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Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast.
Thrilled today to be joined by Michael Carson,
who's the president and CEO of WellCare, which
is part of Centene.
Michael, thank you so much for taking the
time to be with me on the podcast
today. Thanks, Jacob.
And, Michael, 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 WellCare?
For sure. Pleasure to be here. Thanks for
giving me the opportunity to connect.
So time flies when you're having fun. I
can't believe it's been thirty years in health
care, but it's been a great ride and
a great opportunity to work with some great
organizations
over those years. I've had privilege of working
in in leading
a few payer organizations,
a few provider value based care type organizations,
as well as some population health companies.
So spectrum of administration and financing,
care delivery
mixed in with the care management aspect of
things, which has been a great experience around
those perspectives
out. I've also had an opportunity to work
across the types of benefits that we offer
in our health care system, so fully in
self insured commercial
businesses,
ACA business
from a marketplace perspective,
lots of Medicaid and lots of Medicare background.
And then thinking across
the types of companies that exist who've also
had the opportunity to work in nonprofit,
regional health plans, publicly traded companies,
as well as some private equity start up
organizations. So,
again, I'd bring all that up just because
of the breadth of experience and breadth of
perspective that brings to what we're here to
do for our members and constituents and communities.
Before health care, I spent seven years in
the air force. People ask me what kind
of planes I flew. I say I flew
a desk. So I did, like, quality assurance,
standardization
work for aircraft maintenance type work, and then
I spent several years within as a bush
after the military,
something called total quality management. But it was
really around performance improvement,
helping businesses, helping companies do better.
So that's sort of health care background and
the things that led me into health care
itself,
which
thinking about how to improve businesses
and trying to be a change agent, those
would are the kinds of things that have
brought me throughout my career. And today at
WellCare, where I serve, as you said, as
the presidency of our of a WellCare Medicare
business,
It's,
again, Centene's Medicare business. We're serving about 32
states across the country
with a very strong mission on on really
serving our communities and improving the health of
our communities one person at a time.
Wow. I mean, so clearly, you've had a
very
diverse career background, Michael. And you mentioned you
you served in the Air Force before
really diving into the the health care industry.
And for our audience who isn't aware, Michael
served at organizations
like Harvard Pilgrim Health Care, Bright Health Plan,
and Care About.
So, Michael, talk to us about how all
these past experiences
brought you brought you to Wealthcare
and how that's really shaped your approach of
leading what what you just said, Centene's
Medicare division, such a massive,
organization.
Yeah. And not to my colleagues at this
stage of our careers, the the list of
companies becomes embarrassingly long to have to run
through, But I actually started my health care
career with a regional blues plan,
Colorado, Nevada, New Mexico at the time. It
was a non for profit plan
just before,
Anthem acquired it in the late nineties
or so. So I've spent my time,
as you said, with Harvard Pilgrim and Bright
and care about sort of from a provider
perspective,
but also with, Amerigroup serving national Medicaid businesses,
with Anthem quite a bit helping to build
Medicare businesses as well,
which again has been a great challenge and
and opportunity.
As I think about, you know, how those
things have led me here and how they
helped shape my approach
to leading well care today,
but really overall,
I kinda reflect on the combination of my
work and health care experience with my uplink.
And at the risk of sort
of getting boring here, I think we all
have a background and certain pillars
to our foundation. And to me,
I was born and raised in Germany, grew
up in Europe.
Mom was a factory worker.
My dinner was the stuff that was left
over from the cafeteria.
Dad wasn't in the picture, so no silver
spoon, a healthy dose of reality of what
we have to work very hard for.
That coupled with that early military
and business improvement experience
being, you know, on the ready at any
given time to go do what we have
to do to fulfill a mission.
So those pieces as a foundation combined with
my health care experience
have me focused on WellCare today in terms
of what's our vision. Where do we need
to go? What are opportunities?
What plan do we need to put in
place? How do we execute on that plan
in a diligent rigorous way? I love the
eighty twenty rule. To what extent can we
build an infrastructure that allows us to
manage what we have to manage
at the 80% levels that we can be
ready to react
to the 20% of things that sort of
punches in the mouth, and then we have
to react to with the healthy dose of
courage to make a difference.
Many of us pride ourselves on being disruptors
or
challenging the status quo, but I think all
of us that are trying to make a
difference and that are led by a mission
lean into that and try to find our
own space
in creating improvement, creating difference.
Very few of us,
sort of just view this as a job.
We view this as an opportunity
to make a difference.
Sure. That makes a lot of sense, and
I appreciate you weaving in for us how
your your upbringing,
has really influenced how you,
oversee,
the current population that you serve as well.
And in that vein, Michael, I wonder if
you could talk with us about one segment
of the Medicare population that that you serve
and and, of course, that we've seen,
major growth in terms of enrollment in over
these last few years. And I'm I'm referring
to the dual eligible
population,
that, of course, Centene has, so many,
enrollees in this segment as well.
Talk to us a little bit about this
this specific segment. What are some of the
unique challenges,
that you are seeing dual eligible beneficiaries
face right now? And how does WellCare specifically
approach support for this vulnerable population?
As I think about mission, I I oftentimes
speak to
how
there are very few other populations for which
our mission comes to life the way it
does for dual eligibles.
Across the country, there are roughly 13,000,000,
dual eligibles, so people that qualify for Medicaid
and Medicare benefits and services.
Many of us know the demographics
of this population,
but seventy percent have at least three, if
not four,
chronic conditions that they work that they're dealing
with.
Almost half are have at least one,
a mental health condition that exasperates
the chronic conditions
that they're experiencing.
The food insecurity rate is roughly four times
higher
than,
for other populations.
And then,
there's so many sort of dynamics,
to this population, but another one that's of
interest and importance is that over 50% are
people of color and cultural
diversity. So so adding to all of those
components, there are other barriers,
to care. So oftentimes, it's
urban communities
that may be underserved from a clinical
care access or rural
areas that are that aren't served well and
where we need to do better in finding
penetrating
opportunities to provide care. There are, as I
said, cultural and generational diversity
components that come into play in terms of
how people have engaged with the health care
system,
over their lives. So all these things make
it extremely challenging for members to navigate what's
already
a very complex fragmented health care system. I
often
sort of joke that even as a health
care CEO, it's hard for me to navigate
the system at times.
So, unfortunately,
in a complex fragmented system
with all of those
complexities and dynamics that pertain to a dual,
it it means that it makes it extra
challenging for them. So we have complex enrollment
and eligibility processes,
that combined with
high medical
and social needs
really create one of the most challenging environments
in health care for doulas. But, frankly, it's
also
where I think we can make the biggest
difference.
I'm always encouraged and,
sort of motivated
to lean into
where
we have populations or communities
that have particular opportunity in this, and I
think the duals, certainly represent that. So, financially,
just another sort
financially,
just another sort of foundational component.
Duals is a growing population,
but they also
make up a significant portion of the overall
spend in Medicare and Medicaid.
Roughly,
less than 20% of the Medicare population
are dual eligible, but they drive over 35%
of the cost. That's about $500,000,000,000
in state and federal spending.
So not only are we an opportunity to
do good by helping
members, communities navigate this health care system for
better health care outcomes, it also addresses a
significant driver of health care costs. So what's
WellCare focused on specifically around this? Obviously, all
the talk is integration and alignment.
So we're very much focused on how do
we connect the dots for our members in
our communities to make it easier
to navigate and optimize
their access to benefits and to services.
Simple things like one ID card so that
we don't have to show up with two,
three, four different
cards for things. It's one customer service representative
to be able to speak to. Take that
to the provider side, a single point of
contact for our providers
to ensure that their Medicaid and Medicare benefits,
and services are appropriately communicated so that the
provider can be a best asset,
to the member as well.
But it also comes down to one of
Centene's major strengths.
Centene,
for the record here, is the number one
provider of Medicaid,
coverage in the country.
That includes being the number one provider of
long term supports and services
as well as age blind and disabled coverage,
in the country. We collectively
within Centene serve over a million duals today.
What that means is
Centene and WellCare are deeply embedded in the
communities that we serve. We're deeply embedded in
state as well as federal relationships
that pertain to how programs and policies are
designed
to best serve,
dual eligible members.
We're embedded in provider relationships,
I e,
FQHCs
and other sort of community health organizations
as well as other community organizations that are
there to serve
and engage,
dual members in our community. So we really
try to lean in on the breadth and
depth of our relationships at the community,
at the state, and at the federal level,
combined with that integrated approach from a member
experience,
consumerism perspective
that needs to happen. Because of the complexities
of the population
and the complexities of the health care system,
we feel like it's our responsibility to lean
in and figure out ways to make it
easier to do business work.
Absolutely. And navigating these system complexities across so
many different geographies and and systems. Like you
mentioned, Centene operates in so many different states.
What you're really touching on, Michael, is drilling
down into it is is improving that member
experience across
the spectrum. And, you know, that's something that
we hear about consistently
right now from leaders like yourself here on
the podcast, and and certainly what we've heard
from the Centene leaders we've spoken to over
these last few years is that the major
focus is is improving that member experience. So
how do you ensure that these investments you're
making, this focus you are having on this
experience for those that you serve,
how does that also translate into better health
outcomes at the end of the day?
Yep.
We have our metrics that we,
hold ourselves accountable to and that certainly states
and CMS and federal government holds accountable to.
So things like
voluntary disenrollment rates, member satisfaction scores, provider
satisfaction scores. So there's a litany of sort
of metrics that we evaluate there and work
toward constant improvement.
But as I think about this question about
member experience and how to make it better,
I think of some real hardcore blocking and
tackling. Think of a member selecting a health
plan.
Maybe they're with a company from Medicaid, and
now they're joining a dual eligible SNP plan
for their Medicare benefits, or they're just new
to managed care to begin with. What is
that onboarding experience? So to me, I'm looking
for our teams
and our capabilities
to get ahead of that. How do we
engage with the member
where appropriate and where permitted even pre effective
dates so that we can hit the ground
running? We can know each other. We can
develop an understanding of who our members are,
what their most critical needs are right from
day one,
and begin to build that trusting,
reliable relationship
right up front. So we're looking for solutions
to be
early starters,
proactive engagement,
trusting relationship up front. Obviously, that requires us
to be there for our folks to be
trained, for
our systems to work, for our,
provider directors to be correct. So it's all
it we need to be able to be
a reliable source
of appropriate access. And then couple that with
making sure that our provider partnerships are strong
so that our providers can be our eyes
and ears on the ground, especially as members
come to receive care so that we create
a bit of a triangle,
effect between us as a payer, our providers,
and our members and really create an optimal
solution there. But it really starts with us
leaning in and saying, we have a responsibility
from the get go to know,
to connect with,
and to help
the member navigate into,
managed care as well as through then the
initial process so that there's familiarity and trust
that's built.
Understood. Your your passion for serving these members
really comes through the the conversation,
Michael. One thing I wanted to also ask
you about is, again, when we've spoken to
other leaders at Centene,
we've heard so many about so many new
innovations
in terms of the clinical model across the
different populations that the company serves. And I
wonder if you could delve into that for
us a bit in terms of your perspective
at WellCare and and how you see the
integration of behavioral, physical, and and social health
evolving,
within your part of the company?
The beauty of
dual eligibles,
I find, you know, we can we have
a whole list of things that can become
challenging from a,
regulatory requirement perspective at times. But the beauty
of the dual eligible program,
it introduces requirements such as an ICT, an
integrated care team.
And the intent and and objective here is
to have multidisciplinary
team working together
with a single point of contact for that
member.
So this is where I love and I
welcome
the public private partnership coming together because that's
really what we should be doing. So for
WellCareforce and team,
as our colleagues do across the industry,
we lean in on building the most effective
interdisciplinary
care teams possible
that bring together the medical
or the physical,
behavioral,
and social components of things and try to
bring solutions to them that are hands on.
So just, you know,
use your single point of contact care manager
or,
LTSS
service coordinator
that helps you navigate the system. But it's
then also complementing that with the right data
at the right time, perhaps
an app
to those that wanna use it. Access to
data
and access to digital strategies
appropriately
to complement sort of the blocking and tackling,
just rolling up our sleeves
and being there in person or being there
live for a member as well. So the
innovation
here really is
the the right
interdisciplinary
focus,
where the member is. We can't wait for
the member
to
come meet us at the doctor's office
or wait for them to call us. We
have to go to where the members are,
and that's in the community. It's important for
us to be in the community.
And then to the extent that people want
to use it, bring
digital
data solutions,
that help them navigate the system in a
more efficient and effective manner.
Wonderful. Well, Michael, before we go today, what
else are we missing? What other final thoughts
or final bits of advice do you wanna
share with our listeners? We've got so many
others from across the industry listening in, within
the dual eligible, the Medicare, and the Medicaid
spaces.
What else do you wanna share with them
today? Listen. I appreciate you, Jacob. I appreciate
you calling out that the passion is coming
through. It's one of these things where we're
dealing
with
complex,
high financial matters in these
managed care organization roles.
But at the end of the day, what
I find,
uniformly across my colleagues
is that most of us love what we
do, and
we have this passion
and that aligns to a mission.
And
everybody I know, I think, we we love
that we're able to do something good for
the communities
that we serve and our neighbors
that you know, what I encourage us all
to do is continue to double down on
that passion,
keep leaning into it, and,
sort of allow our industry to reinvent itself,
become more consumer focused, more agile,
more digitally and data enabled.
The consumer focused thing is interesting. I I
sometimes quote, it's probably a few years dated
now, but there was net promoter score,
results by industry,
and it had cable companies
as the worst ranking at the time. I
have no idea if that's today, by the
way. So I hope cable company
leaders don't reach out to me at the
time some years ago.
Next to last,
guess what?
Health insurance.
So we need to do better from a
consumer
perspective
and need to make sure it's a priority.
It's understandable that the time that somebody has
to engage with the health insurance
is a time of need and a time
of stress, either for themselves or for
a family member
or somebody else close to them. So it's
a stressful situation, and it makes it really
hard.
But we have to take on the responsibility,
put that passion to work that we all
have,
and move the ball down the field in
terms of doing better on consumerism
and reinventing the business.
Absolutely. I mean, it's a great and and
timely call to action for all those listening
in. So, Michael, I wanna thank you for
taking the time to sit down with us
and for sharing your insights with us and
with our listeners. We really appreciate it.
Thank you very much, Jacob. And to our
listeners, if you'd like to listen to more
podcasts from Becker's Health Care, you can visit
beckershospitalreview.com.
At athena Health, we know your ambulatory practice
wants healthier,
A healthier business, healthier care teams, and healthier
patients.
But the complexities of modern healthcare tech make
it hard for you and your care teams
to focus on what matters most.
That's where athena Health can help. Our AI
native all in one solutions reduce administrative burdens,
health. See how simpler is healthier at athenahealth.com.