Evernorth brings the power of wonder and relentless
innovation to create world class pharmacy care and
benefit solutions. Our connected health services make the
treatment, prediction, and prevention of health care's most
complex conditions
easier and more accessible as we drive organizations
and people forward. Ever North Home Based Care
provides value based care that helps patients with
multiple chronic conditions
and social determinant of health barriers get the
care they need and the personalized experience they
deserve. We serve patients who struggle to navigate
the health care system by bringing high quality
primary
and preventative care services to the home. By
providing clinical care and support services that provide
whole person care, we improve health equity, access,
and outcomes for the populations we serve.
Hello, and welcome to the Becker's Healthcare podcast.
I'm joined today by Gary Rosenfield, director of
Medicaid product and strategy at United Concordia Dental.
Gary, can you start off by telling us
a little bit about yourself and your background?
Sure. I am, as you said, the director
of Medicaid product and strategy at United Concordia
Dental.
We are the wholly owned subsidiary dental plan
under the umbrella of Highmark Health.
I joined in
January of this year after spending a lot
of my career on the Medicaid managed care
side
of the of the business.
So I ran the Medicaid line of business
in a couple health plans in New York,
ran
Medicaid strategy for a number of years at
a large health plan on the West Coast.
And I was excited to join United Concordia
because in my
experience on the managed care side,
dental is a
a huge
challenge
for the Medicaid population,
and I believe United Concordia Dental is positioned
well to, address those challenges. So I'm tasked
with,
really growing our
Medicaid footprint beyond our, you know, beyond Highmark
Health, which is where we currently serve Medicaid
in 3 states.
From improving member experience and expanding value based
care to controlling costs, You know, payer executives
have ambitious growth goals for the rest of
the year and into next year. In your
role, what would you say is your top
priority right now, and how are you planning
to get there?
So
the top priority I mean, there there's there
are several top
priorities. I would say
2 of them that are are
probably equal is 1.
Access to care is a is a challenge,
especially for the Medicaid population.
So what yeah. One of the things that
we're looking at is
we have the
largest provider network. United Concordia, which I didn't
mention before,
has the TRICARE
contract. So we have the military contract. So
we have a network provider. If there's a
post office, we have a network provider.
So
how do we
leverage
that network
in a way that
expands
access.
But with the challenges,
within the current providers who take Medicaid,
one of the, like, kind of priorities is
how do we expand the capacity for those
existing
providers? So that's one. The other is
more you know, this this is like a
team effort.
The head has,
for an inexplicable
reason, been separated from the body when it
comes to regulations
and funding.
We need to really work on advocating
to get the
proper attention to make oral health
really part of the conversation so that there's
the appropriate funding to to really
make that connection between the oral and systemic
health link.
At an industry level, what would you say
are the biggest barriers to effectively serving and
engaging members?
You know, what opportunities do you see for
large scale improvements in this area, and how
are you currently applying these strategies?
Yeah. So, you know, great question. You know,
in the in the dental space and, again,
with Medicaid,
I I could cite, you know,
some statistics,
like 93%
of
people in poverty
have not used dental services.
People of color are 3 times more likely
to have never seen a dentist, and they're
also 3 times more likely to go to
the emergency department when they have an oral
health care issue.
So one of the biggest
barriers
to engaging members is
we need to
really figure out or really
get to the community level. You know, much
like community health workers, we at United Concordia
have a team of government relations liaisons who
actually go out in the communities,
where the military bases are, and they educate
the active duty military members and their families,
help get them connected to providers that are
in their neighborhood or area
with with the intent to make sure that
the active duty military member is fit for
deployment.
We could take that same model and have
the the boots on the ground that kind
of address
the
kind of trust barriers that we find with
those populations,
help get them connected to social
services that may be impediments,
help get them connected to to providers,
really put some programs in there that drives
not only engagement, but actually
access,
adaptability,
or adoption
of of the care.
And so so we're looking at that as
far as like large scale improvements.
It's it it is a team
effort and Medicaid
as as the saying goes, you've seen one
Medicaid member, you've seen one Medicaid member. It
is really community driven. So how can we
leverage
some of the, you know, the technology
tools that we have
to remove some of the,
barriers
of getting providers in the network. Right? So
administrative
kind of burdens that are placed on them.
How can we
get creative with value based contracting
with the providers who are in our network
so that they're more open to enrolling in
Medicaid and taking those those members? Mhmm. Things
like that.
So keeping up with, today's rapidly evolving health
care landscape is is challenging.
What's one piece of advice you'd like to
share with other leaders in your space to
help grow their businesses while keeping members top
of mind?
That that is a really good question. I
I would say the the first piece of
advice is
patience. This is it's not a sprint. It's
a marathon. It's a complicated
population like Medicaid. So really kind of understanding
that it is
local, you know, community driven.
Also,
don't get caught in the trap of trying
to boil the ocean, which is often a
lot of leaders wanna just fix everything.
Really start on a
a kind
of a a deliberate
kind of more focused approach
to solving
or addressing
challenges that that they're facing. All that being
said, that does keep the members in mind
It because
if you're understanding
the challenges of the local communities
and then putting programs in place to address
those challenges, you will start seeing
outcomes, drive delivering a better member experience,
and all the things that are related to
that.
So we we talked about the rapidly changing
health care landscape.
It's also ever evolving from a regulatory environment
as well. What are some of the tools
and strategies that have helped your organization improve
quality and clinical outcomes
while staying,
compliant?
So very good question. So we we are
a heavily regulated industry. It especially with Medicaid,
you you have to be in compliance. Right?
So the contract is scrutinized,
the reporting,
everything that we do for the members, how
we engage them, you know, the marketing,
the messaging, all has to be approved.
And and to your point, it is an
evolving
regulatory environment and, you know, given
what happened
with the election, not to bring that in,
but
Medicaid is going to be in the crosshairs
of massive changes at the federal level, most
likely. So we have to start thinking about
that. But in terms of of, you know,
being able to improve the quality and clinical
outcomes
while staying compliant,
we at United Concordia Dental, and and and
this this kind of is one of the
advantages of having Highmark Health, which is an
MCO as our parent company,
have are you know, we take a total
health approach.
So we are, yeah, like, really
deliberate
about driving better health overall health outcomes. So
we do that by
making that, like, medical, dental integration. So kind
of connecting the oral systemic health link.
You know,
60 chronic conditions, including, like, diabetes
and and heart disease.
Those are all things that could actually be
diagnosed
or or mitigated if you get your oral
health care. There's a link between oral health
and and those chronic conditions.
There are other like like, with prenatal
care,
there are connections to if you get the
moms in for
a teeth cleaning
during pregnancy,
it actually
reduces
the risk
of
preterm births and low birth weight. Those are
all things that that we're doing. So we've
we've created, like, a dental medical insights platform
Mhmm. That allows us to kind of take
the data and and
gain some
actionable insights
that allow us to take action to improve
quality
in terms of, you know, managing diabetes
or
improving
quality for maternal health.
So a little bit ago, you talked about
some of the
disparities in the dental space in your communities.
What are some of the things your organization
is doing to address these? And, you know,
do you have any measurable examples of success?
So that that is a great question. You
know, measurable, you know, we're, you know, still
kinda sifting through that. Mhmm. But some of
the things that that we're doing, like I
mentioned, kind of, using our kind of government
relations liaisons or GRL model,
you know, we could call them community dental
advocates, like, use that model
or the Medicaid population
to really get into the communities
to
address the diverse needs, you know, one community
at a time. So we could, you know,
look at rural areas or certain ZIP codes
where there are some challenges and kind of
develop a framework or a model where we
actually have
boots on the ground, people from the community
who could build that trust and address some
of those inequities and disparities that are out
there.
We also
have
kind of recognized or identified, you know, some
of the, you know, prior auth
challenges, like prior authorizations.
So, you know, for example, like with diabetes,
like,
removing the
prior auth need so that someone with diabetes
could get, like, an extra cleaning, get an
extra exam.
You know? So kind of working with with
those populations
on a on a disease level. We also
are you know, use benefit limits exceptions. So
a lot of states with Medicaid, they have
for the adult population, they have, you know,
strict limits on
how much is paid in dental.
There are certain kind of
procedures, again, with the chronic conditions
that we make exceptions
and and because it's the right thing to
do from a health standpoint.
So those things
are delivering,
you know, better outcomes.
And, again, it's like one community at a
time. Mhmm. Mhmm.
Well, Gary, I really appreciate you sharing your
insights today. But before I let you go,
do you have any final thoughts you'd like
to leave with our listeners?
So final thought is and I I say
this to everyone. I said at the beginning.
It's real we we need to make
the head part of the body, and we
need everyone out there,
especially on the payer side,
recognizing
that oral health is part of physical health.
It is part of the body. Mhmm. And
and really
get, you know, take take some focus and
and really, you know, lean into
addressing
oral health care needs as part of total
health. Well, Gary, thank you again for joining
us today on the Beckers Health Care Podcast,
and I hope you have a lovely rest
of your day. Alright. Thank you so much.
Bye bye.