Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast.
Thrilled today to be joined by doctor Jennifer
Nuovo, who's the chief medical officer at Blue
Shield of California's Promise Health Plan. Doctor Nuovo,
thank you so much for taking the time
to be with me on the podcast today.
Well, thank you for having me. Absolutely. And
before we dive into everything we wanna talk
with you about, can you tell us a
little bit more about yourself, your background in
health care, and what it is that you
do today at Blue Shield?
Sure.
I'm an internal medicine physician, and my, subspecialty
is endocrinology.
I practiced,
in Seattle and in Sacramento for about twenty
years,
and then I came to the health plan
side on,
in managed care,
particularly focused on low income populations and the
medical population here in California
as the phase of my career. And I've
done
medical director work with Health Net of Cal
of California Health
Net, with Sutter Health Plan in the Bay
Area and the Sacramento area,
with UnitedHealthcare.
And now I've landed with, Blue Shield of
California
on their Promise Health Plan, which is their,
medical medical only health plan here in California
for,
with lives in
Los Angeles and San Diego.
Fantastic. So a long career in the industry,
Jennifer.
And in that vein, we wanted to talk
with you today to start out about a
recent survey from Aflac that was showed that
nine out of ten Americans have missed health
checks or preventive screenings,
at some point in their life, which and
that's a lot of people, the majority of
people. So from your perspective,
how important is preventive health overall,
and and what's what is Blue Shield Promise
Health Plan doing to increase access to preventive
care?
Sure. Well, that's a long question. Two questions,
really.
Preventive health care is really the cornerstone
of
health
in
our culture, in our society, and really all
societies.
Our wealth as people is our health.
And
protecting health,
ensuring
people are healthy
is really done
a variety of ways, but primarily in the
health care world, it's done through prevention.
And, you know, I think the statistics sounds
shocking and is
is alarming,
but if you think of a lifetime
and all of the preventive services that are,
requested
and recommended for people, it's not surprising
that people miss an annual well visit at,
you know, at age of 53 and then
their next well visit is age of 55.
Right? So all everyone gets thrown into that
statistic.
Health insurance
and physicians
really partner together
to try to make sure our
members and the patients for the for our
doctors
know what the preventive
service
need is for that particular age and stage
of life. We all know that babies, for
example, have lots of visits their three years
of life, much of that for vaccination
and for developmental screenings,
and well child visits,
but then really annually thereafter
for all children. And then there's another
batch of vaccinations
that we highly recommend for kids going into,
junior high and then again going into college.
Adults
really also need preventive health care. How do
you know if you have hypertension?
It's a silent disease. Right? So you only
know by testing your blood pressure, and we
get that done through annual visits with your
physician.
How do you know you have diabetes?
Again,
very comes on slowly, very silent, quiet,
disorders, a disorder that we know we need
to identify early and treat early.
But without getting the preventive screenings, very hard
to know if you have those
conditions.
Absolutely.
It makes sense. So, really, your perspective here
is preventive health is wealth.
And it makes sense that so many people
have missed these these types of screens over
the span of their lifetimes.
I'm I'm wondering how you think the Blue
Shield's efforts in this space are helping to
address health disparities
in a place like California.
Sure. And I think I didn't even really
answer part two of your of your last
question, so I think I'll take a stab
at that and then talk about health disparities,
a little bit on top of that. But
whether you are just a middle class person
with employer based insurance or whether you have
Medi Cal or whether you are in the
one of the exchange products,
really, prevention is an area that that that
Blue Shield of California and Promise Health Plan
really focus on
making sure
that the
member or the patient
knows what prevention needs to be done for
that particular year. We do that with a
variety of touches and outreaches,
either telephonic
or mailed,
sometimes texting,
and sometimes through our, app that we make
available to our, membership so that you know
what you need to get done in this
particular year. We send very similar information
to the patient's doctor, to their primary care
doctor so that they know for the patients
and the members that are assigned to them
who needs a mammogram,
who needs a colonoscopy,
who's due for,
you know, a vaccination,
who's due for a well visit.
Those
notices,
hopefully,
align enough that the patient schedules a visit,
the doctor knows what to get done when
the patient comes in for that visit. So
there is a variety of messaging done by
the by the health plan by both Blue
Shield of California for their lives and by
promise for the Medi Cal lives. We also
have a variety of incentives
that we pay both to the provider
as well as some incentives that we can,
provide to the member for going in and
going to the inconvenience
and disruption of life of going into the
doctor
to get that done. And certainly on the
medical plan, we do offer transportation benefit
so that if transportation is an if issue,
if you don't have a car, you're not
on a bus line, you it's not easy
to get to the doctor,
we can arrange those
visits for you to try to remove that
barrier to access.
Sure. Sure. It may it makes complete sense.
So a lot of outreach, a lot of
incentives from from the health plans, towards providers
and towards the members to access this care.
Jennifer, coming back to the other question, how
do you think that these efforts are helping
to address,
health disparities among your members?
Yeah. So what we do notice is that,
in certain ZIP codes and certain,
of our membership,
there is lagging in getting the preventive services
done. Some of that is due to language
barriers, not understanding,
what it is that's available or what it
is you need to get done, just because
of not having, you know, English skills here.
Some of it is cultural.
Some of it is, you know, people are
new to this country and new to this
state, and they just, you know,
may not prioritize
getting into the doctor in their,
you know, in their
year or so here. So we do,
notice that there are a variety of populations
that really lag behind.
We also know that certainly in the African
American community, for example, there is often widespread
distrust of the medical establishment
not believing
that the primary care provider that you're assigned
to is really the right person for you,
and not knowing what their
recommendation
are their recommendations
truly,
you know, important for me? So there is
a fair amount of distrust among,
certain
people in this country, and then there's just
widespread,
I don't know what you're talking about. I
don't know I don't know what this is.
Why should I do this? So
a a lot of our focus really is
on
areas and populations
that really may not have good trust or
good understanding of what needs to be done.
So in addition to what we talked about
a few minutes ago of just sort of
a peanut butter spread, I call it, giving
messaging to everybody and giving messaging to every,
one of our providers,
we also do very targeted
outreach to certain populations that we know,
either from our own data or from just,
you know, historical data, no,
access
health care
reluctantly perhaps or or not frequently enough. And
in those particular populations,
at least on the Promise Health Plan side,
we have,
specific,
and targeted programs to reach into those communities.
You know, it it makes sense. There's it
has to be very targeted outreach to reach
different and diverse populations, but but please, continue.
Yeah. I mean, I think for a long
time, we didn't really think about that. Right?
We we just thought about, well, if we
just let people know, here's your doctor, here's
what you need to get done,
that folks would pick up the phone and
schedule.
And we have certainly found over time that
it it takes a little more effort with
certain populations,
and everyone
deserves preventive health care. Everyone
needs to be seen, and everyone needs to
be welcomed into the health care community
and become comfortable and familiar,
in those settings.
So particularly what we have,
launched and what we do, for,
certain communities is we offer,
appointment visits, well child visits, for example,
after hours and on weekends in,
specific,
targeted
ZIP codes and targeted areas where we know
it's very difficult
for families to get in for routine care
to their assigned PCP.
So we'll have these,
events,
in the evenings and on weekends. We also
know that our medical population
is often working, often very busy, and they're,
you know, working at jobs where they can't
really
take time off.
They if they take time off, they don't
get paid, or if they take time off,
they're told not to bother to come back.
So sometimes scheduling during routine doctor offices just
really doesn't work very well for a lot
of our population, and so those are areas
that we really target for our evening and
our weekend clinics.
And then we also know that there are
certain
services that people just don't wanna have. Right?
Either either culturally or they're just unpleasant services.
Mammograms
come to mind, right, as something that that
people will also often put up and be
reluctant about. So we have,
scheduled just, you know, just mammogram only visits
in provider offices or, you know, in certain
areas where we feel that people can get
into and schedule fairly fairly readily.
And we we make those events a little
festive, honestly,
Jacob. So, you know, balloons and a little
gift and, you know, a flower after you
get your mammogram done, a lot of counseling
and coaching.
There are,
a lot of women who are really reluctant
to get undressed in front of strangers
just either because of personal experience or cultural
beliefs. So,
you know, we have people like myself. I
tend to go to these events and and
do a little counseling and coaching as well.
My mother, for example, died of breast cancer.
So it's a it's a issue that's important
to me, and I know that a lot
of our members
get really caught up in,
their families' lives, making sure their kids are
doing well, making sure that everything is going
well, but often neglect themselves.
So we really try to work in those
particular
mammogram events on you're important to, your health
matters. It's really important for you to be
healthy because your family depends on you.
Absolutely. And if we're sticking to this to
this topic, Jennifer, of all the different ways
that Promise Health Plan is reaching your membership,
as as I understand that you have a
brick and mortar presence across the state through
your community resource centers. Can you talk to
us a little bit about about that and
and how these centers play a role in
in what we're talking about right now?
Yeah. Absolutely. We partner with,
LA Care Health Plan.
We are a a delegate to LA Care
Health plan, the local initiative health plan in
Los Angeles County.
And with,
LA Care, we have
13 or 14 community resource centers through, throughout
Los Angeles. We just opened, I think, our
center.
We have a couple of centers that are
our own as well.
But with the partnership with LA Care, we've
really been able to build these hubs within
low income communities
that are
places anyone in the community can walk in
and ask a health related question.
Classes are offered, wellness classes, fitness classes, Zumba
classes,
health education classes, diabetes, hypertension.
We have after school
places for kids to come and do homework.
Kids can get dropped off and play while
parents do a little bit of shopping. And
it's a place where you can,
learn about the Medi Cal program and get,
assistance with enrollment in the Medi Cal program.
So these community centers
not only,
really are hubs for the neighborhoods, but they're
really a way for
us as the health insurance company to reinforce
the importance of health care in your life.
Wow. So so more than a dozen of
these centers in the Los Angeles area, it's
amazing. And and I wonder you know, we
hear so much from insurers today, Jennifer, about
their their focus on whole person care, really
providing comprehensive
integrated services to their members. I wonder, you
know, based on everything we've talked about today
in terms of all the different ways,
that's the Blue Shield and the Promise Health
Plan is reaching its membership, How do all
these efforts really fit into Blue Shield's focus
on on whole person care?
Well, we understand
that
health doesn't exist in a silo,
and health care doesn't exist in a silo.
So the more we can understand,
the context
of someone's social and cultural and environment,
the better we can serve our population, whether
that means
that we really come up with,
specific outreach and bringing health care to people
who are perhaps unhoused.
You know, as you know, I think a
of all the unhoused people in the country
live in Los Angeles County.
So, you know, it and and just imagine
living in a tent under a freeway, and
then how are you gonna get your dental
care? How are you gonna get your your
annual flu shot? How are you gonna get
your annual well visit and find out about
your hypertension or get refills on your on
your diabetes medication
if we don't come to you?
So,
really understanding the context and that people are
not just,
you know, bodies for doctors to examine and
write prescriptions for. They really are living whole
lives. So how can we fit ourselves into
that life? And I think some of our
evening and weekend clinics really kind of speak
to that a little bit.
Our work with the,
street medicine,
providers,
you know, really fits with that.
And then really the state of California
or the Medi Cal population has really,
set up criteria and guidelines
and assistance for the health plans
for us to,
work with
very specific populations.
For example, if you are justice involved, if
you have if you are being released from
jail
and maybe while you were in jail or
in prison, you were getting
a treatment for substance abuse, and then all
of a sudden you're out on the street,
how do we make sure that insurance
is available to that person
at the time of release and that they
can continue on their medications, whether it's medications
for mental health, medications for diabetes, medications for
substance abuse
so that the health that has
been stabilized
in
the incarcerated setting
can be
seamlessly
continued. So there are certain populations
that the state has asked us to focus
on specifically.
We've talked for a minute about the unhoused
population,
the justice involved population,
also foster youth.
You know, how how can the health plans
really,
lift up and work effectively
with the foster families and the foster youth
to make sure that those health care for
those kids and teens is also happening.
And, you know, in that way, I think
we really have been asked to not just
think about the social environment people are living
in and how to deliver health
effectively in that environment, but also what can
health care provide
that
stabilizes
your health? Housing,
for example,
sober centers,
recuperative
shelters. So if you're discharged from a hospital,
but you still have some lingering,
health needs,
you know, you don't have to go right
into the regular shelter system. You can go
to a recuperative shelter and continue to get
those health needs.
Home modifications,
you know, people often have to leave their
home and go into nursing care, nursing home
care because they don't have a ramp. So
now we can provide ramps to people so
they can stay in their own housing.
That's the sort of activities that we're really
incorporating
into the provision of health. It's not doctors
exactly and it's not medicines exactly,
but it is
it is sometimes more powerful
than than the medication to have a secure
place to live.
Certainly. And it's wonderful to hear how much
of a focus Blue Shield is placing on
serving
such vulnerable populations across the state, Jennifer.
Before we go, anything else that we're missing?
You have the ears of a lot of
other health plan leaders from around the country.
Is there any final thoughts or final bits
of advice you wanna share with them?
We wanna highlight one more program that I
think other health plans could, you know, perhaps
pick up on. We offer a program called
GED Works. So we really,
encourage
our members
to get their high school equivalency,
degree accomplished
so that they can go out into the
workforce
and be a more attractive,
employee for people. So, you know, again, it's
not
it's not a medicine,
but it's a lifetime and it's a lifetime
investment
in a person,
so that they can have a successful
life,
you know, in America.
And, so things like that. How do you
help people with high school equivalency?
How do you help them,
enroll and and persist in a in a
college,
program or in a training program? Those are
the kind of things I think that, health
insurance companies should think deeply about and figure
out how do we really get everyone
on
close enough to a level playing field that
they can have a successful adult life.
My final thoughts or my recommendations
is we have to do
we have to continue to figure out ways
to reach people
and to encourage access to care and encourage
preventive,
health care and make sure that we are
following the recommendations
of the
United States preventive task force
on that. And then we also have to
think creatively about how do we make lives
more,
healthy
in
ways that aren't just doctors and pills. Right?
How do we encourage
healthy lifestyles,
exercise,
healthy eating, healthy neighborhoods,
you know, all safety, safe neighborhoods so that
you can, you know, take a walk every
evening and not be frightened.
Those are areas I think that health insurance
can be involved in and can really think
creatively and deeply about.
Wonderful. Well, doctor Nuovo, thank you so much
for taking the time to sit down with
us on the podcast and for sharing your
insights with our listeners. We really appreciate it.
You are welcome, and thank you for having
me. Absolutely.
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