many of us pride ourselves on being disruptors or challenging the status quo. But I think all of us that are trying to make a difference and that are led by a mission, lean into that and try to find our own space in creating improvement, creating difference. Very few of us sort of just view this as a job. We view this as an opportunity to make a difference.
- [06:34]
B
Sure, that makes a lot of sense. And I appreciate you weaving in for us how your upbringing has really influenced how you oversee the current population that you serve as well. And in that vein, Michael, I wonder if you could talk with about one segment of the Medicare population that you serve and of course that we've seen major growth in terms of enrollment in over these last few years. And I'm referring to the dual eligible population that of course Centene has so many enrollees in this segment as well. Talk to us a little bit about this specific segment. What are some of the unique challenges that you are seeing dual eligible beneficiaries face right now? And how does WellCare specifically approach support for this vulnerable population?
- [07:23]
C
As I think about mission, I oftentimes speak to how there are very few other populations for which our mission comes to life the way it does for dual eligibles. Across the country there are roughly 13 million dual eligibles. So people that qualify for Medicaid and Medicare benefits and services. Many of us know the demographics of this population, but 70% have at least three, if not four chronic conditions that they're dealing with. Almost half have at least one mental health condition that exasperates the chronic conditions that they're experiencing. The food insecurity rate is roughly four times higher than for other populations. And then there's so many sort of dynamics to this population. But another one that's of interest and importance is that over 50% are people of color and cultural diversity. So adding to all of those components, there are other barriers to care. So oftentimes it's urban communities that may be underserved. From the clinical care access or rural areas that aren't served well and where we need to do better in finding penetrating opportunities to provide care. There are, as I said, cultural and generational diversity components that come into play in terms of how people have engaged with the healthcare system over their lives. All these things make it extremely challenging for members to navigate what's already a very complex, fragmented healthcare system. I often joke that even as a healthcare CEO, it's hard for me to navigate the system at times. Unfortunately, in a complex fragmented system with all of those complexities and dynamics that pertain to a dual, it means that it makes it extra challenging for them. So we have complex enrollment and eligibility processes that combined with high medical and social needs really create one of the most challenging environments in healthcare for duals. But frankly, it's also where I think we can make the biggest difference. I'm always encouraged and sort of motivated to lean into where we have populations or communities that have particular opportunity in this. And I think the tools certainly represent that. So financially, just another sort of foundational component. Duels is a growing population, but they also make up a significant portion of the overall spend in Medicare and Medicaid. Roughly less than 20% of the Medicare population are dual eligible, but they drive over 35% of the cost. That's about $500 billion in state and federal spending. So not only do we have an opportunity to do good by helping members communities navigate this health care system for better health care outcomes, it also addresses a significant driver over health care costs. So what's WellCare focused on specifically around this? Obviously all the talk is integration and alignment. So we're very much focused on how do we connect the dots for our members in our communities to make it easier to navigate and optimize their access to benefits and to services. Simple things like one ID card so that we don't have to show up with 2, 3, 4 different cards for things. It's one customer service representative to be able to speak, to take that to the provider side. A single point of contact for our providers to ensure that their Medicaid and Medicare benefits and services are appropriately communicated so that the provider can be a best asset to the member as well. But it also comes down to one of Centene's major strengths. Centene, for the record, here, is the number one provider of Medicaid coverage in the country. That includes being the number one provider of long term supports and services as well as age blind and disabled coverage in the country. We collectively within Centene, serve over a million Duals today, what that means is Centene and ballcare are deeply embedded in the communities that we serve. We're deeply embedded in state as well as federal relationships that pertain to how programs and policies are designed to best serve. Dual eligible members were embedded in provider relationships, I.e. fQHCs and other sort of community health organizations, as well as other community organizations that are there to serve and engage dual members in our community. So we really try to lean in on the breadth and depth of our relationships at the community, at the state and at the federal level, combined with that integrated approach from a member experience, consumerism perspective that needs to happen. Because of the complexities of the population and the complexities of the healthcare system, we feel like it's our responsibility to lean in and figure out ways to make it easier to do business work.
- [12:41]
B
Absolutely. And navigating these system complexities across so many different geographies and systems, like you mentioned, Centene operates in so many different states. What you're really touching on, Michael, is drilling down into it is, is improving that member experience across the spectrum. And you know, that's something that we hear about consistently right now from leaders like yourself here on the podcast. And certainly what we've heard from the Centene leaders we've spoken to over these last few years is that the major focus is improving that member experience. So how do you ensure that these investments you're making, this focus you are having on this experience for those that you serve, how does that also transl into better health outcomes at the end of the day?
- [13:26]
C
Yeah, we have our metrics that we hold ourselves accountable to and that certainly states and CMS and federal government holds us accountable to. So things like voluntary disenrollment rates, member satisfaction scores, provider satisfaction scores. So there's a litany of sort of metrics that we evaluate there and work toward constant improvement. But as I think about this question about member experience and how to make it better, I think of some real hardcore blocking and tackling. Think of a member selecting a health plan. Maybe they're with a company for Medicaid and now they're joining a dual eligible SNP plan for their Medicare benefits. Or they're just new to managed care to begin with. What is that onboarding experience? So to me, I'm looking for our teams in our capabilities to get ahead of that. How do we engage with the member where appropriate and where permitted, even pre effective dates, so that we can hit the ground running, we can know each other, we can develop an understanding of who our members are. What their most critical needs are right from day one and begin to build that trusting, reliable relationship right up front. So we're looking for solutions to be early starters, proactive engagement, trusting relationship up front. Obviously that requires us to be there for our folks to be trained, for our systems to work, for our provider directors to be correct. So it's all we need to be able to be a reliable source of appropriate access and then couple that with making sure that our provider partnerships are strong so that our providers can be our eyes and ears on the ground, especially as members come to receive care, so that we create a bit of a triangle effect between us as a payer, our providers and our members and really create an optimal solution there. But it really starts with us leaning in and saying we have a responsibility from the get go to know to connect with and to help the member navigate into managed care as well as through then the initial process so that there's familiarity and trust that's built.
- [15:45]
B
Understood. Your passion for serving these members really comes through the conversation. Michael, one thing I wanted to also ask you about is again, when we've spoken to other leaders at Centene, we've heard so many about so many new innovations in terms of the clinical model across the different populations that the company serves and I wonder if you could delve into that for us a bit in terms of your perspective at WellCare and how you see the integration of behavioral, physical and social health evolving within your part of the company.
- [16:19]
C
The beauty of dual eligible I find, you know, we can, we have a whole list of things that can become challenging from a regulatory requirement perspective at times. But the beauty of the dual eligible program, it introduces requirements such as an ict, an integrated care team, and the intent and objective here is to have multidisciplinary team working together with a single point of contact for that member. So this is where I love and I welcome the public private partnership coming together because that's really what we should be doing. So for Wellcare, for Centene, as our colleagues do across the industry, we lean in on building the most effective interdisciplinary care teams possible that bring together the medical or the physical, behavioral and social components of things and try to bring solutions to them that are hands on. So just, you know, here's your single point of contact care manager or LTSS service coordinator that helps you navigate the system, but it's then also complementing that with the right data at the right time, perhaps an app to those that want to use it, access to data and access to digital strategies appropriately to complement sort of the blocking and tackling, just rolling up our sleeves and being there in person or being there live for a member as well. So the innovation here really is the right interdisciplinary focus where the member is. We can't wait for the member to come meet us at the doctor's office or wait for them to call us. We have to go to where the members are and that's in the community. It's important for us to be in the community and then to the extent that people want to use it, bring digital data solutions that help them navigate the system in a more efficient and effective manner.
- [18:26]
B
Wonderful. Well, Michael, before we go today, what else are we missing? What other final thoughts or final bits of advice do you want to share with our listeners? We've got so many others from across the industry listening in within the dual eligible the Medicare and the Medicaid spaces. What else do you want to share with them today?
- [18:44]
C
Listen, I appreciate you Jacob, I appreciate you calling out that the passion is coming through. It's one of these things where we're dealing with, with complex high financial matters in these managed care organization roles. But at the end of the day, what I find uniformly across my colleagues is that most of us love what we do and we have this passion and that aligns to a mission and everybody I know, I think we love that we're able to do something good for the communities that we serve and our neighbors that, you know, what I encourage us all to do is continue to double down on that passion, keep leaning into it and sort of allow our industry to reinvent itself, become more consumer focused, more agile, more digitally and data enabled. The consumer focused thing is interesting. I sometimes quote, it's probably a few years dated now, but there was net promoter score results by industry and it had cable companies as the worst ranking at the time. I have no idea if that's today by the way. So I hope cable company leaders don't reach out to me at the time, some years ago, next to last, guess what? Health insurance. So we need to do better from a consumer risen perspective and need to make sure it's a priority. It's understandable that the time that somebody has to engage with the health insurance is a time of need and a time of stress either for themselves or for a family member or somebody else close to them. So it's a stressful situation and that makes it really hard. But we have to take on the responsibility, put that passion to work that we all have and move the ball down the field in terms of doing better on consumerism and reinventing the business.
- [20:41]
B
Absolutely. It's a great and timely call to action for all those listening in. So Michael, I want to thank you for taking the time to sit down with us and for sharing your insights with us and with our listeners. We really appreciate it.
- [20:55]
C
Thank you very much, Jacob, and to our listeners.
- [20:57]
B
If you'd like to listen to more podcasts from Becker's Healthcare, you can visit.
- [21:01]
A
Beckershospitalreview.com@athenahealth we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com.