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Becker’s Healthcare Podcast
Melanie Fernando on Expanding Women’s Health Access at Aetna Better Health of Illinois
00:19:53
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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
Hi everyone, this is Elizabeth Casalow with the Becker's Payer Issues podcast. I'm so thrilled today to be joined by Melanie Fernando, CEO of Aetna Better Health of Illinois. Melanie, thanks so much for joining us today.
- [00:46]
C
Hi, thank you for having me. Excited to be here, of course.
- [00:50]
B
So before we jump in and chat a bit more about your collaboration with Electra Health, can you tell us a bit more about yourself and and your health care career background and what you currently do in your role now?
- [01:02]
C
Sure. So I have been the CEO of Aetna Better Health of Illinois since October, so nearly stepping into the role and it's truly an honor and privilege to lead our Aetna plan and Medicaid. I've been with Aetna Medicaid since 2020 and prior to that was with another Illinois Medicaid and managed care organization. And really my health career has been focused on Medicaid. So before joining industry I was in government sponsored program consulting, working with both health care providers and payers really to optimize programs for the Medicaid population, whether that be health care transformation, cost optimization, optimizing revenue, process improvement, etc. And really I wanted to focus my career on government sponsored programs and particularly Medicaid because growing up I was a first generation daughter of immigrant parents and all of our family, except for my immediate are still in a developing nation, so experience a lot of just material challenges with access to care, subsequent healthcare issues because of that, and it really took a toll on just the overall family and their ability to live healthy and fulfilling lives. So seeing that growing up, but then also seeing that happening in our own backyard in the most developed nation in the world, it was shocking. So that really was a call to action to me. And also, you know, my father and my brother all work in the healthcare industry as well. So I think we all just felt called to work in an industry that could make a difference for those who need it most.
- [02:41]
B
Thank you for giving us some background there. So just for our listeners today, we're going to be chatting a little bit more about your organization's work with Electra Health, which is a virtual menopause and midlife care provider. So, Melanie, can you walk us through how this collaboration came, came to be, who initiated it and what stakeholder needs it's meant to address?
- [03:02]
C
Sure. So as a part of our normal course of business process, we're always looking at analyzing our data and trying to understand our members and our populations better. So we were taking a look at what areas or demographics in our membership are largely unaddressed. Where are we seeing healthcare needs popping up that don't have a solution? And so through that data analysis, we did identify that particularly in women's health, there was an opportunity to build that more robust programming. And that's where a focus on the paramenopausal, but then menopausal kind of age range of women came up as not having a very robust programmatic olution. And about 51% of the Illinois population is women and everyone at every stage of life. And we found that only about 8,8% of women in the menopausal age range seek any sort of treatment or seek to understand their symptoms, which is just a very low percentage given that every woman, you know, eventually reaches that age range. And menopause and perimenopausal symptoms aren't widely talked about just in the healthcare education space either. So it's kind of like a silent suffering and no one talks about it. Also was a part of the conversation we had with our, our doctors was what opportunities can we have to just create public awareness about a condition again that every woman faces, but and oftentimes with very little support. So that's when we started looking out into the landscape to see what types of solutions were available. We found Elektra talked to Janine and there was a fantastic solution that was available that kind of checked all the boxes of what we were looking for, something that offered clinician support. So, so, you know, evidence based medicine. We could actually have electronic office visits so accessible, there are multiple languages offered and there's a lot of high touch support. So coaching that was available as well as education, which again, I think is important because just from our surveys with members, there's definitely an opportunity, especially in the Medicaid population, for understanding the symptoms and what they mean about women's bodies.
- [05:23]
B
Yeah. And I want to ask about some of those gaps with women's health you see in the Medicaid population in a minute. But since talking to Electra CEO Janine, who you mentioned earlier, what was the timeline for rolling out this initiative.
- [05:35]
C
Sure. So typically what we do is a one month or so assessment process to just really understand the vendors. That's kind of like a meet and greet, getting to know the solution. And then the contracting process usually takes anywhere from three to four months because we really want to do our due diligence on identifying the right control population, creating a program that's meaningful in terms of guaranteeing outcomes and ensuring the proper coverage of services for our members and ease of utilization. So that part is probably the most time intensive. And then we actually get into implementation which might be anywhere from, you know, 60 to 90 days depending on how much technology has to be set up, data sharing and then ultimately setting up outreach modalities as well. So all in all, I would say around a year to to go through that end to end process and then we launch the program.
- [06:31]
B
So what early usage data and trends have you been seeing with member engagement in terms of adding these resources?
- [06:38]
C
So far leading indicators have been just click throughs into the ads. So we do a broader marketing campaign. And so it's still a little early because we just launched about a month or two ago. But we are looking at digital engagement. So we are starting to see a ramp up in the number of users who are opening up on the text messages that are going out, the emails that are going out, etc. And my hope is we typically like to see above a 30% engagement rate in a Medicaid population. Medicaid is historically and currently the hardest population to reach because of evolving contact information. And some people are transient and they lose phones, things like that. Their addresses change because they're changing to live with family members. So 30% floor I would say, but if we exceed that then it's a home run.
- [07:39]
B
So how do you plan to address those technological and logistical barriers? Also just thinking about the age range of people who may be using these services and what are some long term indicators you're going to look to as this program progresses.
- [07:53]
C
So we always take an omnichannel approach to any kind of communication modality of a new solution. So to your point about the age range, anywhere from 40 to 64 is typically that perimenopausal or menopausal age group. So we expect some technological adoption. And so email tends to be the highest rate modality followed closely by text message. And so we're constantly using skip tracing vendors, data scrub and data integrity vendors to try to get the latest contact information. We're also just building in checkpoints in every Channel in which a member can interact with us. So it could include whenever a member calls in, we ask them for updated contact information. Whenever they log into the member portal, there's a prompt that asks them for updated information, so on and so forth. So always trying to just have a pulse on that directly with our members, but then also again, trying to do different outreaches is key. So in addition to digital, we do have a lot of community events and some that are more geared towards women. We have things like baby showers where whole families come and typically again, it's large groups of women. So we add our women's health programs to those types of events as well. So then we get that in person component in the community. We have community based partners where we can drop off flyers, QR codes, things like that. And then also we have our care management staff. So our care managers are actually staff that work closely with our higher acuity membership. And so they have a higher touch program and are able to actually interface with members on a more frequent basis. So they too can share information more regularly because they're in more regular contact with our members and they're able to tell them about new programs. Because that's another thing. There are different programs for different types of people. We don't want to overwhelm our members. We want to make sure that they get the right fit for their condition in life. And so that's why as a part of our communication strategy, we're also just always looking at better understanding how we can make those communications more tailored to the individual. And I think that's just a movement overall. Right, in terms of communications and all industries is how do we use our data, how do we even look at AI to tailor that messaging to make sure we're fulfilling member interests and member needs.
- [10:27]
B
How do you plan to translate those findings with the marketing efforts, the early marketing efforts you have going, and also eventually your care insights into broader quality improvement or care coordination programs that y' all host.
- [10:41]
C
So we are able to take care insights, meaning we can from the coaching sessions that Elektra has take and process qualitative and quantitative information to be able to then create a more or less a profile for the member. So we already have a profile based on just their healthcare setting utilization data. And so then we can build upon it whether they cite that maybe they have a health related social need, maybe they have symptoms outside of the realm of menopause that need to be unaddressed that haven't been historically, maybe they have an ask for a multilingual Care manager or they want to engage in care management and don't know how. So it depends on the type of feedback. But really this is the benefit of having different types of partners that are connecting with our different member demographics is they can take different approaches and their own unique engagement strategies to obtain information that can just again better help us tailor our programming for membership. So when it comes to, for instance, trying to close hedis care gaps, which ultimately translate into improved coordination, quality scores and health plan ratings, again, another a key barrier to being able to do that is effectively communicating with our members. Help them appreciate the importance of, you know, going to get certain screenings or going to certain healthcare visits. So when we have partners who are able to build trust through care navigation through coaching, it just improves the overall member experience and engagement in all of our programs.
- [12:21]
B
And how are you expecting to see ROI on this initiative?
- [12:25]
C
Some of through which I already mentioned, just the improved member engagement. Improved member engagement leads to health plan member retention. It leads to again higher engagement in all required activities, whether that be contractual with the state or quality improvement initiatives. It improves likelihood of our members going to PCP visits. There's a very clear link between our members going to their PCP and regularly scheduled health appointments and their ultimate health outcomes. Just regular engagement in programming, whether it be virtual visits, virtual coaching, or even digesting and reading through and engaging in kind of gamified health education, is all linked back to better engagement in the healthcare system and better understanding of how to manage health. And so we see and track ROI on just for the members that are actually using the platform and you know, engaging with Electra. How do we see their usage of the healthcare system change? Do we find that previously they were not seeking care at all or only seeking care once a year in the emergency room for non acute conditions? And now they're actually feeling empowered through Electra and through being able to trust them clinician to start to see others and go to their PCP visit, for instance. So we do have some criteria, you know, in our contracts that speak to what we would expect to see for members who engage in the platform.
- [14:00]
B
Absolutely, that makes a lot of sense. So what other opportunities are you seeing in women's health for Medicaid right now, but also other life stage conditions and where else are you looking to next?
- [14:13]
C
That is a great question. The sky's the limit in terms of opportunity. I think one thing that we're continuing to dive in and focus on is not to reiterate or re emphasize the same thing over and over again, but Just that unable to reach population. That has always been kind of the Achilles heel of Medicaid payer organizations and that they tend to have the lowest performing health outcomes, but because of life condition and circumstances, they're the harder or hardest to reach and hardest to engage. So that continues to be a focus where they might only be receiving care in inpatient or emergency room and have never seen a primary care physician or a specialist. So so we're continuing to explore and test and experiment different again modalities of how to reach and engage this type of person. Additionally, in terms of women's health, Chicago is one of the most disproportionately impacted areas in terms of maternal, child and infant morbidity and mortality. And so women's health in terms of the maternal population continues to be a focus. The tanf, or in Illinois it's called NDCA population, which is moms and babies, tends to make up a significant portion of Medicaid in any state. And so it's a continued focus in an area where again we're continuing to try to learn and test different types of solutions. And Illinois has been extremely progressive in expanding access to care for moms. So they've recently covered doulas under Medicaid, lactation consultants, midwives, which is fantastic and we're really excited about that. So we've been looking at solutions that can you continue to expand those types of non traditional services and really see if that helps build trust and engagement. Outside of that, we're just continuing to look at where are there again gaps in health care engagement and or outcomes performance. So if we're seeing that, you know, a certain age group, for instance, children ages 18 to 30 months aren't going to their, well child visits and we're seeing that again more care is being sought in acute settings. That's an area where we're looking to fill the gap and create a program. So I'd say again it's really based on what we're seeing in the current state and our populations are continuing to change. Right. We, we just went through the post public health emergency redetermination where a lot of people lost coverage and we're seeing the membership and the healthcare trends shift a little. And I anticipate that's going to continue as we see some of the other changes that have come through federal policy as well. So just keeping a pulse on that. But really our intent and objective is to have true population health programming for every age and every stage. I actually one of my friends from a health care provider said from twinkle to wrinkle, which I absolutely loved. I hadn't heard that terminology before, but truly, every age in life, every acuity stage across the continuum, whether you're walking well or whether you have a chronic condition, we're looking to have a tailored solution for every kind of subgroup that we can identify. So that's the aim, that's what we continue to focus on. And of course, all tied to value and tied to improving health outcomes.
- [17:55]
B
I've also never heard that terminology either, but that's a really interesting way to put it. I would love to hear if you have any final thoughts or advice for other industry leaders in Medicaid or even beyond as they navigate these types of solutions.
- [18:11]
C
Yeah, yeah, definitely. I mean, I would say, and I think many of us or most of us know this, there really is no one size fits all. Medicaid is such a unique population and there are so many exacerbated social needs layered throughout that many approaches that work for other lines of business and insurance don't work for the Medicaid population. And so we all just need to be cognizant of that and continue to tailor our solutions to include cultural competence, building trust, meeting members where they are in the modalities that they prefer, and not assuming that we know them, but truly having responsive bidirectional feedback channels that allow us to understand the current state of our members and how they want to engage, and then offering nimble platforms that are self service but also high touch where needed. So again, it's really all, all centered on simplifying the member experience, enabling our members to feel empowered and taking control of their health care. And that really just leads to success all around. So that would be my advice for industry leaders is even if something has existed for 30 years, if it hasn't worked the way you wanted it to, sometimes you just have to dismantle it and rebuild it.
- [19:30]
B
Well, thank you so much Melanie for joining us today. This was such a great conversation.
- [19:34]
C
Thank you for having me. It was fun to participate and I hope everyone derives some value from from a part of it.
- [19:42]
B
Oh absolutely. And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com thank you.