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Welcome everyone to the Becker's Healthcare podcast series.
I'm Mariah Mohammed, writer and moderator of Becker's
Healthcare, and I'm thrilled to have with me
today Jo Glinka, director of PA Health Choices
at Highmark Whole Care. Jo, welcome to the
podcast. We're very excited to have you join
us today. To get us started, would you
mind please introducing yourself and telling us a
bit about your background?
Sure. It's great to be here, Mariah. Appreciate
the opportunity.
I again, director of health choices at Highmark
WholeCare. Highmark WholeCare is part of the Highmark
family of companies
and the largest, Medicaid managed care organization within
Highmark's Medicaid segment.
We have the privilege and responsibility of serving
approximately
340,000
Pennsylvanians in need at the current time.
The HealthChoices program in Pennsylvania is really the
Commonwealth's,
Medicaid Managed Care Program.
And there are 3 domains within that program
because Pennsylvania is not an integrated state when
it comes to Medicaid service delivery.
The Health Choices program exists for, 1, physical
health, which is where
our purview is, where where we operate within.
But there's also a behavioral health health choices
and a health choices program for to manage
long term services and supports delivery.
I'm Pittsburgh born and bred and graduated at
Carnegie Mellon University
and, started my career,
quite a few years ago back at a
company called US HealthCare.
And, over my 35 years in managed care,
I've had the privilege of serving in a
number of different capacities, which would encompass,
both the commercial and the government plan space.
And then as far as actual,
career steps,
I've been in marketing
and sales. I've served in business development efforts,
enrollment,
the government affairs and government relations as well,
and now plan administration,
for Highmark Whole Care.
Wonderful. Wonderful. Thank you so much for giving
us that background on Highmark and your professional
experience.
And with the years of experience you have
in this field, I'm sure you've seen a
lot of things come and go, problems and
solutions.
For you, what are some of the big
trends and headwinds you're following right now in
the news?
Well,
there's a lot of thing and it's not
necessarily in the news. It's things that we're
encountering every day.
And and we've just,
at least in Pennsylvania,
we have find come through the public health
emergency unwinding process. Some states are still going
through it.
But during the
epidemic, Medicaid programs throughout the country
maintained continuous enrollment
in order to bolster and keep the safety
net available for those who are
many millions of people who were losing their
jobs and so forth.
And, in Pennsylvania, we saw an escalation in
the role of the Medicaid enrollment
to the tune of about 500000 or 600000
people,
above and beyond what it typically
is.
We have, you know, beginning in April of
last year,
the unwinding of that continuous enrollment was commenced.
And, now what we're seeing,
after losing
quite a few people off our roles, we're
not the only managed care organizations that has
experienced that. But the overall acuity,
the,
of our population that remains
on the enrollment has increased dramatically,
costing us more on a per member per
month basis. And that's simply because
when you look at how Pennsylvania Medicaid enrollment
grew,
60 to 65%
of that growth was within the Medicaid expansion
population
that that would, you know, that Pennsylvania embarked
upon per the Affordable Care
Act. So, you know, that population itself,
is a population of 19 to 64s,
typically single adults.
But when it comes to
risk, they are of a lower risk profile
than what you'll find in your more traditional
categories of aid. It would include TANF and
ABD and SSI and so forth.
So you have a basically,
a healthier risk that's diluting,
the more severe risk when you have all
the continuous enrollment going on. And now with
that lower risk, if you will, vacating the
plan through unwinding,
you you you're left with the stairs
who need services, but you don't have the
revenue you had before in order to,
care for those individuals. So the the acuity
has gone up and it's and it's got
our attention as well as other managed care
organizations that we do compete against.
One of the other things we're also looking
at is the escalation continued escalation and the
use of GLP-1s.
These are the weight management medications. Many of
us have seen plenty of advertisements on TV
for medications such as Ozempic, Wegovy,
Victoza,
Saxenda and a number of others.
These drugs are very, very expensive
and they are being prescribed quite a bit.
They're being driven by
consumer requests coming into the office and they're
used in the treatment of diabetes
and and weight management.
To give you an idea of, what we're
experiencing right now on that escalation since January,
although our enrollment has gone down for the
unwinding,
our utilization per for 1,000 members has escalated
36%
since January just with this one class of
medications.
And the overall cost per member per month
basis has escalated some 33%
since January of this year alone.
It really has our concern. It's driving,
our overall cost trend
and it's making things very, very difficult to
manage within the means that we have. You
know, we're funded by taxpayers, and we need
to be great fiscal stewards of the of
the people's money,
but it's it's escalations like this which are
particularly challenging.
One of the other things we're looking at
is the, you know, the elevated attention to
health related social needs. You
know, it seems to be the new nomenclature
in place of social determinants of health.
Imer ColdCare and its roots,
we've been paying attention to social determinants of
health or socioeconomic
impact to health for some 25 years.
And, you know, as analytical tools become more
sophisticated,
you know, we are striving to know everything
we can as far as what the socioeconomic
impact is to our members.
There's been plenty of studies done where,
when it comes to a person's overall health
status, 20% of a person's overall health status
is clinical,
which may be counterintuitive to what most people
would think. You have a component there of
heredity,
but then that remaining space around 60% or
so,
is
that determines a person's health status will be
things like
the level of education they have,
the mode of transportation they have available,
where they live,
the quality of their water, their proximity,
to a provide their provider do they go
see, proximity to a reliable food source if
they're in a food desert
and so forth.
And,
so,
this area continues to get
more and more focus
because of the huge impact it has. And
and now, you know, you've mentioned before, I've
been in the industry for a long time,
you know, we've gone from people calling in
to, to get a new card, to change
their doctor, to ask if the medication's on.
And so and we still get those calls.
But now we're getting calls like, can you
help me get a GED so I can
get a job?
Can you help me find,
resources that I can have broadband access in
my area? Can you help me find a
childcare center so I can go get a
job? Can you provide me transportation to a
food bank? I mean, these are very, very
compelling
things,
that add up to an overall socioeconomic
impact
that can be
significant at the individual level.
And then, the last thing that I wanted
to mention was
the application of artificial intelligence
and decision making. We,
here at the plan, we've incorporated
a number of machine learning disciplines in how
we look at our membership,
you know, so that we can begin to
understand,
you know, what,
what
possibility there is for
one of our members to
present in the emergency room and for what
condition,
if we know what they're gonna present for
and we know what the precursors to that
condition may be,
we wanna be able to work upstream
to meet a person earlier in that journey
so we can bend the cost curve earlier
and achieve a desired health outcome without being
as costly had that individual gotten to point
x.
And so what we're finding is, you know,
through that as the machine continues to design
on itself, you have artificial intelligence. And where
we see AI going is
it will provide
an incredible opportunity
for more precision in imaging
and diagnosing
and mining electronic health records.
And one of the things that we are
also seeing is that the human element is
still going to have to be involved with
that,
because we want to make sure that as
conclusions are reached that those conclusions
can be reached in an equitable manner. And
so that we we wanna make every effort
to reduce health inequities, which are,
considerable in this day and age.
Yeah. Yeah. Absolutely. Thank you so much for
giving us all that insight. You know, the
the weight loss meds are definitely a trending
topic right now. And I know at some
of our conferences later this year, we have
several panels on it. I'm very interested to
see what other execs in your field are,
you know, kinda handling this this wave.
In your opinion, how are you thinking about
growth for the future, whether it's focused on
insurance, you know, the weight loss medications,
workforce, or anything else?
In terms of
we as a matter of fact, I personally
involved within Pennsylvania Pennsylvania has what's known as
a medical assistance advisory committee.
It's, it's a a stakeholder body
to
advise the Department of Human Services on ways
to improve access and quality of care.
And one of the things that the the
managed care subcommittee that I chair is working
on right now
are are we're trying to research
what opportunities there would be to improve,
accessibility to providers,
in in in the primary care space, the
dental space, and behavioral health space. And we're
you know, because there are workforce issues in
all of those areas,
so we're trying to to tackle that at
the state level.
In terms of other growth items on our
enterprise lines, we're always going to be looking
at new markets to be able to take
our mission
and capability into other markets to be a
catalyst
for
improvement in the overall model.
Not that we're the silver bullet, but we
believe that we can bring that to a
market.
So we will be carefully looking at various
opportunities
to do that. And then in terms of
growth, we want to be able to continue
to grow in our relationship
and relating to our members,
relating to the providers that we're partnered with
that actually deliver the care, partnering, you know,
in growing in our relationships with community based
partners that run the food banks and the
workforce development,
entities to help people get jobs and so
forth. So
the growth is, you know, in terms of
that competency and connection
as well as geographic and trying to take,
you know, take our track record abroad.
Yeah. Thank you so much for giving us
that insight on that. And and, Joe, before
I I, let you go and, you know,
have you enjoy the rest of your day,
can you tell me more about a project
or initiative from the the last year that
yielded the best results for you?
Yeah. Thank you for asking that question. During
the public health on, emergent well, during continuous
enrollment,
and then, of course, the following unwinding,
we're, you know, we're looking at a period
of time of some 3 years where people
were
were not
required
to submit information because they were gonna they
once they were eligible for Medicaid, they were
gonna be maintained. And so after a 3
year period of time,
you know, you have individuals who
may not remember that they have to begin,
you know, submitting their information to be redetermined.
You have
individuals who may have came on during the
epidemic and didn't know that you had to
be redetermined,
and then you have individuals who had an
idea that they probably weren't gonna qualify
and no and had no idea to to
turn.
So
through that process, we were trying
to ascertain,
any way that we could
engage at least our membership
to connect with them, to be able to
provide needed assistance to them,
with their eligibility determination
and and shepherd them to other insurance domains
to the within the parameters we have to
work within.
So one of the things that we developed,
very proud to talk about is our title
1 school initiative,
which, Title 1 Schools are those individuals who
really have
a considerable proportion of their students that are
in need. They are low income
and,
what we wanted to do was we wanted
to make ourselves
available
to the parents of such individuals who may
qualify for Medicaid,
so that we could actually help them, with
their digital submissions of their eligibility information in
Pennsylvania. Pennsylvania system is called Compass.
We have dozens
of our employees who are registered as Compass
Community Partners
and they're engaged in helping our members apply,
reapply from an eligibility standpoint
in order to maintain coverage and to maintain
a continuity of care.
So what we're finding now in working with
the literally
dozens
dozens and dozens of school districts that fall
into this category and throughout our service area,
the schools
value what we bring,
to them. Not just in terms of the
Compass navigation, but now we're being able to
we're bringing additional services in, health fairs.
And one of the other things we're being
able to do is bring a mobile farmers
markets into these school districts and various schools
on a repeated basis.
I'm very proud to to share that to
date here in 2024 alone, we have distributed
over 27 tons
of food, fresh produce, meat, poultry, and fish
to families in need. And we're on track
for exceeding the 30 ton
mark, by the end of this year, just
in the Highmark Whole Care, a regional Medicaid
managed care organization.
Why? Because food is medicine.
And, the healthier we can help people,
eat,
we think that's that's a certainly
helpful
in managing overall health conditions. So schools are
inviting us back on a repeated basis. Schools
tend to be the centerpiece of a lot
of, a lot of communities,
and, we just continue to see the growth
and the proliferation of that program. And we're
very excited about what that may morph into
down the road in terms of additional,
resources
and services we can bring to bear in
that type of setting.
Yeah. Wow. That is an amazing accomplishment, and
I just love hearing about organizations
really helping the community they're servicing. So thank
you so much for sharing that that statistic.
And thank you so much for those final
thoughts. This has definitely been informative discussion. So,
again, I wanna thank you so much for
coming on Becker's HealthCare, especially for the first
time. And I look forward to connecting with
you again soon, Joe. Yeah. Thank you very
much for the opportunity, and,
look forward to the next time when and
if that when that comes.