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This is Jacob Emerson with the Becker's Payer
Issues podcast.
Thrilled today to be joined by a special
guest,
Rashil Desai is the President and CEO of
Aetna Better Health of Illinois. Rashil, thank you
so much for taking the time to be
with me on the podcast today.
Thanks, Jacob. Thanks for having me. Yeah. We're
we're glad to have you with us, and
we've got a lot we wanna talk with
you about. But before we do that, can
you tell us a little bit more about
yourself, your background in health care, and what
it is that you're doing today at Aetna?
Yeah. Thanks, Jacob. Thanks for that, Tony. So
I'm Rishal Tsai. I oversee our Medicaid plan
here, in Illinois. So we've got about 380,000
lives across the state.
We have a population of of our TANF
population, which is our moms and babies, our
ABD and IPCP
population, which is our elderly population,
and then our long term services population here
as well, and the Affordable Care Act population
of Illinois. So, yeah, this is your most
vulnerable population that you've got. This is Medicaid.
You've got anywhere from children that are, you
know, being born to all the way to
your really acute and disabled members across the
state.
And, you know, Medicaid, to me, that's just,
been close to heart and close to my
heart for quite some time. You know, my,
my mom way back when was a physical
therapist, and she worked with, you know, a
lot a lot of children that were that
had some disabilities in Medicaid.
But been in the healthcare space now for
over 25 years, been in Medicaid for about
a decade. So been in Aetna for about
4 of those as their COO and now
CEO.
Part of that worked at Centene,
did some work in value based care and
was their COO of their plans as well.
And then hopped over prior to that to
consulting and did a lot of work on
the payer and provider side, really focusing on
value based care, cost of care,
thinking about, you know, the bridge between data
and and quality and,
population health and and bringing that to the
member.
Part of that, was at business school for
a bit at Duke and, was, you know,
did my grad school here at Chicago and
Chicago Med School for a bit. And then
part of that, I was at University of
Miami where I did, my undergrad focus in
neuroscience. So,
been quite a journey through different facets, working
at the provider side before,
you know, and then over the payer side.
But,
you know, all to say, I think that's
a culmination of what Aetna Better Health of
Illinois today is really focusing on in the
market, and how we're thinking about, you know,
health equity, value based care, some of the
member experience.
You know, and and those are the top
three things that I would say we're we're
most focused on in Illinois today that we
wanna bring to our membership and our providers
across the state.
Absolutely. And let's let's talk a little bit
more about that, Rashiel, in terms of some
of the top trends you are currently watching
in the in the Medicaid managed care space.
Obviously, as you know, it's been a pretty
transformative
year for anybody working in in Medicaid around
the country. So talk to us a little
bit about what have you got your eye
on right now, especially as we we look
forward.
Yeah. Absolutely. So, I mean, look, I think
the first thing we're looking at across the
board is trend. Right? Utilization
has been high. We're seeing a lot of
our membership,
you know, going up across the board in
terms of using inpatient services, behavioral health services.
It's one that's got, you know, one that
we're watching rather closely.
Now, part of that is due to delay
of care with COVID and just, you know,
some of that's just due to acuity. Right?
I mean, you got people that didn't go
for their screeners back in COVID that we're
now seeing, you know, cancer diagnosis at a
much higher level.
You know, we're also seeing a lot of
national track on health equity. Right? I mean,
the good news is that Aetna, Better Health
of Illinois, has been doing this work for
many years, but just so we talk about
behavioral health and physical health being so integrated,
you know, our view at Aetna today is
that we think about health related social needs
for housing, workforce, food insecurity,
homelessness prevention, non
violence prevention,
education, all of those things are really merging
together to wrap around a member. And what
we're seeing is the data is showing this
more and more too is
that's what leads to better quality of care
and better outcomes overall. Right? So, you know,
as we look at things the state's launching
here, like the LN 15 waiver, you know,
we're watching this very closely to think about
how providers and community based organizations
are working hand in hand to get to
those better outcomes and offer those resources at
a local level.
You know, health care is local as it
should be, and and the resources that our
members need and have at a local level
is is certainly top of mind for us.
You know, other thing we're we're thinking about
is provider enablement. Right? We wanna make things
easier for our provider and and, you know,
thinking about all the pressure that our providers
have been through from a workforce perspective, as
well as just prior auth and gold carding
and and, you know, how do we make
this easier for our providers? You know, Aetna's
got a gold card program, which basically allows
providers to not submit authorizations today.
But we've also got other things where we're
seeing often AI helping out in the back
end to make that easier for them. You
know, we we've got over half of our
membership in the state of Illinois engaged in
some sort of value based program,
and we're seeing different providers adopt risk. Right?
And there's shared savings that providers are earning
on to to support things like health equity.
So that that continuous feedback loop and how
we're intersecting value based care and creating access
to care and,
tying that to health equity, seems to be
synergizing really well here in Illinois just given
the, you know, ecosystem that we have today.
It's interesting. So you're really focused on inpatient
and behavioral care utilization,
increasing and also really focused on moving that
needle on health equity and and streamlining
administrative processes for providers.
With all that being said, Rashille, what would
you say you're most proud of over the
last,
12 months of your career, not just for
you personally, but for what your teams have
achieved over the last year?
Yeah, you know, look, I think I think
the first thing is your determinations. You know,
it's Illinois here just wrapped up just a
few months ago,
with the redetermination process in Illinois,
where, you know, we've had some really good
outcomes where over 76 to 80% of our
population, you know, has retained their eligibility in
Medicaid. I mean, Illinois is one of the
strongest in the nation and, you know, we're
thankful for the health and family services department
working with us on making sure members have
coverage. So, you know, the most important thing
here is making sure people have access to
care, right?
You know, pushing on that a little bit
further, we we've been able to bring a
lot of different care models to Illinois.
So we work with a group called Maven,
which is one of the world's largest digital
clinics that we have in in, in the
nation today. And you think about Illinois and
the health outcomes, one of the, you know,
we have one of the lowest maternal or
one of the highest maternal morbidity mortality rates
in the state of Illinois today. So part
of that is due to access. Right? Part
of that is due to how members interact.
So we're bringing more digital solutions to our
membership where they can go ahead and connect
to an OBGYN, connect to a lactation consultant,
connect to a doula services
in the moment right then and there when
they need it. Right? And those digital services
connect with the provider that that's their connect
in in the community to get them to
care and perform better. In the school based
side, we are working with a group called
Kooth,
to really create, you know, we we look
at behavioral health and look at some of
the public health issues that are happening there
with high suicide ideation rates, you know, high
behavioral health access issues that we're seeing.
So we're working with our school based partners
to bring in clinics, you know, virtually and
digitally
because there's not enough telehealth providers to, to
be at site, you know, and be at
the, at the schools. So for us, for
the last several months, it's been all about
how are we reengaging with our members, keeping
it simple, bringing in these digital solutions.
You know, we're doing a ton of different
mobile vans, being out in the communities and
and, you know, promoting health care access, just
given some of those utilization issues that we're
seeing on inpatient visits and behavioral health visits.
And it's all to say that we've gotta
continue to push more and more, how do
we, you know, focus on prevention. Right? That's
that's the goal here.
And then the other thing I would just
say is that there's been a lot of
work that's happened today from an entrepreneur perspective
on health equity. I mean, there there's been
you know, we've got affordable housing units that
are coming up. We have, you know, workforce
innovation talent centers that are helping with job
placements. And, you know, you know, we're thinking
about yeah. We're actually one of the only
plants that offer a GED program for our
membership. I mean, you know, I mean, you
know, there is no doubt that if we're
able to make things easier for our members,
not only from an access to care perspective,
but address these health related social needs, we
believe that's the path forward towards better outcomes,
from a quality and cost perspective.
Absolutely. So clearly a lot of amazing work
and initiatives going on under your leadership here
in Illinois, Rashiel.
You mentioned Medicaid redeterminations
being mostly complete, definitely here in Illinois and
mostly complete all over the country.
What would you say are some of the
key insights that you and the company gained
during this massive process for for every company
all over the country working in Medicaid?
You know, I think it's the, first of
all, the process isn't always the easiest. Right?
I think there's been a lot of great
things the state of Illinois has done on
ex parte rules and and how do we
think a little bit differently on on the
re termination process. Right?
So I think that's the first step and
is how do we get more nimble with
with
going forward, making sure that members continue to
be enrolled. Right? But the biggest challenge here
was that you we had a situation where
members that came onto Medicaid in some situations
didn't even go through a retimmonation process before.
Right? And others that have been on Medicaid
for quite some time, you know, they they
had to net pause go through. I think
it's caused us to think about how do
we think about the member experience differently. Right?
It's it's no longer just about snail mail.
It's no longer just about, you know, just
getting getting getting mailers out and postcards out
and phone calls out. But it's it's it's
we're seeing more digital adoption across the board.
Right? So, you know, how do we guide
members towards a platform the state has called
Manage My Case? Right? And, you know, we
intersected that a lot with our community based
events. Right? And that's similar process today of,
you know, where do we find members in
our community? How do we work closely with
our community based organizations, our faith based organizations,
you know, existing community events and and find
out those organizations.
And that's where we spent a lot of
time building our infrastructure and network over the
last several years. And I think that positions
us really uniquely for the 11/15 waiver that's
forthcoming. Right. But if we've got these access
points now where we know where our members
are, I mean, that makes the redetermination process
easier as time goes on, but it also
now becomes a conduit of a network where
you can now focus on quality and prevention
and, you know, bringing provider access to and,
you know, think about that. So, look, these
are things that 5 years ago, we wouldn't
be talking about members going to the website
or using an AI assistant on our website
or using some of these digital tools that
now we've seen that as a result of
COVID, there's just greater adoption, which has been
which has been fantastic to see. You know,
it's been revolutionary on that side from a
digital digitalization perspective.
Absolutely. And, Rochelle, for our listeners who might
not be familiar, can you briefly overview what
the 11/15 waiver
is?
Yeah. Absolutely. So this is this is a
this is a new program the state launched,
working with CMS, you know, where they they
had to seek federal federal approval for they
got federal approval for funding, in addition to
state funding, to really tackle the health related
social needs. And the state of Illinois has
been bold,
and very progressive with what they're looking to
tackle. So they're looking at medical respite, they're
looking at homelessness prevention,
housing as some of their phase one approaches
where they're outlining effectively new services that,
CBOs and providers will be able to go
ahead and and tackle. And, you know, by
by being able to build these services through
Medicaid,
this opens up a whole new level of
funding and and and work for the CBOs
and partnerships. And you're thinking about members that
need to get food and housing and and
now transitioning them for those services. And how
does that how does that how do we
capture that? You know, that's what the 1115
waiver really helps open up the avenue for
when you think about that on how do
we make the health way of social needs
more integrated into the Medicaid program,
provide unique services that new organizations and existing
organizations can bill us for, through through that,
which is great,
as well as, you know, integrating that into
the model of care. Right? That that's that's
what this is all about, right, in terms
of how do we tackle those health related
social needs. So you're gonna see more and
more organizations talking about, you know, housing diversion
and homelessness diversion and, you know, medical respite.
And how do we think about housing and
medicine now and those homeless shelters and providing
care? Right? And the 11 15 waiver is
gonna help open up the opportunity to do
all those things, just which is really quite
quite exciting.
Yeah. It's really interesting, and I think it's
something you don't hear about enough how much
innovative work is going on with these waivers
all over the country with with state Medicaid
programs and and different care models that are
being implemented.
But that being said,
where where do you see the Medicaid industry
moving in terms
of addressing coverage gaps and ensuring better continuity
of care for for beneficiaries?
Yeah. Absolutely. You know, I I think the
11.15 waiver is really where the focus is
gonna right? And this is gonna be this
is how we use Medicaid dollars to attack
the root cause of health inequities, right? So
I expect in the next 5 years or
so that we're gonna spend a lot of
time thinking about, well, what do these new
models of care to look like, Right? How
are we building
a culturally sensitive workforce? How are we working
with our providers to think about culturally sensitive
care?
How are we thinking more and more about
data sharing that involves not just, you know,
population health and claims based information, but now
the health related social needs information. How is
that really built into
each each visit that we have and how
do we have that integrated model?
The other thing, you know, we're we're we're
very focused in Illinois is that provider enabling
component of it. Right? So when half of
our members are in value based care, you
know, we wanna
shift away from just fee for service and
and really help adopter help adopt providers
to get into different models of care, you
know, that talk about risk and upside and
PMPMs and directed payment models to reduce their
administrative burden. Right? And and I think that
ties directly to prior authorization burden and gold
carding and billing. Right? So, you know, and
there's a lot of exciting things happening in
Illinois where, you know, from a member perspective,
we we there's such a big focus now
in access and and resources and different things
that every payer is bringing to the state
to really help inform us on on how
do we think about,
from a Medicaid perspective,
the best outcomes that we wanna get to.
Right? So it's not only about just getting
an a one c. It's about how do
we get the members A1C or their diabetic,
you know, diabetes score down. Right? It actually
gets a better outcomes, right? And diabetes reversal
programs and GLP ones.
But there is so much happening in healthcare
all in the right direction right now. Digitalization,
making things easier for our members, different value
added benefit,
health equity, you know, on the provider side,
more and more are focused to make it
easier for our providers. They're not spending all
their time on on on billing and claims,
where I think that is where the future
of this program is gonna be and and
really to help build, a best in class
program, throughout the state. And I I believe
with the leadership of the at the at
the state today and and, you know, with
the with the with the focus the governor's
put on health care here today,
this is one of those market leading states
that's gonna get to that point where we
have those really strong outcomes. So this has
gotta be about outcomes. We're not performing well
in in quite a few areas, but, we
have a pathway to to do really well
over time.
Mhmm. It's fascinating.
Alright. So what else are we missing? Rochelle,
any final thoughts, Any final piece of advice
you wanna offer while you have the ears
of a lot of health plan leaders all
over the country?
No. We've covered a lot of ground today.
You know? I, you know, I think I
think the biggest question I always think about
when I when I ask our
members is, you know, this is where we
we really value member feedback. You know, I
think AI is one that we're always watching
rather closely and thinking about how are we,
you know, making this easier for our members.
You think about all the unique value added
benefits the payers offer today and, you know,
we covered GED and diapers and
all of that. I you know, I think
how do we continue to make it easier
for our members. Right? And, you know, that
that is one where, for us, it's a
local approach. We're always looking for community partnerships,
working with community,
organizations that that have those strong grassroots that
we can build off of. Right? From a
provider perspective, you know, I I I encourage
us to continue to be nimble there and
think about the different
alternative payment models that are out there.
And, you know, I I I think there's
strong synergies with the payers because every provider
work does a lot. Every provider organization does
a lot of work on health equity today,
and this is one thing that I foresee
is gonna really help bind and shape the
industry, especially in Illinois,
where there is so much commonality of how
we're using our finite amount of resources across
payers and providers. But that synergistic relationship on
value based care, you think about the transformation
projects the state has, all of that is
leading down this common goal of better health
outcomes,
focusing on the structural health inequities,
and that's where we really help reshape and
think about the future of where we're gonna
go. So look. I mean, Jacob, I'm I'm
excited about it. I mean, I think there's
a lot that that keeps us going, and
we're attempting to see where the future of
all this shapes up.
But we know we can't do without our
our our community based organizations, our providers.
And at the end of the day, the
one thing that we we always think about
with every action we're taking out is it's
gotta be member centric. Right? And it's gotta
be what's making things easier for our members
as we go forward. Right? Otherwise, well, what's
the point? So
that's what I leave us with.
Wonderful. I think that's a great place to
leave things. Rochelle, thank you so much for
taking the time to be with us and
for sharing your insights with our listeners. We
truly appreciate it. Yeah. Thanks for having me.
Appreciate the time. If you'd like to listen
to more podcasts from Becker's Healthcare, you can
visit beckershospitalreview.com.