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Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast.
Thrilled today to be joined by
CleverCare's interim CEO, Karen Walker Johnson. Karen, thanks
so much for taking the time to be
with us on the podcast today.
Hi. Thank you. Thanks so much for having
me. It's a pleasure.
So, Karen, there's a lot we wanna talk
with you about and a lot we wanna
hear about, in terms of CleverCare, but can
you tell us a little bit more about
yourself and what your career background in health
care entails?
Happy to do so. I started my career,
as a pediatric nurse, and,
subsequent to that, decided to go to law
school. But I always had,
a very keen interest in health care and
had spent some time doing,
a number of of of varied things, primarily
in what I would say spaces with vulnerable
populations. I worked in peds.
I did some work in a veteran's hospital.
And and so what was really important to
me was to be able to do something
in health care where I felt that I
could have a positive impact
on
groups that historically
may not have had as as great of
access.
Growing up in, I grew up right outside
of Detroit, Michigan,
and had had the opportunity to, be a
public health nurse as well.
And so all of that kinda just kept
me in that health care that health care
space.
Once I got myself really involved in health
care,
I went to work for,
some hospital systems, and so I I got
to learn what it meant to be on
the provider side of things,
and and seeing people at their most vulnerable
when they were hospitalized, and and caring for
myself, feeling that I needed to care for
those people who cared for the patients that
we served.
And somehow, I kinda fell into managed care.
And, when I reflect back now, I think
it was because I had this kinda unique
background, you know, that having both the clinical
side as well as, you know, kinda the
the training from law school. And so I
found myself in a risk management role over
at a a managed care organization more years
than I wanna admit to.
And that's when I really got the bug
about,
insurance and and managed care. And so I
spent the next
15, 20 years, if you will,
in various roles in managed care,
in in various lines of business as well.
So,
I had the opportunity to work in the
commercial space,
in the
Medicaid space, and then ultimately,
over in the Medicare space. And so
I have spent my time, you know, primarily
on the operation side,
but I did do a few stints when
I was with a couple of payers
learning about sales and marketing,
underwriting,
etcetera. So, really, I would say that I
probably have
a pretty well rounded
view and set of experiences in the managed
care space.
And then the final thing I would say
that I think kinda ties into my interest
in how probably I ultimately ended here,
in this interim role at CleverCare
is I also worked in the post acute
care space. And in that space, I had
the opportunity to work with hospice patients and,
palliative care programs
and long term care patients.
And so, you know, again, coming back
to my interest and my desire
to work with
vulnerable populations and, you know, when you look
at people who are either in
care or in long term care, they are
definitely at their most vulnerable.
And so that's that has, you know, kinda
kept my north star, if you will, around
wanting to do things that could impact populations
who are most vulnerable,
those who don't necessarily have the same type
of access as others.
And, and then I found my way into
this really awesome,
health plan called CleverCare.
Fantastic. So clearly a very diverse career background
that, like you said, has brought you to
this point as as interim CEO of CleverCare,
Karen. For those who might not be familiar
with the company, can you give us a
rundown of of what CleverCare is and what
it offers? How long have you been around
for? What kind of markets do you serve,
and how many members,
are you are you now serving?
Yes. I'm I'm happy to do that. So
we were founded in,
2,000 and 18, actually,
by a group of founders who,
are Asian,
ethnicity wise. And what was really behind the
founding of the company
was, in their minds, a way to honor
family and to honor culture.
They knew from their own personal experiences
with their loved ones
that,
they had had that firsthand experience of watching
them struggle, if you will,
because of their limited English proficiency.
What you find in the Asian American Pacific
Islander communities are that about 30%
Pacific Islander
communities are that about 30%
of,
individuals,
you know, English is really much a struggle
for them. And so here,
these founders had
loved ones who were aging into Medicare
and were facing,
you know, some of the struggles that come
along with not being able to manage from
a language perspective.
But they also knew that
it also would hinder, if you will, their
access and and access to the quality of
health care that they would get. And from
there, Clever Care was born.
We are, here in Southern California.
We serve,
5 counties, one of which is the largest
county in in California, Los Angeles County.
But
everything about CleverCare
has been
developed, and what we do each and every
day is really to serve a pretty unique
population. We currently have about,
28,000 lives.
Even though we were founded in 2018,
we didn't actually go into our first,
annual election period until
2020 right at the height of the pandemic
of of course.
And so we got a a slow start,
but since that time, we have had pretty
rapid growth.
And I think a lot of that is
due to the fact that we serve this
niche market, if you will. What I love
to talk about is the fact that when
you look at our our our staff, the
team that helps
for us to be able to take care
of the people that we serve,
70%
of our staff
reflect the populations that we serve.
And so,
that in itself is pretty unique.
The what we do and how we provide
our services through our Medicare Advantage Plan is
a little different than most of the larger
plans.
We have really built a culturally customized
patient center approach.
The providers in our network are reflective of
the members that we serve.
We have built
our tech stack in a way that we
are able to service our members in language.
When we think about, my member services team,
we are able to service members in 6
languages.
All of our staff are bilingual. In fact,
many of them are trilingual,
and so when you think about some of
those large groups, like, whether it be Korean
or Chinese or Vietnamese,
our materials go out to them in language.
When they call us and they have a
problem, we answer them in language.
The
doctors and and facilities in our networks are
in language. And then the last piece I
would share with you that I think is
pretty unique about CleverCare is that
we are very much engaged in the communities
that we serve, and so we have community.
We have health centers and, community health centers
in the communities that we serve, where our
members can walk in, and they can do
things like take Tai
Chi, but they're also open to the community,
and so it's a way for the community
to come in and learn more about us,
and it it really resonates with the people
that we serve.
And then finally, when you look at our
benefits, one of the things we've been able
to do is we offer a lot of
Eastern medicine types
of services. So, we've got one of the
largest acupuncturist
networks, if you will.
We have,
herbal supplements that are available that people,
and this is their preference in terms of
what they like to, to do when they
have a health challenge, and so we make
all that easily available to them. And, for
us, that's what makes us unique. It's it's
what
I think drives
each of of our employees to come to
wanna work with CleverCare because they are serving
their families and their friends and people who
look like them.
Yeah. Absolutely. Well, that's amazing to to hear
about. So clearly,
a relatively new company, but one that is
built around serving the unique needs of this
population in in Southern California.
Karen, as I understand it in that vein,
you're you're intensifying the company's efforts to address
health disparities
among this population that you serve. Why is
that so important to you? Both both from
a personal perspective, but also from a business
perspective now as a CEO.
Well, from a a personal perspective,
you know, I as I shared with you
earlier, you know, having grown up in,
in in the Detroit Greater Detroit area and
having worked as a pediatric nurse, as a
public health nurse,
I saw firsthand health disparities. I'm an African
American woman,
you know, who has grown up in in
a community where,
there has been a lack of
access, where
disproportionately
there are chronic illnesses that impact,
people who look like me. And and and
so as a result of that, it has
been something that has been really important to
me throughout my career
in terms of how to help make access,
available to to,
disadvantaged individuals. It's about
how I have been able to, really work
proactively
to help build networks that are inclusive
and reflective
of the the the patients that we serve.
And so it's really important,
because it's been proven
that cultural competency
really does help,
bridge gaps, help address health disparities,
and ultimately get you better outcomes.
So when you can have the provider look
like and have shared experiences of patients that
they're serving,
it works out better. And so for me,
that has resonated with me, and having
been here in Southern California now,
for greater than 10 years,
when I came here, I was I was
exposed to, if you will, this this whole
new population,
in terms of, you know, really getting myself
very much ingrained in the Asian communities. I
was I was I was leading another health
plan where we had, you know, similar demographics.
And so it gave me a firsthand look
and an appreciation for the similarities
that were being faced
by those,
populations,
as as compared to
the personal experience I had had myself.
So that's really why this is something that
is just so
personal to me and resonates with me. And
then I had the fortune,
about a year ago to be asked to
join the Clever Care board.
And so, I currently serve as as the
exec chair for the board, and and then
during that time, it gave me an opportunity
to really see how
by way by virtue of the way that
our benefits were structured, by those supplemental things
that I mentioned earlier that we were offering,
by the fact that the staff,
were reflective of the people we were serving,
and how
how that really helped to advance,
some of the things that we were trying
to accomplish.
I was honored to have the opportunity to
then step into the interim CEO role. And
so,
it has now allowed me to get even
closer if you will to
our chief medical officer, and officer
and everyone else on our team who works
to help us identify how best we can
close some of those health equity gaps. And
so,
that's
why it's personal. From a business perspective,
why is that important?
For several reasons. First of all,
you know, it may sound all altruistic,
but, you know, at the end of the
day,
we do this. The reason we have CleverCare
is
to take care of people. It is it
is is it at the core of what
we do?
And so the ability for us to
be able to look and say that in
the populations we serve, there is a greater
propensity of, for example,
pulmonary disease.
The fact that we see in our populations,
a greater incidence of tuberculosis,
etcetera.
We can address that because we have providers
who look like and speak the language of
our members. And so those
those patients, those members
are more
willing
to come in to see a provider.
They're much more apt to be,
adherent to whatever that provider,
prescribes for them. They are keeping their appointments,
and all of those things are helping us
to close that gap around health equity. We
are making things accessible,
to them. We are,
and that's from a business perspective. That's good
business for us. That's good that's good business
for communities.
That's good business for the overall,
health care space,
because if we can help around,
reducing the the cost curve, if you will,
if we are,
providing
good service,
if we are able to show that our
clinical outcomes,
and our patients do better, if you will.
Then from a business perspective, that means that
providers want to participate and be a part
of my network. It means that
the government, who is my my only contract.
Right? That means then that they are much
more supportive of my health plan,
in terms of my investors.
That helps them to get a better return.
So all of those are, to me, the
best of both worlds. We are
serving a community need. We are helping to
improve,
the health outcomes for people that we're serving,
but we are also,
creating
a thriving business.
Absolutely. Thank you so much, Karen. And I
appreciate the the the nuance and the complexity
of your answers. It's really great insights for
our listeners right now. I wanna continue to
follow-up with you in terms of,
the business perspective that you were just sharing
and some of your experiences,
throughout,
the last few decades within managed care.
As you know, the Medicare Advantage Industry is
facing a lot of challenges right now, especially
as we head into the annual enrollment period
this fall.
So I wanted to ask you a little
bit about how CleverCare is is navigating these
these industry headwinds,
especially as we've seen other, large national carriers,
really make some some moves recently in the
last few weeks and even today in terms
of how they'll be pricing and and navigating
their business,
over the next months and and and years
to come?
Yes.
Well, there is no secret that,
CMS likes to keep us on our toes.
That's for sure.
And so a couple of the things that
that that that we've been doing,
you know, as as you heard earlier, you
know, we have a smaller membership as compared
to the larger carriers,
and we have a a more nuanced
membership as well.
And so when you think about the fact
that we are serving primarily,
you know, Asian Americans,
Island Pacificers,
In terms of how health is approached is
much more from a preventive perspective.
And so our membership,
they actually prefer,
if possible, to not end up in the
hospital, for example.
And so when you think about, you know,
what you hear a lot in in in
out in the in in the nationals
are around
increased utilization,
etcetera.
That's not necessarily our biggest challenge,
because again, that isn't
historically where our populations end up.
We are instead
much more focused on quality, for example. You
know, and and in our world, it's all
about the stars. Right? And so,
we are focused on what can we do
to ensure that we are driving,
the best outcomes in our HEDIS measures, for
example.
How do we
continue to ensure that
on that part d, on on on the
medication adherence, for example, that our that our
that our members are picking up their meds.
So we are very, very focused
on quality.
We are,
making sure that our benefit design
is marketable, but yet we don't wanna be
out front of everyone else. And, again, from
a benefits perspective for us, it's more about
Eastern medicine,
etcetera.
We are leveraging technology, you know, so we
know some of the things that are headwinds.
And so we're leveraging technology so that we
can have smarter solutions, so that we can
become,
more streamlined from an administrative perspective.
We're also thinking more strategically
about our investments.
So, you know, whereas I would tell you,
you know, my team probably would like
to, you know, to implement
6 or 7 new things next year, but
we're saying, look.
We are going to be extremely
strategic about what investments we need to make,
what investments are gonna really drive
quality,
what investments are gonna drive us to be
much more efficient from an administrative perspective.
And then the the other thing I would
say that's really important is just around
how you engage,
your your members and your and your employees.
You know, with the headwinds coming,
it's about keeping people focused. It's about keeping
your membership
happy, if you will,
and satisfied.
And so the things that we do around
that is
for members specifically,
we we have an advisory board of members.
And so, you know, we're using the insights
and the intel and the inputs
from our membership to help us to ensure
that we are staying relevant, to make sure
that
we can, if you will, and sometimes
kinda test the waters with them about changes
we may be considering making
because of some of the headwinds are coming,
but that are coming towards us, but wanting
to make sure that we're not going to,
you know,
put off, if you
will, our our members or potential new
members. And then finally, again, around the employee
engagement piece,
I think that your most valuable asset is
your human capital.
And so with that in mind, you know,
we wanna keep employees engaged. We don't we
don't we wanna reduce turnover.
We don't want people running scared because they're
hearing everything that's going on in the news
about Medicare Advantage.
Right? And so those those are the things
that we're doing.
It's really,
great insights, but it's really interesting to hear
that you're not facing some of these same,
challenges around rising inpatient costs as some of
the other carriers simply because of the unique
population that you serve and and and their
preferences. So Yeah. That's really interesting to hear
about.
What else are we missing? Karen, any any
final thoughts that you wanna share while you
have the ears of of a lot of
health plan leaders from from all over the
country?
You know, I guess the a couple things
I would say in that regards is that
I'm gonna go back to
your best asset to me, and that is
your human capital, your people. And so, you
know, I I would
just advise
that that you express gratitude and you recognize
them and you acknowledge them because
they are working in difficult times,
and, often, they are going over and above.
And
so
it's
so
important to often, they are going over and
above. And so it's so important to say
thank you. I will tell you I had
when I was working on the hospital side,
I had a great leader, and,
I was lamenting one day about the fact
that I was doing hospital rounds, and and
I kinda felt inadequate because I would go
on the critical care unit and
see the nurses, and they were working so
hard. And and I was like, I don't
do that anymore. You know, I I I
just felt like, gosh, am I really doing
much? And you know what he said to
me? He said, Karen, if you aren't taking
care of a patient, then you need to
be taking care of someone who is. And
I will tell you that that has stuck
with me
for years years, and I try to use
that
analogy no matter where I'm working about taking
care of
your teams.
So that's one thing is if you do
that, they will follow you. You know, give
them a vision,
say thank you, acknowledge them, and they they
will follow you, and they will bend over
backwards to make sure that you can execute
on your business.
Another I would I would share is, you
know, is is just how you
manage your your your board dynamics.
That's so important. I feel very fortunate. We
have an extremely supportive board
very much who believe in the work that
we're doing, and that is so vitally important,
and my team knows that as well.
So that's another thing just to to make
sure that you have that healthy,
that board interaction, and that you that you
leverage your board and that you partner with
them.
And then finally, I I think I would
say is that, you know,
it's turbulent for our business right now,
but but I've seen, I've been around long
enough to know that that's cyclical.
You know? So right now, it's a bit
more challenging,
but we will come out,
you know, to the other side. And so
it's about it's about
tenacity.
It's about, you know, not getting too discouraged,
and and just kinda
staying focused and and and and doing the
right thing.
Wonderful. Really great advice and perspective.
So, Karen, thank you so much for taking
the time to sit down with us and
for sharing your insights with our listeners. We
truly appreciate it.
Thank you. It's been a pleasure. If you'd
like to listen to more podcasts from Becker's
Healthcare, you can visit beckershospitalreview.com.