1 00:00:00,240 --> 00:00:02,720 Imagine this. You're at the Swiss Hotel in 2 00:00:02,720 --> 00:00:06,399 Chicago surrounded by top executives from leading insurance 3 00:00:06,399 --> 00:00:08,099 companies and health systems. 4 00:00:08,480 --> 00:00:12,160 Welcome to Becker's Fall Pair Issues Roundtable, November 5 00:00:12,160 --> 00:00:13,859 4th through 6, 2024. 6 00:00:14,625 --> 00:00:17,345 Picture the excitement as you gather business cards 7 00:00:17,345 --> 00:00:20,005 from over 500 executive level attendees, 8 00:00:20,545 --> 00:00:22,164 building invaluable connections. 9 00:00:22,704 --> 00:00:25,345 Feel the energy as you participate in over 10 00:00:25,345 --> 00:00:29,285 26 educational sessions led by 90 elite speakers. 11 00:00:29,769 --> 00:00:32,969 Envision yourself engaging in lively discussions about new 12 00:00:32,969 --> 00:00:36,409 health plans, hospital at home models, behavioral health, 13 00:00:36,409 --> 00:00:37,549 and price transparency. 14 00:00:38,170 --> 00:00:41,690 Now imagine being inspired by keynotes from boxing 15 00:00:41,690 --> 00:00:45,045 legend, Sugar Ray Leonard, and 4 time NBA 16 00:00:45,184 --> 00:00:47,744 All Star, Chris Webber. Their stories will leave 17 00:00:47,744 --> 00:00:50,004 you motivated and ready to innovate. 18 00:00:50,384 --> 00:00:53,024 Don't miss out on this unique opportunity. Get 19 00:00:53,024 --> 00:00:55,939 registered today. Visit beckershospital everyone. 20 00:00:56,399 --> 00:00:56,799 This is Jacob Emerson with the Becker's Payer 21 00:00:56,799 --> 00:00:57,460 Issues podcast. 22 00:01:10,694 --> 00:01:13,174 Thrilled today to be joined by a special 23 00:01:13,174 --> 00:01:13,674 guest, 24 00:01:14,135 --> 00:01:16,935 Rashil Desai is the President and CEO of 25 00:01:16,935 --> 00:01:19,575 Aetna Better Health of Illinois. Rashil, thank you 26 00:01:19,575 --> 00:01:21,415 so much for taking the time to be 27 00:01:21,415 --> 00:01:22,795 with me on the podcast today. 28 00:01:23,450 --> 00:01:25,689 Thanks, Jacob. Thanks for having me. Yeah. We're 29 00:01:25,689 --> 00:01:27,129 we're glad to have you with us, and 30 00:01:27,129 --> 00:01:28,329 we've got a lot we wanna talk with 31 00:01:28,329 --> 00:01:30,170 you about. But before we do that, can 32 00:01:30,170 --> 00:01:32,009 you tell us a little bit more about 33 00:01:32,009 --> 00:01:34,649 yourself, your background in health care, and what 34 00:01:34,649 --> 00:01:36,429 it is that you're doing today at Aetna? 35 00:01:37,325 --> 00:01:39,084 Yeah. Thanks, Jacob. Thanks for that, Tony. So 36 00:01:39,084 --> 00:01:41,805 I'm Rishal Tsai. I oversee our Medicaid plan 37 00:01:41,805 --> 00:01:44,385 here, in Illinois. So we've got about 380,000 38 00:01:44,765 --> 00:01:46,305 lives across the state. 39 00:01:47,405 --> 00:01:49,770 We have a population of of our TANF 40 00:01:49,770 --> 00:01:52,010 population, which is our moms and babies, our 41 00:01:52,010 --> 00:01:53,469 ABD and IPCP 42 00:01:53,770 --> 00:01:56,430 population, which is our elderly population, 43 00:01:57,129 --> 00:01:59,209 and then our long term services population here 44 00:01:59,209 --> 00:02:01,334 as well, and the Affordable Care Act population 45 00:02:01,415 --> 00:02:04,301 of Illinois. So, yeah, this is your most 46 00:02:04,301 --> 00:02:04,353 vulnerable population that you've got. This is Medicaid. 47 00:02:04,353 --> 00:02:04,890 You've got anywhere from children that are, you 48 00:02:04,890 --> 00:02:06,935 know, being born to all the way to 49 00:02:06,935 --> 00:02:08,775 your really acute and disabled members across the 50 00:02:08,775 --> 00:02:09,275 state. 51 00:02:15,750 --> 00:02:17,909 And, you know, Medicaid, to me, that's just, 52 00:02:18,150 --> 00:02:19,349 been close to heart and close to my 53 00:02:19,349 --> 00:02:20,789 heart for quite some time. You know, my, 54 00:02:20,949 --> 00:02:22,709 my mom way back when was a physical 55 00:02:22,709 --> 00:02:24,549 therapist, and she worked with, you know, a 56 00:02:24,549 --> 00:02:26,229 lot a lot of children that were that 57 00:02:26,229 --> 00:02:27,849 had some disabilities in Medicaid. 58 00:02:28,405 --> 00:02:29,844 But been in the healthcare space now for 59 00:02:29,844 --> 00:02:31,525 over 25 years, been in Medicaid for about 60 00:02:31,525 --> 00:02:33,525 a decade. So been in Aetna for about 61 00:02:33,525 --> 00:02:35,365 4 of those as their COO and now 62 00:02:35,365 --> 00:02:35,865 CEO. 63 00:02:36,485 --> 00:02:37,865 Part of that worked at Centene, 64 00:02:38,245 --> 00:02:39,844 did some work in value based care and 65 00:02:39,844 --> 00:02:41,865 was their COO of their plans as well. 66 00:02:42,139 --> 00:02:43,900 And then hopped over prior to that to 67 00:02:43,900 --> 00:02:45,340 consulting and did a lot of work on 68 00:02:45,340 --> 00:02:47,739 the payer and provider side, really focusing on 69 00:02:47,739 --> 00:02:49,439 value based care, cost of care, 70 00:02:49,979 --> 00:02:51,979 thinking about, you know, the bridge between data 71 00:02:51,979 --> 00:02:53,259 and and quality and, 72 00:02:53,900 --> 00:02:55,900 population health and and bringing that to the 73 00:02:55,900 --> 00:02:56,400 member. 74 00:02:57,604 --> 00:02:59,444 Part of that, was at business school for 75 00:02:59,444 --> 00:03:01,924 a bit at Duke and, was, you know, 76 00:03:02,004 --> 00:03:03,924 did my grad school here at Chicago and 77 00:03:03,924 --> 00:03:05,284 Chicago Med School for a bit. And then 78 00:03:05,284 --> 00:03:06,884 part of that, I was at University of 79 00:03:06,884 --> 00:03:08,884 Miami where I did, my undergrad focus in 80 00:03:08,884 --> 00:03:09,864 neuroscience. So, 81 00:03:10,269 --> 00:03:12,110 been quite a journey through different facets, working 82 00:03:12,110 --> 00:03:13,650 at the provider side before, 83 00:03:14,030 --> 00:03:15,549 you know, and then over the payer side. 84 00:03:15,549 --> 00:03:16,049 But, 85 00:03:16,389 --> 00:03:18,430 you know, all to say, I think that's 86 00:03:18,430 --> 00:03:20,269 a culmination of what Aetna Better Health of 87 00:03:20,269 --> 00:03:22,669 Illinois today is really focusing on in the 88 00:03:22,669 --> 00:03:25,004 market, and how we're thinking about, you know, 89 00:03:25,165 --> 00:03:27,405 health equity, value based care, some of the 90 00:03:27,405 --> 00:03:28,224 member experience. 91 00:03:29,165 --> 00:03:31,165 You know, and and those are the top 92 00:03:31,165 --> 00:03:32,685 three things that I would say we're we're 93 00:03:32,685 --> 00:03:34,444 most focused on in Illinois today that we 94 00:03:34,444 --> 00:03:36,305 wanna bring to our membership and our providers 95 00:03:36,365 --> 00:03:37,344 across the state. 96 00:03:38,639 --> 00:03:40,560 Absolutely. And let's let's talk a little bit 97 00:03:40,560 --> 00:03:42,560 more about that, Rashiel, in terms of some 98 00:03:42,560 --> 00:03:44,479 of the top trends you are currently watching 99 00:03:44,479 --> 00:03:46,719 in the in the Medicaid managed care space. 100 00:03:46,719 --> 00:03:48,479 Obviously, as you know, it's been a pretty 101 00:03:48,479 --> 00:03:48,979 transformative 102 00:03:49,280 --> 00:03:51,840 year for anybody working in in Medicaid around 103 00:03:51,840 --> 00:03:53,544 the country. So talk to us a little 104 00:03:53,544 --> 00:03:55,585 bit about what have you got your eye 105 00:03:55,585 --> 00:03:57,344 on right now, especially as we we look 106 00:03:57,344 --> 00:03:57,844 forward. 107 00:03:58,705 --> 00:04:00,305 Yeah. Absolutely. So, I mean, look, I think 108 00:04:00,305 --> 00:04:01,665 the first thing we're looking at across the 109 00:04:01,665 --> 00:04:03,044 board is trend. Right? Utilization 110 00:04:03,425 --> 00:04:04,865 has been high. We're seeing a lot of 111 00:04:04,865 --> 00:04:05,444 our membership, 112 00:04:06,250 --> 00:04:08,889 you know, going up across the board in 113 00:04:08,889 --> 00:04:11,710 terms of using inpatient services, behavioral health services. 114 00:04:12,490 --> 00:04:14,810 It's one that's got, you know, one that 115 00:04:14,810 --> 00:04:16,110 we're watching rather closely. 116 00:04:16,410 --> 00:04:17,689 Now, part of that is due to delay 117 00:04:17,689 --> 00:04:19,850 of care with COVID and just, you know, 118 00:04:20,250 --> 00:04:22,085 some of that's just due to acuity. Right? 119 00:04:22,085 --> 00:04:23,605 I mean, you got people that didn't go 120 00:04:23,605 --> 00:04:25,444 for their screeners back in COVID that we're 121 00:04:25,444 --> 00:04:28,165 now seeing, you know, cancer diagnosis at a 122 00:04:28,165 --> 00:04:29,064 much higher level. 123 00:04:29,444 --> 00:04:30,485 You know, we're also seeing a lot of 124 00:04:30,485 --> 00:04:32,564 national track on health equity. Right? I mean, 125 00:04:32,564 --> 00:04:34,004 the good news is that Aetna, Better Health 126 00:04:34,004 --> 00:04:35,685 of Illinois, has been doing this work for 127 00:04:35,685 --> 00:04:37,629 many years, but just so we talk about 128 00:04:37,629 --> 00:04:39,550 behavioral health and physical health being so integrated, 129 00:04:39,550 --> 00:04:41,230 you know, our view at Aetna today is 130 00:04:41,230 --> 00:04:43,069 that we think about health related social needs 131 00:04:43,069 --> 00:04:45,009 for housing, workforce, food insecurity, 132 00:04:45,550 --> 00:04:47,089 homelessness prevention, non 133 00:04:47,710 --> 00:04:48,460 violence prevention, 134 00:04:48,925 --> 00:04:51,485 education, all of those things are really merging 135 00:04:51,485 --> 00:04:53,564 together to wrap around a member. And what 136 00:04:53,564 --> 00:04:55,485 we're seeing is the data is showing this 137 00:04:55,485 --> 00:04:56,625 more and more too is 138 00:04:57,004 --> 00:04:58,925 that's what leads to better quality of care 139 00:04:58,925 --> 00:05:01,620 and better outcomes overall. Right? So, you know, 140 00:05:01,620 --> 00:05:03,379 as we look at things the state's launching 141 00:05:03,379 --> 00:05:04,900 here, like the LN 15 waiver, you know, 142 00:05:04,900 --> 00:05:06,980 we're watching this very closely to think about 143 00:05:06,980 --> 00:05:09,480 how providers and community based organizations 144 00:05:09,780 --> 00:05:11,780 are working hand in hand to get to 145 00:05:11,780 --> 00:05:13,939 those better outcomes and offer those resources at 146 00:05:13,939 --> 00:05:14,920 a local level. 147 00:05:15,345 --> 00:05:16,865 You know, health care is local as it 148 00:05:16,865 --> 00:05:18,384 should be, and and the resources that our 149 00:05:18,384 --> 00:05:20,545 members need and have at a local level 150 00:05:20,545 --> 00:05:22,645 is is certainly top of mind for us. 151 00:05:23,185 --> 00:05:24,785 You know, other thing we're we're thinking about 152 00:05:24,785 --> 00:05:26,944 is provider enablement. Right? We wanna make things 153 00:05:26,944 --> 00:05:29,019 easier for our provider and and, you know, 154 00:05:29,019 --> 00:05:31,019 thinking about all the pressure that our providers 155 00:05:31,019 --> 00:05:32,860 have been through from a workforce perspective, as 156 00:05:32,860 --> 00:05:35,579 well as just prior auth and gold carding 157 00:05:35,579 --> 00:05:37,019 and and, you know, how do we make 158 00:05:37,019 --> 00:05:38,779 this easier for our providers? You know, Aetna's 159 00:05:38,779 --> 00:05:41,419 got a gold card program, which basically allows 160 00:05:41,419 --> 00:05:43,839 providers to not submit authorizations today. 161 00:05:44,414 --> 00:05:45,935 But we've also got other things where we're 162 00:05:45,935 --> 00:05:47,935 seeing often AI helping out in the back 163 00:05:47,935 --> 00:05:49,294 end to make that easier for them. You 164 00:05:49,294 --> 00:05:50,974 know, we we've got over half of our 165 00:05:50,974 --> 00:05:52,974 membership in the state of Illinois engaged in 166 00:05:52,974 --> 00:05:54,834 some sort of value based program, 167 00:05:55,294 --> 00:05:57,854 and we're seeing different providers adopt risk. Right? 168 00:05:57,854 --> 00:06:00,060 And there's shared savings that providers are earning 169 00:06:00,060 --> 00:06:02,139 on to to support things like health equity. 170 00:06:02,139 --> 00:06:04,860 So that that continuous feedback loop and how 171 00:06:04,860 --> 00:06:07,660 we're intersecting value based care and creating access 172 00:06:07,660 --> 00:06:08,639 to care and, 173 00:06:09,020 --> 00:06:11,020 tying that to health equity, seems to be 174 00:06:11,020 --> 00:06:13,339 synergizing really well here in Illinois just given 175 00:06:13,339 --> 00:06:15,814 the, you know, ecosystem that we have today. 176 00:06:16,675 --> 00:06:19,574 It's interesting. So you're really focused on inpatient 177 00:06:19,714 --> 00:06:21,175 and behavioral care utilization, 178 00:06:21,875 --> 00:06:24,355 increasing and also really focused on moving that 179 00:06:24,355 --> 00:06:26,295 needle on health equity and and streamlining 180 00:06:26,835 --> 00:06:29,175 administrative processes for providers. 181 00:06:29,680 --> 00:06:31,680 With all that being said, Rashille, what would 182 00:06:31,680 --> 00:06:33,360 you say you're most proud of over the 183 00:06:33,360 --> 00:06:33,759 last, 184 00:06:34,240 --> 00:06:36,240 12 months of your career, not just for 185 00:06:36,240 --> 00:06:38,319 you personally, but for what your teams have 186 00:06:38,319 --> 00:06:39,860 achieved over the last year? 187 00:06:40,160 --> 00:06:42,000 Yeah, you know, look, I think I think 188 00:06:42,000 --> 00:06:44,240 the first thing is your determinations. You know, 189 00:06:44,240 --> 00:06:46,274 it's Illinois here just wrapped up just a 190 00:06:46,274 --> 00:06:47,254 few months ago, 191 00:06:47,714 --> 00:06:49,654 with the redetermination process in Illinois, 192 00:06:50,834 --> 00:06:52,834 where, you know, we've had some really good 193 00:06:52,834 --> 00:06:55,154 outcomes where over 76 to 80% of our 194 00:06:55,154 --> 00:06:57,875 population, you know, has retained their eligibility in 195 00:06:57,875 --> 00:06:59,399 Medicaid. I mean, Illinois is one of the 196 00:06:59,399 --> 00:07:01,800 strongest in the nation and, you know, we're 197 00:07:01,800 --> 00:07:03,959 thankful for the health and family services department 198 00:07:03,959 --> 00:07:06,039 working with us on making sure members have 199 00:07:06,039 --> 00:07:08,120 coverage. So, you know, the most important thing 200 00:07:08,120 --> 00:07:10,519 here is making sure people have access to 201 00:07:10,519 --> 00:07:11,419 care, right? 202 00:07:11,879 --> 00:07:13,544 You know, pushing on that a little bit 203 00:07:13,544 --> 00:07:15,384 further, we we've been able to bring a 204 00:07:15,384 --> 00:07:17,404 lot of different care models to Illinois. 205 00:07:17,785 --> 00:07:19,564 So we work with a group called Maven, 206 00:07:20,345 --> 00:07:22,745 which is one of the world's largest digital 207 00:07:22,745 --> 00:07:24,745 clinics that we have in in, in the 208 00:07:24,745 --> 00:07:27,169 nation today. And you think about Illinois and 209 00:07:27,169 --> 00:07:29,250 the health outcomes, one of the, you know, 210 00:07:29,250 --> 00:07:31,089 we have one of the lowest maternal or 211 00:07:31,089 --> 00:07:33,490 one of the highest maternal morbidity mortality rates 212 00:07:33,490 --> 00:07:35,649 in the state of Illinois today. So part 213 00:07:35,649 --> 00:07:37,490 of that is due to access. Right? Part 214 00:07:37,490 --> 00:07:39,105 of that is due to how members interact. 215 00:07:39,105 --> 00:07:41,904 So we're bringing more digital solutions to our 216 00:07:41,904 --> 00:07:43,585 membership where they can go ahead and connect 217 00:07:43,585 --> 00:07:45,845 to an OBGYN, connect to a lactation consultant, 218 00:07:45,904 --> 00:07:47,205 connect to a doula services 219 00:07:47,665 --> 00:07:49,025 in the moment right then and there when 220 00:07:49,025 --> 00:07:51,824 they need it. Right? And those digital services 221 00:07:51,824 --> 00:07:53,790 connect with the provider that that's their connect 222 00:07:54,029 --> 00:07:55,470 in in the community to get them to 223 00:07:55,470 --> 00:07:57,629 care and perform better. In the school based 224 00:07:57,629 --> 00:07:59,069 side, we are working with a group called 225 00:07:59,069 --> 00:07:59,569 Kooth, 226 00:08:00,029 --> 00:08:02,430 to really create, you know, we we look 227 00:08:02,430 --> 00:08:03,790 at behavioral health and look at some of 228 00:08:03,790 --> 00:08:05,310 the public health issues that are happening there 229 00:08:05,310 --> 00:08:07,810 with high suicide ideation rates, you know, high 230 00:08:08,214 --> 00:08:10,394 behavioral health access issues that we're seeing. 231 00:08:11,014 --> 00:08:12,694 So we're working with our school based partners 232 00:08:12,694 --> 00:08:14,615 to bring in clinics, you know, virtually and 233 00:08:14,615 --> 00:08:15,115 digitally 234 00:08:15,495 --> 00:08:18,055 because there's not enough telehealth providers to, to 235 00:08:18,055 --> 00:08:19,574 be at site, you know, and be at 236 00:08:19,574 --> 00:08:21,660 the, at the schools. So for us, for 237 00:08:21,660 --> 00:08:23,740 the last several months, it's been all about 238 00:08:23,740 --> 00:08:26,060 how are we reengaging with our members, keeping 239 00:08:26,060 --> 00:08:28,479 it simple, bringing in these digital solutions. 240 00:08:28,779 --> 00:08:30,300 You know, we're doing a ton of different 241 00:08:30,300 --> 00:08:32,220 mobile vans, being out in the communities and 242 00:08:32,220 --> 00:08:34,139 and, you know, promoting health care access, just 243 00:08:34,139 --> 00:08:36,195 given some of those utilization issues that we're 244 00:08:36,195 --> 00:08:39,095 seeing on inpatient visits and behavioral health visits. 245 00:08:39,235 --> 00:08:41,315 And it's all to say that we've gotta 246 00:08:41,315 --> 00:08:43,715 continue to push more and more, how do 247 00:08:43,715 --> 00:08:45,955 we, you know, focus on prevention. Right? That's 248 00:08:45,955 --> 00:08:47,254 that's the goal here. 249 00:08:47,634 --> 00:08:48,914 And then the other thing I would just 250 00:08:48,914 --> 00:08:50,355 say is that there's been a lot of 251 00:08:50,355 --> 00:08:52,399 work that's happened today from an entrepreneur perspective 252 00:08:52,399 --> 00:08:54,240 on health equity. I mean, there there's been 253 00:08:54,320 --> 00:08:56,080 you know, we've got affordable housing units that 254 00:08:56,080 --> 00:08:57,920 are coming up. We have, you know, workforce 255 00:08:57,920 --> 00:08:59,920 innovation talent centers that are helping with job 256 00:08:59,920 --> 00:09:02,799 placements. And, you know, you know, we're thinking 257 00:09:02,799 --> 00:09:04,240 about yeah. We're actually one of the only 258 00:09:04,240 --> 00:09:05,792 plants that offer a GED program for our 259 00:09:05,792 --> 00:09:07,134 membership. I mean, you know, I mean, you 260 00:09:07,134 --> 00:09:08,774 know, there is no doubt that if we're 261 00:09:08,774 --> 00:09:11,095 able to make things easier for our members, 262 00:09:11,095 --> 00:09:12,794 not only from an access to care perspective, 263 00:09:12,855 --> 00:09:15,575 but address these health related social needs, we 264 00:09:15,575 --> 00:09:19,674 believe that's the path forward towards better outcomes, 265 00:09:20,375 --> 00:09:21,995 from a quality and cost perspective. 266 00:09:23,470 --> 00:09:25,789 Absolutely. So clearly a lot of amazing work 267 00:09:25,789 --> 00:09:28,110 and initiatives going on under your leadership here 268 00:09:28,110 --> 00:09:29,329 in Illinois, Rashiel. 269 00:09:29,949 --> 00:09:31,809 You mentioned Medicaid redeterminations 270 00:09:32,509 --> 00:09:35,309 being mostly complete, definitely here in Illinois and 271 00:09:35,309 --> 00:09:37,649 mostly complete all over the country. 272 00:09:38,625 --> 00:09:39,665 What would you say are some of the 273 00:09:39,665 --> 00:09:42,404 key insights that you and the company gained 274 00:09:42,465 --> 00:09:46,245 during this massive process for for every company 275 00:09:46,304 --> 00:09:48,004 all over the country working in Medicaid? 276 00:09:49,184 --> 00:09:51,184 You know, I think it's the, first of 277 00:09:51,184 --> 00:09:53,370 all, the process isn't always the easiest. Right? 278 00:09:53,370 --> 00:09:54,490 I think there's been a lot of great 279 00:09:54,490 --> 00:09:56,409 things the state of Illinois has done on 280 00:09:56,409 --> 00:09:58,330 ex parte rules and and how do we 281 00:09:58,330 --> 00:09:59,929 think a little bit differently on on the 282 00:09:59,929 --> 00:10:01,789 re termination process. Right? 283 00:10:02,330 --> 00:10:03,929 So I think that's the first step and 284 00:10:03,929 --> 00:10:05,690 is how do we get more nimble with 285 00:10:05,690 --> 00:10:06,190 with 286 00:10:07,024 --> 00:10:09,264 going forward, making sure that members continue to 287 00:10:09,264 --> 00:10:11,904 be enrolled. Right? But the biggest challenge here 288 00:10:11,904 --> 00:10:13,504 was that you we had a situation where 289 00:10:13,504 --> 00:10:15,684 members that came onto Medicaid in some situations 290 00:10:15,745 --> 00:10:18,144 didn't even go through a retimmonation process before. 291 00:10:18,144 --> 00:10:20,144 Right? And others that have been on Medicaid 292 00:10:20,144 --> 00:10:21,745 for quite some time, you know, they they 293 00:10:21,745 --> 00:10:23,559 had to net pause go through. I think 294 00:10:23,559 --> 00:10:25,159 it's caused us to think about how do 295 00:10:25,159 --> 00:10:27,820 we think about the member experience differently. Right? 296 00:10:27,960 --> 00:10:29,720 It's it's no longer just about snail mail. 297 00:10:29,720 --> 00:10:31,240 It's no longer just about, you know, just 298 00:10:31,240 --> 00:10:33,559 getting getting getting mailers out and postcards out 299 00:10:33,559 --> 00:10:35,720 and phone calls out. But it's it's it's 300 00:10:35,799 --> 00:10:38,625 we're seeing more digital adoption across the board. 301 00:10:38,625 --> 00:10:40,625 Right? So, you know, how do we guide 302 00:10:40,625 --> 00:10:42,705 members towards a platform the state has called 303 00:10:42,705 --> 00:10:44,625 Manage My Case? Right? And, you know, we 304 00:10:44,625 --> 00:10:46,705 intersected that a lot with our community based 305 00:10:46,705 --> 00:10:49,184 events. Right? And that's similar process today of, 306 00:10:49,184 --> 00:10:50,785 you know, where do we find members in 307 00:10:50,785 --> 00:10:52,679 our community? How do we work closely with 308 00:10:52,679 --> 00:10:55,259 our community based organizations, our faith based organizations, 309 00:10:55,639 --> 00:10:57,879 you know, existing community events and and find 310 00:10:57,879 --> 00:10:59,019 out those organizations. 311 00:10:59,399 --> 00:11:01,240 And that's where we spent a lot of 312 00:11:01,240 --> 00:11:03,639 time building our infrastructure and network over the 313 00:11:03,639 --> 00:11:06,115 last several years. And I think that positions 314 00:11:06,174 --> 00:11:08,575 us really uniquely for the 11/15 waiver that's 315 00:11:08,575 --> 00:11:10,975 forthcoming. Right. But if we've got these access 316 00:11:10,975 --> 00:11:12,735 points now where we know where our members 317 00:11:12,735 --> 00:11:15,235 are, I mean, that makes the redetermination process 318 00:11:15,294 --> 00:11:16,975 easier as time goes on, but it also 319 00:11:16,975 --> 00:11:19,554 now becomes a conduit of a network where 320 00:11:19,639 --> 00:11:21,899 you can now focus on quality and prevention 321 00:11:21,960 --> 00:11:24,460 and, you know, bringing provider access to and, 322 00:11:24,519 --> 00:11:26,440 you know, think about that. So, look, these 323 00:11:26,440 --> 00:11:27,960 are things that 5 years ago, we wouldn't 324 00:11:27,960 --> 00:11:30,919 be talking about members going to the website 325 00:11:30,919 --> 00:11:32,919 or using an AI assistant on our website 326 00:11:32,919 --> 00:11:35,065 or using some of these digital tools that 327 00:11:35,065 --> 00:11:36,345 now we've seen that as a result of 328 00:11:36,345 --> 00:11:38,745 COVID, there's just greater adoption, which has been 329 00:11:38,745 --> 00:11:40,664 which has been fantastic to see. You know, 330 00:11:40,664 --> 00:11:42,184 it's been revolutionary on that side from a 331 00:11:42,184 --> 00:11:43,565 digital digitalization perspective. 332 00:11:44,504 --> 00:11:46,584 Absolutely. And, Rochelle, for our listeners who might 333 00:11:46,584 --> 00:11:49,144 not be familiar, can you briefly overview what 334 00:11:49,144 --> 00:11:50,524 the 11/15 waiver 335 00:11:50,879 --> 00:11:51,379 is? 336 00:11:52,000 --> 00:11:53,679 Yeah. Absolutely. So this is this is a 337 00:11:53,679 --> 00:11:55,460 this is a new program the state launched, 338 00:11:56,000 --> 00:11:58,000 working with CMS, you know, where they they 339 00:11:58,000 --> 00:12:00,000 had to seek federal federal approval for they 340 00:12:00,000 --> 00:12:02,240 got federal approval for funding, in addition to 341 00:12:02,240 --> 00:12:04,894 state funding, to really tackle the health related 342 00:12:04,894 --> 00:12:06,735 social needs. And the state of Illinois has 343 00:12:06,735 --> 00:12:07,475 been bold, 344 00:12:08,014 --> 00:12:10,174 and very progressive with what they're looking to 345 00:12:10,174 --> 00:12:12,174 tackle. So they're looking at medical respite, they're 346 00:12:12,174 --> 00:12:13,634 looking at homelessness prevention, 347 00:12:14,415 --> 00:12:16,915 housing as some of their phase one approaches 348 00:12:17,600 --> 00:12:20,899 where they're outlining effectively new services that, 349 00:12:21,360 --> 00:12:23,120 CBOs and providers will be able to go 350 00:12:23,120 --> 00:12:25,759 ahead and and tackle. And, you know, by 351 00:12:25,759 --> 00:12:28,080 by being able to build these services through 352 00:12:28,080 --> 00:12:28,580 Medicaid, 353 00:12:29,680 --> 00:12:31,574 this opens up a whole new level of 354 00:12:31,574 --> 00:12:33,735 funding and and and work for the CBOs 355 00:12:33,735 --> 00:12:35,254 and partnerships. And you're thinking about members that 356 00:12:35,254 --> 00:12:37,334 need to get food and housing and and 357 00:12:37,334 --> 00:12:39,334 now transitioning them for those services. And how 358 00:12:39,334 --> 00:12:40,855 does that how does that how do we 359 00:12:40,855 --> 00:12:43,194 capture that? You know, that's what the 1115 360 00:12:43,414 --> 00:12:45,720 waiver really helps open up the avenue for 361 00:12:45,879 --> 00:12:47,159 when you think about that on how do 362 00:12:47,159 --> 00:12:49,419 we make the health way of social needs 363 00:12:49,799 --> 00:12:51,819 more integrated into the Medicaid program, 364 00:12:52,439 --> 00:12:55,959 provide unique services that new organizations and existing 365 00:12:55,959 --> 00:12:58,360 organizations can bill us for, through through that, 366 00:12:58,360 --> 00:12:59,174 which is great, 367 00:12:59,735 --> 00:13:01,575 as well as, you know, integrating that into 368 00:13:01,575 --> 00:13:03,414 the model of care. Right? That that's that's 369 00:13:03,414 --> 00:13:04,934 what this is all about, right, in terms 370 00:13:04,934 --> 00:13:06,375 of how do we tackle those health related 371 00:13:06,375 --> 00:13:08,534 social needs. So you're gonna see more and 372 00:13:08,534 --> 00:13:11,654 more organizations talking about, you know, housing diversion 373 00:13:11,654 --> 00:13:14,340 and homelessness diversion and, you know, medical respite. 374 00:13:14,340 --> 00:13:16,019 And how do we think about housing and 375 00:13:16,019 --> 00:13:18,899 medicine now and those homeless shelters and providing 376 00:13:18,899 --> 00:13:20,899 care? Right? And the 11 15 waiver is 377 00:13:20,899 --> 00:13:23,460 gonna help open up the opportunity to do 378 00:13:23,460 --> 00:13:25,539 all those things, just which is really quite 379 00:13:25,539 --> 00:13:26,360 quite exciting. 380 00:13:26,664 --> 00:13:28,424 Yeah. It's really interesting, and I think it's 381 00:13:28,424 --> 00:13:30,024 something you don't hear about enough how much 382 00:13:30,024 --> 00:13:32,345 innovative work is going on with these waivers 383 00:13:32,345 --> 00:13:34,424 all over the country with with state Medicaid 384 00:13:34,424 --> 00:13:36,664 programs and and different care models that are 385 00:13:36,664 --> 00:13:37,404 being implemented. 386 00:13:38,184 --> 00:13:39,245 But that being said, 387 00:13:39,670 --> 00:13:41,690 where where do you see the Medicaid industry 388 00:13:41,990 --> 00:13:43,050 moving in terms 389 00:13:43,429 --> 00:13:46,250 of addressing coverage gaps and ensuring better continuity 390 00:13:46,309 --> 00:13:47,929 of care for for beneficiaries? 391 00:13:49,350 --> 00:13:51,509 Yeah. Absolutely. You know, I I think the 392 00:13:51,509 --> 00:13:53,910 11.15 waiver is really where the focus is 393 00:13:53,910 --> 00:13:56,154 gonna right? And this is gonna be this 394 00:13:56,154 --> 00:13:58,075 is how we use Medicaid dollars to attack 395 00:13:58,075 --> 00:14:00,575 the root cause of health inequities, right? So 396 00:14:00,875 --> 00:14:03,034 I expect in the next 5 years or 397 00:14:03,034 --> 00:14:04,394 so that we're gonna spend a lot of 398 00:14:04,394 --> 00:14:06,075 time thinking about, well, what do these new 399 00:14:06,075 --> 00:14:07,500 models of care to look like, Right? How 400 00:14:07,500 --> 00:14:08,279 are we building 401 00:14:08,660 --> 00:14:10,740 a culturally sensitive workforce? How are we working 402 00:14:10,740 --> 00:14:12,660 with our providers to think about culturally sensitive 403 00:14:12,660 --> 00:14:13,160 care? 404 00:14:13,779 --> 00:14:15,460 How are we thinking more and more about 405 00:14:15,460 --> 00:14:17,460 data sharing that involves not just, you know, 406 00:14:17,460 --> 00:14:19,620 population health and claims based information, but now 407 00:14:19,620 --> 00:14:21,540 the health related social needs information. How is 408 00:14:21,540 --> 00:14:22,840 that really built into 409 00:14:23,345 --> 00:14:24,945 each each visit that we have and how 410 00:14:24,945 --> 00:14:26,644 do we have that integrated model? 411 00:14:27,264 --> 00:14:29,105 The other thing, you know, we're we're we're 412 00:14:29,105 --> 00:14:31,105 very focused in Illinois is that provider enabling 413 00:14:31,105 --> 00:14:32,865 component of it. Right? So when half of 414 00:14:32,865 --> 00:14:34,545 our members are in value based care, you 415 00:14:34,545 --> 00:14:35,524 know, we wanna 416 00:14:35,990 --> 00:14:38,789 shift away from just fee for service and 417 00:14:38,789 --> 00:14:41,209 and really help adopter help adopt providers 418 00:14:41,509 --> 00:14:43,829 to get into different models of care, you 419 00:14:43,829 --> 00:14:46,549 know, that talk about risk and upside and 420 00:14:46,549 --> 00:14:49,875 PMPMs and directed payment models to reduce their 421 00:14:49,875 --> 00:14:51,875 administrative burden. Right? And and I think that 422 00:14:51,875 --> 00:14:54,834 ties directly to prior authorization burden and gold 423 00:14:54,834 --> 00:14:56,914 carding and billing. Right? So, you know, and 424 00:14:56,914 --> 00:14:58,834 there's a lot of exciting things happening in 425 00:14:58,834 --> 00:15:01,495 Illinois where, you know, from a member perspective, 426 00:15:01,634 --> 00:15:03,875 we we there's such a big focus now 427 00:15:03,875 --> 00:15:06,250 in access and and resources and different things 428 00:15:06,250 --> 00:15:08,750 that every payer is bringing to the state 429 00:15:08,970 --> 00:15:10,649 to really help inform us on on how 430 00:15:10,649 --> 00:15:11,629 do we think about, 431 00:15:12,090 --> 00:15:13,309 from a Medicaid perspective, 432 00:15:14,009 --> 00:15:15,610 the best outcomes that we wanna get to. 433 00:15:15,610 --> 00:15:16,970 Right? So it's not only about just getting 434 00:15:16,970 --> 00:15:19,014 an a one c. It's about how do 435 00:15:19,014 --> 00:15:21,095 we get the members A1C or their diabetic, 436 00:15:21,095 --> 00:15:23,415 you know, diabetes score down. Right? It actually 437 00:15:23,415 --> 00:15:25,575 gets a better outcomes, right? And diabetes reversal 438 00:15:25,575 --> 00:15:27,035 programs and GLP ones. 439 00:15:27,495 --> 00:15:29,754 But there is so much happening in healthcare 440 00:15:29,975 --> 00:15:32,154 all in the right direction right now. Digitalization, 441 00:15:32,535 --> 00:15:34,690 making things easier for our members, different value 442 00:15:34,690 --> 00:15:35,429 added benefit, 443 00:15:35,809 --> 00:15:38,370 health equity, you know, on the provider side, 444 00:15:38,370 --> 00:15:39,730 more and more are focused to make it 445 00:15:39,730 --> 00:15:42,049 easier for our providers. They're not spending all 446 00:15:42,049 --> 00:15:44,309 their time on on on billing and claims, 447 00:15:45,009 --> 00:15:46,769 where I think that is where the future 448 00:15:46,769 --> 00:15:48,129 of this program is gonna be and and 449 00:15:48,129 --> 00:15:50,394 really to help build, a best in class 450 00:15:50,394 --> 00:15:52,654 program, throughout the state. And I I believe 451 00:15:52,875 --> 00:15:54,394 with the leadership of the at the at 452 00:15:54,394 --> 00:15:56,394 the state today and and, you know, with 453 00:15:56,394 --> 00:15:58,154 the with the with the focus the governor's 454 00:15:58,154 --> 00:15:59,534 put on health care here today, 455 00:15:59,995 --> 00:16:01,434 this is one of those market leading states 456 00:16:01,434 --> 00:16:02,794 that's gonna get to that point where we 457 00:16:02,794 --> 00:16:04,860 have those really strong outcomes. So this has 458 00:16:04,860 --> 00:16:06,860 gotta be about outcomes. We're not performing well 459 00:16:06,860 --> 00:16:09,420 in in quite a few areas, but, we 460 00:16:09,420 --> 00:16:12,300 have a pathway to to do really well 461 00:16:12,300 --> 00:16:13,040 over time. 462 00:16:13,899 --> 00:16:14,960 Mhmm. It's fascinating. 463 00:16:15,500 --> 00:16:17,680 Alright. So what else are we missing? Rochelle, 464 00:16:17,740 --> 00:16:20,365 any final thoughts, Any final piece of advice 465 00:16:20,365 --> 00:16:22,365 you wanna offer while you have the ears 466 00:16:22,365 --> 00:16:23,884 of a lot of health plan leaders all 467 00:16:23,884 --> 00:16:24,705 over the country? 468 00:16:25,404 --> 00:16:26,924 No. We've covered a lot of ground today. 469 00:16:26,924 --> 00:16:28,045 You know? I, you know, I think I 470 00:16:28,045 --> 00:16:29,725 think the biggest question I always think about 471 00:16:29,725 --> 00:16:31,169 when I when I ask our 472 00:16:31,490 --> 00:16:33,570 members is, you know, this is where we 473 00:16:33,570 --> 00:16:35,409 we really value member feedback. You know, I 474 00:16:35,409 --> 00:16:37,970 think AI is one that we're always watching 475 00:16:37,970 --> 00:16:39,889 rather closely and thinking about how are we, 476 00:16:39,889 --> 00:16:41,649 you know, making this easier for our members. 477 00:16:41,649 --> 00:16:43,649 You think about all the unique value added 478 00:16:43,649 --> 00:16:46,024 benefits the payers offer today and, you know, 479 00:16:46,024 --> 00:16:48,125 we covered GED and diapers and 480 00:16:48,585 --> 00:16:50,024 all of that. I you know, I think 481 00:16:50,024 --> 00:16:51,705 how do we continue to make it easier 482 00:16:51,705 --> 00:16:53,545 for our members. Right? And, you know, that 483 00:16:53,545 --> 00:16:55,304 that is one where, for us, it's a 484 00:16:55,304 --> 00:16:57,865 local approach. We're always looking for community partnerships, 485 00:16:57,865 --> 00:16:58,764 working with community, 486 00:16:59,590 --> 00:17:02,230 organizations that that have those strong grassroots that 487 00:17:02,230 --> 00:17:04,390 we can build off of. Right? From a 488 00:17:04,390 --> 00:17:06,950 provider perspective, you know, I I I encourage 489 00:17:06,950 --> 00:17:08,470 us to continue to be nimble there and 490 00:17:08,470 --> 00:17:09,529 think about the different 491 00:17:09,910 --> 00:17:12,089 alternative payment models that are out there. 492 00:17:12,710 --> 00:17:14,265 And, you know, I I I think there's 493 00:17:14,505 --> 00:17:17,384 strong synergies with the payers because every provider 494 00:17:17,384 --> 00:17:20,105 work does a lot. Every provider organization does 495 00:17:20,105 --> 00:17:21,805 a lot of work on health equity today, 496 00:17:21,865 --> 00:17:23,625 and this is one thing that I foresee 497 00:17:23,625 --> 00:17:25,865 is gonna really help bind and shape the 498 00:17:25,865 --> 00:17:27,484 industry, especially in Illinois, 499 00:17:27,859 --> 00:17:29,539 where there is so much commonality of how 500 00:17:29,539 --> 00:17:31,539 we're using our finite amount of resources across 501 00:17:31,539 --> 00:17:34,340 payers and providers. But that synergistic relationship on 502 00:17:34,340 --> 00:17:36,359 value based care, you think about the transformation 503 00:17:36,500 --> 00:17:38,420 projects the state has, all of that is 504 00:17:38,420 --> 00:17:40,785 leading down this common goal of better health 505 00:17:40,785 --> 00:17:41,285 outcomes, 506 00:17:41,664 --> 00:17:43,924 focusing on the structural health inequities, 507 00:17:44,625 --> 00:17:46,785 and that's where we really help reshape and 508 00:17:46,785 --> 00:17:48,865 think about the future of where we're gonna 509 00:17:48,865 --> 00:17:50,785 go. So look. I mean, Jacob, I'm I'm 510 00:17:50,785 --> 00:17:52,225 excited about it. I mean, I think there's 511 00:17:52,225 --> 00:17:54,049 a lot that that keeps us going, and 512 00:17:54,049 --> 00:17:55,250 we're attempting to see where the future of 513 00:17:55,250 --> 00:17:56,390 all this shapes up. 514 00:17:56,690 --> 00:17:58,049 But we know we can't do without our 515 00:17:58,049 --> 00:18:00,309 our our community based organizations, our providers. 516 00:18:00,930 --> 00:18:02,289 And at the end of the day, the 517 00:18:02,289 --> 00:18:04,210 one thing that we we always think about 518 00:18:04,210 --> 00:18:05,809 with every action we're taking out is it's 519 00:18:05,809 --> 00:18:07,605 gotta be member centric. Right? And it's gotta 520 00:18:07,605 --> 00:18:09,704 be what's making things easier for our members 521 00:18:10,164 --> 00:18:12,484 as we go forward. Right? Otherwise, well, what's 522 00:18:12,484 --> 00:18:13,464 the point? So 523 00:18:13,845 --> 00:18:15,144 that's what I leave us with. 524 00:18:15,845 --> 00:18:17,684 Wonderful. I think that's a great place to 525 00:18:17,684 --> 00:18:20,085 leave things. Rochelle, thank you so much for 526 00:18:20,085 --> 00:18:21,960 taking the time to be with us and 527 00:18:21,960 --> 00:18:23,960 for sharing your insights with our listeners. We 528 00:18:23,960 --> 00:18:25,880 truly appreciate it. Yeah. Thanks for having me. 529 00:18:25,880 --> 00:18:28,039 Appreciate the time. If you'd like to listen 530 00:18:28,039 --> 00:18:30,279 to more podcasts from Becker's Healthcare, you can 531 00:18:30,279 --> 00:18:31,180 visit beckershospitalreview.com.